Academic journal article Australian Health Review

Relationship between Frailty and Discharge Outcomes in Subacute Care

Academic journal article Australian Health Review

Relationship between Frailty and Discharge Outcomes in Subacute Care

Article excerpt

Introduction

Frailty has been defined as a clinical syndrome of apparent vulnerability or inability to withstand illness without loss of function.1-3 The majority of frailty studies have been conducted oncommunity-dwelling olderadults,andcommonlyinvestigated dependent variables include risk of hospitalisation or residential care placement.4-6

Quantifying frailty and its influence on functional status is important, as it may assist policy makers and program planners, and may help predict patient outcomes.7,8 Degree of frailty could also be an indicator of rehabilitation potential, allowing service providers to target those most at risk and to assist in advocacy for additional hospital staff and resources.3,9 In a community-dwell- ing population, level of frailty has been found to predict poor outcomes from surgery, falls, fractures, disability, need for residential care and mortality.4,5,10-12 Little is known, however, about the impacts of frailty among patients in the subacute hospital setting.

The Edmonton Frail Scale (EFS) is a 17-point scale that was developed asa screen in 2006and tested for validityandreliability in a sample comprising both inpatients and outpatients.2 It covers the important domains of mood, cognition and social support.2 The EFS has been found to have good inter-rater reliability, good construct validity and acceptable internal consistency.2 Unlike other scales designedfor usebygeriatricians,theEFScan beused by any health professional, making it more widely applicable than many of the alternative measures. It delivers a wide range of scores (0-17), which is particularly important when investigating an older inpatient population due to the risk of floor effects. High scores on the EFS (indicating higher levels of frailty) predict poor discharge outcomes and post-operative complications in older adults inacute care,11but its usefulness as a predictor ofoutcomes in subacute care has not been evaluated.

The aim of the present study was to investigate the usefulness oftheEFSasameasureoffrailty forusewithagedcareinpatients. The researchers hypothesised that high frailty would be associ- ated with longer duration of subacute hospital length of stay (LOS), greater likelihood of discharge to residential care, smaller improvement in mobility between admission and discharge, and poorer attendance at inpatient physiotherapy sessions.

Methods

Ethics approval

Ethics approval was obtained from the Alfred Health Ethics Committee (273/10) and the La Trobe University Faculty of Health Sciences Human Ethics Committee (FHEC10/178).

Participants

Participants were 86 patients admitted consecutively to two subacute aged care wards of a large Melbourne rehabilitation hospital. Recruitment occurred between February and July 2011. Potential participants (or next of kin) provided informed consent before their inclusion in the study, according to the ethical requirements of the project.

A summary of participants ' baseline characteristics is pre- sented in Table 1. Participants were 60 years or older and slightly more than half were women. The majority of participants lived at home before admission, rather than in supported accommodation or residential care. The most common reason for participant hospital admission was fracture (33.7%), followed by presence of a cardiac condition (14.0%). The median number of co- morbidities per participant was six, with a maximum of 13.

Most participants provided consent for the project indepen- dently and assistance to answer questions was requested by only two participants. The remaining participants were able to answer questions independently, or the research coordinator was able to access the required information from the participant's medical record without assistance from the participant's next of kin.

Potential participants were excluded due to inadequate cog- nition (Mini Mental State Examination score less than 23)13 combined with lack of availability of next of kin to provide consent; inability to answer simple questions; admission to the subacute ward for less than 48 h duration; palliation; and cultur- ally and linguistically diverse (CALD) background requiring written material to be translated. …

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