Readmission To Hospital Higher In Frail, Older Patients

New findings published in CMAJ (Canadian Medical Association Journal) reveal that frailer, older patients are typically at a higher risk of readmission to the hospital or death within just 30 days after discharge from general internal medicine ward.

For the study, researchers assessed whether the Clinical Frailty Scale could help to predict readmission or death within 30 days after hospital discharge in a group of 495 patients at 2 Alberta Hospitals.

The Clinical Frailty Scale, an easy-to-use tool developed several years ago, can be used at the bedside by physicians and other health care professionals to determine frailty. The scale measures difficulty in daily living activities with mild frailty (score of 5) corresponding to difficulty with 1 or more complicated daily living activities such as finances, shopping, meal preparation and housework. Moderate frailty (score of 6) indicates difficulty in bathing, dressing or climbing stairs. Severe frailty (score of 7) means a patient is physically or mentally dependent on someone for 3 or more daily living activities, according to a news release.

Half of the patients in the study were women with the median age of 64 years. One-third of the patients (162) were frail, with a score of 5 or higher on the Clinical Frailty Scale in the week before admission to hospital. Within 30 days after discharge, 85 patients (17 percent) were readmitted or had died. Compared with nonfrail patients, frail patients were at greater risk of readmission or death within 30 days (24 percent v. 14 percent), especially those with moderate or severe frailty (31 percent v. 14 percent).

Fortunately, frality assessments seemed to improve the prediction of post-discharge outcomes, which lead the authors to suggest that it could included in discharge planning procedures to help identify patients at highest risk of poor transition from hospital to home. However, overall, a variety of vactors are likely to contribute to hospital readmission. 

"Although frailty or vulnerability before becoming ill may affect outcomes after discharge, patients in hospital may also experience an acquired, transient period of risk for adverse events that is harmful in addition to the stress of the acute illness," writes Dr. Finlay McAlister, University of Alberta, with coauthors. "This 'post-hospital syndrome' is a multidimensional construct that incorporates sleep deprivation, cognitive stress, poor nutrition and physical pain. Patients who are already frail before hospital admission may be more sensitive to the stresses of this syndrome and at higher risk of readmission and poor outcomes."

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