Outcomes of hospital admissions among frail older people: a 2-year cohort study
Open accessAbstract
Background: ‘Frailty crises’ are a common cause of hospital admission among older people and there is significant focus on admission avoidance. However, identifying frailty before a crisis occurs is challenging, making it difficult to effectively target community services. Better longer-term outcome data are needed if services are to reflect the needs of the growing population of older people with frailty. Aim: To determine long-term outcomes of older people discharged from hospital following short (<72 hours) and longer hospital admissions compared by frailty status. Design and setting: Two populations aged ≥70 years discharged from hospital units: those following short ‘ambulatory’ admissions (<72 hours) and those following longer inpatient stays. Method: Data for 2-year mortality and hospital use were compared using frailty measures derived from clinical and hospital data. Results: Mortality after 2 years was increased for frail compared with non-frail individuals in both cohorts. Patients in the ambulatory cohort classified as frail had increased mortality (Rockwood hazard ratio 2.3 [95% confidence interval {CI} = 1.5 to 3.4]) and hospital use (Rockwood rate ratio 2.1 [95% CI = 1.7 to 2.6]) compared with those patients classified as non-frail. Conclusion: Individuals with frailty who are discharged from hospital experience increased mortality and resource use, even after short ‘ambulatory’ admissions. This is an easily identifiable group that is at increased risk of poor outcomes. Health and social care systems might wish to examine their current care response for frail older people discharged from hospital. There may be value in a ‘secondary prevention’ approach to frailty crises targeting individuals who are discharged from hospital.
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Number of comorbidities, arrival mode, and patient age latently encode patient frailty, which is closely related to higher long-term admission and re-admission risk.
“These are all factors that latently encode patient frailty, closely related to both higher long-term admission and re-admission risk30,31.”
From Using explainable machine learning to characterise data drift and detect emergent health risks for emergency department admissions during COVID-19 (2021) · cites this paper as [30]
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Additional file 1 of Acute frailty services: results of a national day of care survey
Kamwa, V., Knight, T., Atkin, C., Cooksley, T., Subbe, C., Holland, M., Lasserson, D., & Sapey, E. (2024) · Figshare · doi:10.6084/m9.figshare.26315569
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Allen, M. J., Carter, H. E., Cyarto, E., Meyer, C., Dwyer, T., Oprescu, F., Aitken, C., Farrington, A., Shield, C., Rowland, J. T. J., et al. (2024) · Figshare · doi:10.6084/m9.figshare.24761890
Inglis, J. M., Caughey, G. E., Thynne, T., Brotherton, K., Liew, D., Mangoni, A. A., & Shakib, S. (2024) · Figshare · doi:10.6084/m9.figshare.26944128
Allen, M. J., Carter, H. E., Cyarto, E., Meyer, C., Dwyer, T., Oprescu, F., Aitken, C., Farrington, A., Shield, C., Rowland, J. T. J., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26650125
- Authors
- Keeble, E., Roberts, H. C., Williams, C. D., Van Oppen, J., & Conroy, S. P.
- Affiliations
- Nuffield Trust (GB)
- University of Southampton (GB)
- University of Leicester (GB)
- Venue
- British Journal of General Practice
- Published
- 2019-07-15
- Volume
- 69
- Issue
- 685
- Pages
- e555-e560
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC6650131
- OpenAlex
- W2958518805
- Cited by
- 132
- References
- 36
- Citations by year
- 2026: 12 · 2025: 10 · 2024: 38 · 2023: 23 · 2022: 19 · 2021: 20 · 2020: 8 · 2019: 1 · 2017: 1
- FWCI
- 6.32
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- British Journal of General Practice (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (ACF-2017-11-008, CL-2015-11-003)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- frailty, older adults, hospitalization, long-term mortality, hospital readmission, resource utilization (health care), secondary prevention, post-discharge outcomes
- MeSH terms
- Aged, Aged, 80 and over, Female, Hospitalization, Humans, Length of Stay, Male, Cohort Studies, Geriatric Assessment, Frail Elderly, Outcome Assessment, Health Care
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