Association between patient-reported frailty and nonhome discharge among older patients with acute stroke: A prospective study

Abstract

Objective

To investigate the association between prestroke frailty and nonhome discharge, prolonged length of stay as well as functional outcomes.

Design

Prospective observational study.

Setting

Single urban teaching hospital in Guangzhou, China.

Participants

Consecutive sample of 271 older patients admitted with acute stroke.

Intervention

N/A.

Main measures

A five-item FRAIL scale (0∼5 points) and the stroke severity at onset were measured. The primary outcome of interest was nonhome discharge, with secondary outcomes including prolonged length of stay and worse short-term prognosis. Multivariable logistic regression adjusting for confounding factors was used to determine the association between patient-reported frailty and nonhome discharge, prolonged length of stay, worse short-term prognosis.

Results

The population had a median age of 68 [interquartile range (IQR), 64∼74)]years, with 50 individuals (18.5%) identified as frail. After adjusting for age, sex, Barthel index, National Institutes of Health Stroke Scale, and Mini-Mental Status Exam score at admission, patients with self-reported frailty were significantly likely to experience nonhome discharge (Odds Ratio [OR] = 4.788; 95% confidence interval [CI] = 1.272∼18.017; p = .021), prolonged length of stay (OR = 4.76; 95% CI = 1.80∼12.56; p = .002), mRS scores at 30 days (OR = 6.72;95% CI = 1.79∼25.20; p = .005) and three months postdischarge and three-month (OR = 8.94; 95% CI = 2.10∼38.08; p = .003).

Conclusions

In older adults with stroke, frailty is associated with nonhome discharge, prolonged length of stay, and worse short-term prognosis, regardless of the stroke severity, cognition, and Barthel index score at admission. FRAIL scale can be used as a practical screening tool in acute care setting by multidisciplinary team in supporting discharge process.

Keywords

Frailty discharge disposition stroke discharge planning hospitalization-associated outcomes

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References

Roth

Mensah

Johnson

, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019. J Am Coll Cardiol 2020; 76: 2982–3021.

Hall

Levant

DeFrances

. Hospitalization for stroke in U.S. Hospitals, 1989-2009. NCHS Data Brief 2012; 95: 1–8.

Nations

. World population prospects: the 2015 revision. [EB/OL]. (2015-05-09) [2022-05-12]. https://population.un.org/wpp/publications/files/key_findings_wpp_ 2015.

Taylor-Rowan

Cuthbertson

Keir

, et al. The prevalence of frailty among acute stroke patients, and evaluation of method of assessment. Clin Rehabil 2019; 33: 1688–1696.

Xue

. The frailty syndrome: definition and natural history. Clin Geriatr Med 2011; 27: 1–15.

van Kan

Rolland

Morley

, et al. Frailty: toward a clinical definition. J Am Med Dir Assoc 2008; 9: 71–72.

Van Kan

Rolland

Bergman

, et al. The I.A.N.A. task force on frailty assessment of older people in clinical practice. The Journal of Nutrition Health and Aging 2008; 12: 29–37.

Luker

Bernhardt

Grimmer

, et al. A qualitative exploration of discharge destination as an outcome or a driver of acute stroke care. Bmc Health Serv Res 2014; 14: 193.

Bacchi

Oakden-Rayner

Menon

, et al. Prospective and external validation of stroke discharge planning machine learning models. J Clin Neurosci 2022; 96: 80–84.

10.

Cho

Place

Salstrand

, et al. Developing a predictive tool for hospital discharge disposition of patients poststroke with 30-day readmission validation. Stroke Res Treat 2021; 2021: 1–9.

11.

Palmer

. The acute care for elders unit model of care. Geriatrics-Basel 2018; 3: 59.

12.

Noguchi

Kubo

Kanai

, et al. Relationship between pre-stroke frailty status and short-term functional outcome in older patients with acute stroke–A mediation analysis. Arch Gerontol Geriat 2021; 94: 104370.

13.

Yang

, et al. Association of pre-stroke frailty with prognosis of elderly patients with acute cerebral infarction: a cohort study. Front Neurol 2022; 13: 855532.

14.

Infarction. CECG. Expert consensus on rehabilitation of acute phase of cerebral infarction in China. Chinese Journal of Physical Medicine and Rehabilitation 2016; 38: 1–6.

15.

Pashmdarfard

Azad

. Assessment tools to evaluate activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults: a systematic review. Med J Islam Repub Iran 2020; 34: 33.

16.

Alfian Hidayat

Arief

Happyanto

. LOVETT scaling with flex sensor and MYO armband for monitoring finger muscles therapy of post-stroke people. International Journal of Engineering Technology 2016; 3: 60–76.

17.

Folstein

McHugh

. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198.

18.

Downer

Al Snih

Howrey

, et al. Combined effects of cognitive impairment and pre-frailty on future frailty and death in older Mexican Americans. Aging Ment Health 2018; 23: 1405–1412.

19.

Aprahamian

Cezar

NODC

Izbicki

, et al. Screening for frailty with the FRAIL scale: a comparison with the phenotype criteria. J Am Med Dir Assoc 2017; 18: 592–596.

20.

Wei

Cao

Yang

, et al. Investigation on the frailty status of the elderly inpatients in Shanghai using the FRAIL (fatigue, resistance, ambulation, illness, and loss) questionnaire. Medicine (Baltimore) 2018; 97: e581.

21.

Turner

Clegg

. Best practice guidelines for the management of frailty: a British geriatrics society, age UK and royal college of general practitioners report. Age Ageing 2014; 43: 744–747.

22.

Seamon

Simpson

. The effect of frailty on discharge location for Medicare beneficiaries after acute stroke. Arch Phys Med Rehab 2019; 100: 1317–1323.

23.

Hong

Saver

. Quantifying the value of stroke disability outcomes. Stroke 2009; 40: 3828–3833.

24.

Launay

Kabeshova

Lanoé

, et al. Age effect on the prediction of risk of prolonged length hospital stay in older patients visiting the emergency department: results from a large prospective geriatric cohort study. Bmc Geriatr 2018; 18: 127.

25.

Pilotto

Brass

Fassbender

, et al. Premorbid frailty predicts short- and long-term outcomes of reperfusion treatment in acute stroke. J Neurol 2022; 269: 3338–3342.

26.

Nozoe

Noguchi

Kubo

, et al. Association between the coexistence of premorbid sarcopenia, frailty, and disability and functional outcome in older patients with acute stroke. Geriatr Gerontol Int 2022; 22: 642–647.

27.

de Berker

Aung

, et al. Pre-stroke disability and stroke severity as predictors of discharge destination from an acute stroke ward. Clin Med 2021; 21: e186–e191.

28.

Romero-Ortuno

Wallis

Biram

, et al. Clinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: an observational study. Eur J Intern Med 2016; 35: 24–34.

29.

Ito

Kawakami

Ishii

, et al. Cognitive function is associated with home discharge in subacute stroke patients: a retrospective cohort study. Bmc Neurol 2022; 22: 219.

30.

Slenders

Verberne

Visser-Meily

, et al. Early cognitive and emotional outcome after stroke is independent of discharge destination. J Neurol 2020; 267: 3354–3361.

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