The impact of frailty on the outcome of hospitalised older people in Johannesburg, South Africa

Coetzer, Susan Franci
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8.1 Aim: To determine the impact of frailty measured clinically using the FRAIL scale in participants aged 65 years and older, hospitalised in the Johannesburg environment. 8.2 Methods: This is an observational prospective study of patients admitted to the medical wards of Helen Joseph hospital and Wits Donald Gordon Medical Centre. Participants were evaluated for frailty according to the FRAIL scale. Nutritional status was determined using the mini-nutritional assessment (MNA®). Functional status was determined using the modified Rankin score. Participants had telephonic follow-ups at 6 months to review their functional status and living environment. 8.3 Results: Of the 108 recruited participants, 78 (72%) were assessed as frail by the FRAIL scale on admission. Hospital survival overall was 93.5%. All participants who died were classified as frail. Frail participants were older (81.0 vs. 77.3 years, p=0.027), more likely to be malnourished (90.3% vs. 9.7%, p<0.001), more functionally disabled (93.5% vs. 46,7%, p<0.0001) and more likely to have required care assistance prior to admission (70.5% vs. 36.7%, p=0.0029). There were no significant differences between frail and robust participants in polypharmacy, hospital length of stay, cognitive impairment, and gender. Follow-up data were available for 94 participants. Frail participants had higher mortality (39.5% vs. 4.3%, p=0.0013, RR 9.1 (95% CI 1.3-63). Frail participants had more functional impairment at hospital discharge than non-frail participants (98.6% vs. 30%, p<0.0001). At 6 months followup there was no functional difference between frail and non-frail participants due to the increased mortality. 8.4 Conclusions: The FRAIL scale has utility in identifying older participants at risk of mortality and in hospital functional decline
A research report submitted to the University Of Witwatersrand, Johannesburg in fulfilment of the degree of Masters of Medicine 2020