Abstract
Introduction
With the onset of frailty, there is often a rapid, progressive, and self-perpetuating downward spiral towards death. Frailty has enormous impact on acute hospital care and has been shown to be a more effective predictor of mortality than conventional clinical measures.
Methods
Hospitalized older patients admitted in medical wards at a teaching public hospital were studied to determine the prevalence of frailty; its association with anemia, congestive heart failure, clinically active tuberculosis and cognitive impairment; as well as its impact upon short-term outcome.
Results
A total of 250 older hospitalized patients were included, and their frailty status was assessed using Fried’s criteria. Of these, 83 (33.2%) patients were frail, with frailty found to be significantly associated with increasing age. A lower mean level of haemoglobin (p, 0.002), higher chance of congestive heart failure (p, <0.001), lower mean MMSE score (p, <0.001), was found in frail older patients. Frail subjects had a higher median hospital stay. There were total of 5 deaths, all among the frail group.
Conclusion
Our study showed that almost a third of hospitalized older patients are frail, and have anemia, higher frequency of CHF, cognitive impairment, longer hospital stay and higher mortality.
Similar content being viewed by others
References
Brocklehurst JC, Robertson D, James-Groom P. Skeletal deformities in the elderly and their effect on postural sway. J Am Geriatr Soc 1982;30(8):534–538.
Fried LP, Walston J. Frailty and failure to thrive. In: Hazzard W, Blass JP, Halter JB, eds. Principles of Geriatric Medicine and Gerontology. 5 ed. New York: McGraw-Hill; 2003:1487–1502.
Morley JE, Perry HM, 3rd, Miller DK. Editorial: Something about frailty. J Gerontol A Biol Sci Med Sci 2002;57(11):M698–M704.
Adams K, Corrigan JM. Priority Areas for National Action: Transforming Health Care Quality. 1 ed. Washington DC: National Academies Press; 2003.
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59(3):255–263.
Fried LP. Frailty. In: Cassel C, Leipzig R, Cohen H, Larson E, Meier D, eds. Geriatric Medicine: An evidence based approach. 4 ed. New York: Springer-Verlag; 2003:1067–1074.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56(3):M146–M156.
Campbell SE, Seymour DG, Primrose WR, et al. A multi-centre European study of factors affecting the discharge destination of older people admitted to hospital: analysis of in-hospital data from the ACMEplus project. Age Ageing 2005;34(5):467–475.
Hilmer SN, Perera V, Mitchell S, et al. The assessment of frailty in older people in acute care. Australasian journal on ageing 2009;28(4):182–188.
Gonthier R, Blanc P, Farce S, Stierlam F. [Individualization of the frail elderly people and use of health care services]. Psychologie & neuropsychiatrie du vieillissement 2003;1(3):187–196.
Dey AB, Soneja S, Nagarkar KM, Jhingan HP. Evaluation of the health and functional status of older Indians as a prelude to the development of a health programme. The National medical journal of India 2001;14(3):135–138.
Rao KV. Morbidity, health care and the condition of the aged. In: NSSO, ed.: National Sample Survey Organization, Government of India; 2006.
Podrazik PM, Whelan CT. Acute hospital care for the elderly patient: its impact on clinical and hospital systems of care. Med Clin North Am 2008;92(2):387–406, ix.
Parker SG, Fadayevatan R, Lee SD. Acute hospital care for frail older people. Age Ageing 2006;35(6):551–552.
Mitnitski AB, Mogilner AJ, MacKnight C, Rockwood K. The mortality rate as a function of accumulated deficits in a frailty index. Mech Ageing Dev 2002;123(11):1457–1460.
Covinsky KE, King JT, Jr., Quinn LM, et al. Do acute care for elders units increase hospital costs? A cost analysis using the hospital perspective. Journal of the American Geriatrics Society 1997;45(6):729–734.
Taylor HL, Jacobs DR, Jr., Schucker B, Knudsen J, Leon AS, Debacker G. A questionnaire for the assessment of leisure time physical activities. J Chronic Dis 1978;31(12):741–755.
Nutritional anaemias. Report of a WHO scientific group. World Health Organ Tech Rep Ser 1968;405:5–37.
McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med 1971;285(26):1441–1446.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189–198.
Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. Jama 1993;269(18):2386–2391.
Puts MT, Lips P, Deeg DJ. Static and dynamic measures of frailty predicted decline in performance-based and self-reported physical functioning. J Clin Epidemiol 2005;58(11):1188–1198.
Schuurmans H, Steverink N, Lindenberg S, Frieswijk N, Slaets JP. Old or frail: what tells us more? J Gerontol A Biol Sci Med Sci 2004;59(9):M962–M965.
Purser JL, Kuchibhatla MN, Fillenbaum GG, Harding T, Peterson ED, Alexander KP. Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc 2006;54(11):1674–1681.
Roy CN. Anemia in frailty. Clin Geriatr Med; 27(1):67–78.
Leng S, Chaves P, Koenig K, Walston J. Serum interleukin-6 and hemoglobin as physiological correlates in the geriatric syndrome of frailty: a pilot study. Journal of the American Geriatrics Society 2002;50(7):1268–1271.
Avila-Funes JA, Amieva H, Barberger-Gateau P, et al. Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. Journal of the American Geriatrics Society 2009;57(3):453–461.
Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B. The assessment of frailty in older adults. Clin Geriatr Med; 26(2):275–286.
Pulignano G, Del Sindaco D, Di Lenarda A, et al. Usefulness of frailty profile for targeting older heart failure patients in disease management programs: a costeffectiveness, pilot study. J Cardiovasc Med (Hagerstown); 11(10):739–747.
Buck HG, Riegel B. The impact of frailty on health related quality of life in heart failure. Eur J Cardiovasc Nurs. 2011;10(3):159–166.
Cacciatore F, Abete P, Mazzella F, et al. Frailty predicts long-term mortality in elderly subjects with chronic heart failure. Eur J Clin Invest 2005;35(12):723–730.
Rozzini R, Sabatini T, Frisoni GB, Trabucchi M. Frailty is a strong modulator of heart failure-associated mortality. Arch Intern Med 2003;163(6):737–738.
Mitnitski A, Song X, Skoog I, et al. Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality. J Am Geriatr Soc 2005;53(12):2184–2189.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Khandelwal, D., Goel, A., Kumar, U. et al. Frailty is associated with longer hospital stay and increased mortality in hospitalized older patients. J Nutr Health Aging 16, 732–735 (2012). https://doi.org/10.1007/s12603-012-0369-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12603-012-0369-5