Older, frailer patients more likely to return to hospital after discharge: study
Emily Chan, CTVNews.ca
Published Tuesday, May 26, 2015 8:41AM EDT
Hospital readmission is common and costly in Canada, but a new study suggests that monitoring patients’ frailty levels could help doctors predict who is at-risk.
The study, published in the Canadian Medical Association Journal, tracked almost 500 patients in Edmonton. It found that frailty was linked with "a substantially increased risk of early readmission or death after discharge."
"It’s the pre-hospital frailty that really is the predictor of what’s going to happen," Dr. Marla Shapiro, who was not one of the study’s authors, told CTV’s Canada AM on Tuesday.
Shapiro said that, for patients who are already frail, the combination of stressors in the hospital can make discharge more difficult. Together with frailty, mental and physical stress and poor nutrition can combine to increase a patient’s risk of early readmission or death.
"It’s a perfect storm," Shapiro said. "All of these issues get together and set off on discharge."
While leaving hospital can be difficult for other patients as well, the study suggests it is particularly taxing on older, frailer people.
"If you have an individual who is more frail than another, that correlates with the likelihood of not having a successful transition back into the home, but ending up within the next 30 days back in hospital, or even worse, having a higher index of death," Shapiro said.
According to the study, hospitals currently struggle to predict which patients are most at-risk of readmission or death soon after discharge.
The study suggests that, in the future, doctors should use the Clinical Frailty Scale to identify at-risk patients, and then provide those patients with extra support.
Frailty can be broken down into three basic categories:
- People with mild frailty have difficulty with one or more daily activities, such as housework or preparing meals
- People with moderate frailty struggle with more substantial activities, such as bathing or using stairs
- People with severe frailty are unable to do three or more daily activities and depend on others
Shapiro recommends a number of ways to combat frailty, including:
- Staying active
- Managing pain effectively
- Preventing falls
- Monitoring medication
- Identifying depression
- Promoting good nutrition
"It really is important to be looking at our elders and looking at the entire global picture of how we can keep them from being frail," Shapiro said.