Given the pervasiveness of frailty and its negative effects on health care–related outcomes, we evaluated patient frailty and comorbidity and determined the relationship between these measures and the probability of early readmission and length of hospital stay. Our retrospective analysis includes 435 patients evaluated using the Reported Edmonton Frailty Scale and the Age-Adjusted Charlson Comorbidity Index. We found that frailty as measured by the Reported Edmonton Frailty Scale was a significant predictor of hospital readmission and length of stay, and frailty outperformed the explanatory power of our comorbidity metric. One unit of increase in the Reported Edmonton Frailty Scale increased the odds of readmission by a factor of 1.12 (95% confidence interval [CI]: [1.04, 1.20]), and an increase of 10 units tripled the odds of readmission (odds ratio = 3.02, 95% CI: [1.48, 6.24]). These findings underscore the importance of prompt identification and management of frailty by bedside clinicians.
AlexanderN. B.GuireK. E.ThelenD. G.Ashton-MillerJ. A.SchultzA. B.GrunawaltJ. C.GiordaniB. (2000). Self-reported walking ability predicts functional mobility performance in frail older adults. Journal of the American Geriatrics Society, 48(11), 1408–1413.
2.
AlibhaiS. M.GreenwoodC.PayetteH. (2005). An approach to the management of unintentional weight loss in elderly people. Canadian Medical Association Journal, 172(6), 773–780.
3.
AndersonG. F.SteinbergE. P. (1985). Predicting hospital readmissions in the Medicare population. Inquiry, 22, 251–258.
4.
BurnhamK. P.AndersonD. R. (2002). Model selection and multimodel inference: A practical information-theoretic approach. Springer.
5.
CallahanK. E.LovatoJ. F.MillerM. E.EasterlingD.SnitzB.WilliamsonJ. D. (2015). Associations between mild cognitive impairment and hospitalization and readmission. Journal of the American Geriatrics Society, 63(9), 1880–1885.
6.
CharlsonM.SzatrowskiT. P.PetersonJ.GoldJ. (1994). Validation of a combined comorbidity index. Journal of Clinical Epidemiology, 47(11), 1245–1251.
7.
CleggA.YoungJ.IliffeS.RikkertM. O.RockwoodK. (2013). Frailty in elderly people. The Lancet, 381(9868), 752–762.
8.
CravenE.ConroyS. (2015). Hospital readmissions in frail older people. Reviews in Clinical Gerontology, 25(2), 107–116.
9.
DarasL. C.IngberM. J.CarichnerJ.BarchD.DeutschA.SmithL. M.LevittA.AndressJ. (2018). Evaluating hospital readmission rates after discharge from inpatient rehabilitation. Archives of Physical Medicine and Rehabilitation, 99(6), 1049–1059.
10.
ExtermannM. (2000). Measuring comorbidity in older cancer patients. European Journal of Cancer, 36(4), 453–471.
11.
FriedL. P.FerrucciL.DarerJ.WilliamsonJ. D.AndersonG. (2004). Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59(3), M255–M263.
12.
García-PérezL.LinertováR.Lorenzo-RieraA.Vázquez-DíazJ. R.Duque-GonzálezB.Sarría-SantameraA. (2011). Risk factors for hospital readmissions in elderly patients: A systematic review. QJM: An International Journal of Medicine, 104(8), 639–651.
13.
GrahamK. L.WilkerE. H.HowellM. D.DavisR. B.MarcantonioE. R. (2015). Differences between early and late readmissions among patients: A cohort study. Annals of Internal Medicine, 162(11), 741–749.
14.
HaoQ.ZhouL.DongB.YangM.DongB.WeilY. (2019). The role of frailty in predicting mortality and readmission in older adults in acute care wards: A prospective study. Scientific Reports, 9(1), 1207.
15.
HilmerS. N.PereraV.MitchellS.MurnionB. P.DentJ.BajorekB.MatthewsS.RolfsonD. B. (2009). The assessment of frailty in older people in acute care. Australasian Journal on Ageing, 28(4), 182–188. https://doi.org/10.1111/j.1741-6612.2009.00367.x
16.
HoganD. B. (2018). Chapter 3—Models, definitions, and criteria for frailty. In RamJ. L.ConnP. M. (Eds.), Conn’s handbook of models for human aging (2nd ed., pp. 35–44). https://doi.org/10.1016/B978-0-12-811353-0.00003-8
JoostenE.DemuynckM.DetroyerE.MilisenK. (2014). Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatrics, 14(1), 1. https://doi.org/10.1186/1471-2318-14-1
19.
KahlonS.PedersonJ.MajumdarS. R.BelgaS.LauD.FradetteM.BoykoD.BakalJ. A.JohnstonC.PadwalR. S.McAlisterF. A. (2015). Association between frailty and 30-day outcomes after discharge from hospital. Canadian Medical Association Journal, 187(11), 799–804. https://doi.org/10.1503/cmaj.150100
20.
