Frailty and functional decline indices predict poor outcomes in hospitalised older people

Dent, Elsa, Chapman, Ian, Howell, Stuart, Piantadosi, Cynthia and Visvanathan, Renuka (2014) Frailty and functional decline indices predict poor outcomes in hospitalised older people. Age and Ageing, 43 4: 477-484. doi:10.1093/ageing/aft181

Author Dent, Elsa
Chapman, Ian
Howell, Stuart
Piantadosi, Cynthia
Visvanathan, Renuka
Title Frailty and functional decline indices predict poor outcomes in hospitalised older people
Journal name Age and Ageing   Check publisher's open access policy
ISSN 1468-2834
Publication date 2014-07
Year available 2013
Sub-type Article (original research)
DOI 10.1093/ageing/aft181
Open Access Status Not yet assessed
Volume 43
Issue 4
Start page 477
End page 484
Total pages 8
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Formatted abstract
Background: admission to a Geriatric Evaluation and Management Unit (GEMU) can optimise a patient's chance of functional recovery.

Objective: to evaluate the ability of several commonly used frailty and functional decline indices to predict GEMU outcomes, both at discharge and at 6 months.

Design: prospective, observational study.

Setting and participants: consecutive GEMU patients aged ≥70 years.

Methods: patients were classified as 'frail' or 'at high risk of functional decline' using several frailty and functional decline instruments. Predictive ability was evaulated using logistic regression and area under receiver operator characteristic (ROC) curves (auROC).

Results: a total of 172 patients were included. Frailty prevalence varied from 24 to 94% depending on the instrument used. Several instruments predicted patients at risk of poor outcome, including the Frailty Index of Accumulative Deficits (FI-CD), Fried's Cardiovascular Health Study index, the Study of Osteoporotic Fractures index, an adapted Katz score of activities of daily living (ADL), Instrumental ADL, the Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie (SHERPA) and grip strength [odds ratio (OR) range of 2.06-6.47]. Adequate discriminatory power for discharge outcome was achieved by the FI-CD (auROC = 0.735, P < 0.001) and an adapted Katz score (auROC = 0.704, P = < 0.001). The FI-CD also showed adequate discriminatory power for a poor 6-month outcome (auROC = 0.702, P < 0.001).

Conclusion: frailty and functional decline instruments can predict older patients at risk of poor outcome. However, only the FI-CD showed adequate discriminatory power for outcome prediction at both follow-up time-points.
Keyword 80 and over
Frail elderly
Geriatric assessment/methods
Older people
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: Centre for Research in Geriatric Medicine Publications
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