Geriatric assessment may prevent readmission in frail medical inpatients

INTRODUCTION: Frailty is common in older adults. Many approaches exist to care of hospitalised older medical inpatients. The objectives of this study were to 1) describe frailty occurrence and 2) explore associations between frailty, type of care, 30-day readmission and 90-day mortality.

METHODS: In a cohort of 75+-year-old medical inpatients with daily homecare or moderate comorbidity, frailty was graded as moderate or severe using the record-based Multidimensional Prognostic Index. The emergency department (ED), internal medicine (IM) and geriatric medicine (GM) were compared. Estimates of relative risk (RR) and hazard ratios were calculated in binary regression and Cox regression models.

RESULTS: Analyses included 522 patients (61%) with moderate frailty and 333 (39%) with severe frailty. A total of 54% were females, and the median age was 84 years (interquartile range: 79-89). In GM, the distribution of frailty grade differed significantly from that of the ED (p less-than 0.001) and IM (p less-than 0.001). GM had the highest occurrence of severely frail patients and the lowest readmission rate. Compared with GM, the adjusted RR for readmission in ED was 1.58 (1.04-2.41), p = 0.032; and in IM: 1.42 (0.97-2.07), p = 0.069. Between the three specialities, no differences were seen in 90-day mortality hazard.

CONCLUSION: In a regional hospital, frail older patients were discharged from all medical specialities. Admission to geriatric medicine was associated with a lower readmission risk and no increase in mortality. Comprehensive Geriatric Assessment may explain the observed differences in readmission risk.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.