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Frailty is associated with hospital readmission in geriatric patients: a prognostic study

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Key summary points

AbstractSection Aim

To examine the predictive value of the Multidimensional Prognostic Index (MPI) on unplanned hospital readmission in geriatric patients.

AbstractSection Findings

Frail patients have higher risk of unplanned readmission compared to non-frail.

AbstractSection Message

The aggregated MPI is superior to the prognostic value of every single domain in the tool according to the prediction of unplanned readmission.

Abstract

Purpose

Targeting health care interventions requires valid measurements when predicting unplanned hospital readmission. The Multidimensional Prognostic Index (MPI) based on Comprehensive Geriatric Assessment (CGA) enables the prediction of mortality and length of stay (LOS) in older hospitalized patients. Our aim was to validate if the MPI as a frailty tool could predict unplanned hospital readmission in geriatric patients.

Methods

This prognostic study was conducted in geriatric wards. The target population was 65 + -year-old patients hospitalized with acute illness. The MPI tool is derived from eight CGA domains by an interdisciplinary team: social aspects, number of drugs, activities of daily living (ADL), instrumental-ADL, cognitive status, severity of morbidity, risk of developing pressure sores, and nutritional status. Patients assessed were categorized into three groups: non-frail (MPI-1), moderate frail (MPI-2) or severe frail (MPI-3). Primary outcome was 30-day unplanned readmission and secondary LOS and 90-day mortality.

Results

In total 1467 patients were included from January 1, 2018, to October 1, 2019. Mean age was 84.2 years (± 7.4) and 59% were women. 15.7% were readmitted. Hazard ratio (HR) for readmission in the MPI-2 group (n = 635) was 2.57; 95% confidence interval (CI) 1.25–5.29 (p = 0.01), and 2.60; 95% CI 1.27–5.33 (p = 0.009) in the MPI-3 group (n = 711) compared to the MPI-1 group (n = 121). MPI was a predictor of LOS and mortality.

Conclusion

Using the MPI tool to identify the frail and non-frail patients is applicable to predict unplanned hospital readmission in geriatric patients. The MPI is superior to the prognostic value of each single domain. MPI will be of great value to health professionals’ decision-making.

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Acknowledgements

The authors would like to thank the patients for their invaluable contributions and the staff in the Department of Geriatrics for their outstanding participation in this study and their tireless and profound work in assessing all the patients. The study was funded by “MVU-puljen” from Aarhus University Hospital, Denmark.

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Authors and Affiliations

  1. Department of Geriatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Building, 8200, Aarhus N, Denmark

    Merete Gregersen, Troels K. Hansen, Bodil B. Jørgensen & Else Marie Damsgaard

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  1. Merete Gregersen
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  2. Troels K. Hansen
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  3. Bodil B. Jørgensen
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  4. Else Marie Damsgaard
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Contributions

The first author MG was the project manager, conducted the statistical analyses, and wrote the drafts. TKH and BBJ contributed to the interpretation of data and critically revised the manuscript. EMD contributed to the conception of the work, the interpretation of data, and final approval of the version to be published.

Corresponding author

Correspondence to Merete Gregersen.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study was conducted according to the principles of the Declaration of Helsinki and registered at the Danish Data Protection Agency (No. 1-16-02-28-17).

Informed consent

Since the MPI screening is routinely part of the geriatric assessment in the clinic of the Department of Geriatrics, neither consent from the patients nor approval by The Central Denmark Region Ethical Committee was required.

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Gregersen, M., Hansen, T.K., Jørgensen, B.B. et al. Frailty is associated with hospital readmission in geriatric patients: a prognostic study. Eur Geriatr Med 11, 783–792 (2020). https://doi.org/10.1007/s41999-020-00335-w

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  • DOI: https://doi.org/10.1007/s41999-020-00335-w

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