The impact of frailty on the outcome of hospitalised older people in Johannesburg, South Africa
Date
2020
Authors
Coetzer, Susan Franci
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Abstract
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
Description
A research report submitted to the University Of Witwatersrand, Johannesburg in fulfilment of the degree of Masters of Medicine 2020