KindA. J. H.BartelsC.MellM. W.MullahyJ.SmithM. (2010). For-profit hospital status and rehospitalizations at different hospitals: An analysis of Medicare data. Annals of Internal Medicine, 153(11), 718–727. https://doi.org/10.7326/0003-4819-153-11-201012070-00005
21.
KowalP.DowdJ. E. (2001). Definition of an older person. Proposed working definition of an older person in Africa for the MDS Project. World Health Organization.
22.
LangP.-O.MichelJ.-P.ZekryD. (2009). Frailty syndrome: A transitional state in a dynamic process. Gerontology, 55(5), 539–549. https://doi.org/10.1159/000211949
23.
LeeL.HeckmanG.MolnarF. J. (2015). Frailty: Identifying elderly patients at high risk of poor outcomes. Canadian Family Physician, 61(3), 227–231.
24.
LehnertT.HeiderD.LeichtH.HeinrichS.CorrieriS.LuppaM.Riedel-HellerS.KönigH. (2011). Review: Health care utilization and costs of elderly persons with multiple chronic conditions. Medical Care Research and Review, 68(4), 387–420. https://doi.org/10.1177/1077558711399580
25.
LogsdonR. G.GibbonsL. E.McCurryS. M.TeriL. (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine, 64(3), 510–519.
26.
MakaryM. A.SegevD. L.PronovostP. J.SyinD.Bandeen-RocheK.PatelP.TakenagaR.DevganL.HolzmuellerC. G.TianJ.FriedL. P. (2010). Frailty as a predictor of surgical outcomes in older patients. Journal of the American College of Surgeons, 210(6), 901–908. https://doi.org/10.1016/j.jamcollsurg.2010.01.028
27.
McAdams-DeMarcoM. A.LawA.SalterM. L.ChowE.GramsM.WalstonJ.SegevD. L. (2013). Frailty and early hospital readmission after kidney transplantation. American Journal of Transplantation, 13(8), 2091–2095. https://doi.org/10.1111/ajt.12300
28.
PendergastD. R.FisherN. M.CalkinsE. (1993). 9 cardiovascular, neuromuscular, and metabolic alterations with age leading to frailty [Special issue]. Journal of Gerontology, 48, 61–67. https://doi.org/10.1093/geronj/48.Special_Issue.61
29.
PickensS.NaikA. D.CaticA.KunikM. E. (2017). Dementia and hospital readmission rates: A systematic review. Dementia and Geriatric Cognitive Disorders Extra, 7(3), 346–353.
30.
QuanH.LiB.CourisC. M.FushimiK.GrahamP.HiderP.JanuelJ.SundararajanV. (2011). Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. American Journal of Epidemiology, 173(6), 676–682. https://doi.org/10.1093/aje/kwq433
31.
R Core Team. (2018). R: A language and environment for statistical computing (Version 3.5.1). https://www.R-project.org/
32.
RolfsonD. B.MajumdarS. R.TsuyukiR. T.TahirA.RockwoodK. (2006). Validity and reliability of the Edmonton Frail Scale. Age and Ageing, 35(5), 526–529. https://doi.org/10.1093/ageing/afl041
SiedleckiK. L.TatarinaO.SandersL.AlbertM.BlackerD.DuboisB.BrandtJ.SternY. (2009). Comparison of patient and caregiver reports of patient activity participation and its relationship to mental health in patients with Alzheimer’s disease. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 64(6), 687–695.
35.
SilversteinM. D.QinH.MercerS. Q.FongJ.HaydarZ. (2008). Risk factors for 30-day hospital readmission in patients ≥65 years of age. Baylor University Medical Center Proceedings, 21(4), 363–372. https://doi.org/10.1080/08998280.2008.11928429
36.
SternbergS. A.SchwartzA. W.KarunananthanS.BergmanH.ClarfieldA. M. (2011). The identification of frailty: A systematic literature review. Journal of the American Geriatrics Society, 59(11), 2129–2138. https://doi.org/10.1111/j.1532-5415.2011.03597.x
37.
WallaceJ. I.SchwartzR. S.LaCroixA. Z.UhlmannR. F.PearlmanR. A. (1995). Involuntary weight loss in older outpatients: Incidence and clinical significance. Journal of the American Geriatrics Society, 43(4), 329–337. https://doi.org/10.1111/j.1532-5415.1995.tb05803.x
38.
YangC.-C.ChenP.-C.HsuC.-W.ChangS.-L.LeeC.-C. (2015). Validity of the Age-Adjusted Charlson Comorbidity Index on clinical outcomes for patients with nasopharyngeal cancer post radiation treatment: A 5-year nationwide cohort study. PLOS ONE, 10(1), Article e0117323. https://doi.org/10.1371/journal.pone.0117323
ZuckermanR. B.SheingoldS. H.OravE. J.RuhterJ.EpsteinA. M. (2016). Readmissions, observation, and the hospital readmissions reduction program. New England Journal of Medicine, 374(16), 1543–1551.
