Frailty

Length of stay in Acute Medical Admissions: Analysis from the Society for Acute Medicine Benchmarking Audit

Research Audit and Clinical Practice, Volume 21, Issue 1, Pages 1-64 (2022)

Medical admissions to hospital represent a diverse range of patients, from those managed on ambulatory pathways through Same Day Emergency Care (SDEC) services, to those requiring prolonged inpatient admission. An understanding of current patterns of admission through acute medicine services and patient factors associated with longer hospital admission is needed to guide service planning and improvement.

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The evidence for assessing frailty and sarcopenia in an acute medical unit: a systematic review

Clinical Reviews, Volume 20, Issue 1, Pages 1-88 (2021)

Background/objectives: A systematic review was conducted to assess if frailty and sarcopenia were associated with poorer outcomes in older adults admitted to an acute medical unit (AMU).

Methods: Eligible studies included older adults with an unplanned admission to an AMU and included a measure of frailty or sarcopenia, completed within 72 hours of admission. Risk of bias was assessed.

Results: Of 1659 identified articles, 16 were included (4 on sarcopenia and 12 on frailty). There was significant study heterogeneity. Overall, frailty and sarcopenia were associated with worse outcomes. Targeted interventions appeared to improve outcomes.

Conclusion: Current evidence suggests some benefit in screening older adults admitted to an AMU for frailty and sarcopenia. However, further studies are required before clinical adoption.

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Improving acute care for older people at scale – the Acute Frailty Network

Research Audit and Clinical Practice, Volume 15, Issue 4, Pages 165 – 220 (2016)

Older people form a growing proportion and volume of those accessing urgent care. Non-specific presentations, multiple comorbidities and functional decline make assessment and management of this cohort challenging. Comprehensive Geriatric Assessment offers an evidence based framework to assess and mange older people, especially those with frailty. In this article we describe the CGA approach, underpinned by specific examples illustrating some of the key competencies required, and describe the role of the Acute Frailty Network (AFN). The AFN is a national improvement collaborative designed to support hospitals in delivering evidence based care for older people with frailty and urgent care needs. We describe the principles underlying the approach of the AFN, derived from working with over 20 hospitals, and some of the early successes.

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Into the Night: Factors affecting response to abnormal Early Warning Scores out-of-hours and implications for service improvement

Research Audit and Clinical Practice, Volume 13, Issue 2, Pages 53 - 100 (2014)

Abstract

Background: Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care.

Aims: To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff.

Methods: Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts.

Results: During 2360 observed bed days 109 patients triggered NEWS >=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS >=6 had lower escalation rates.

Conclusion: Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.

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The patient presenting with ‘Acopia’

Trainee Section, Volume 12, Issue 3, Pages 125 - 184 (2013)

Patients may be referred to Acute Medical Units (AMUs) with a diagnosis of ‘acopia’. This term is offensive and lazy, implying fault on the part of the patient and allowing the assessing doctor to erroneously label the patient as a ‘social admission’ when, in fact, such patients are likely to be frail with co-morbidities and have an acute (potentially reversible) illness. Frail older patients should be assessed using the principles of Comprehensive Geriatric Assessment, informed by an understanding of the concept of frailty and of geriatric syndromes such as falls and delirium.

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The Ability of Frailty to Predict Outcomes in Older People Attending an Acute Medical Unit

Research Audit and Clinical Practice, Volume 12, Issue 2, Pages 65 - 124 (2013)

Abstract

Background: This study assessed the role of frailty assessment in the AMU.

Methods: Patients were assessed for frailty and their outcomes ascertained at 90 days.

Results: The Canadian Study on Health and Aging Clinical Frailty Scale categorised 29% of patients as moderately-severely frail. Frailty did not differentially identify those likely to be discharged within one day, nor with long stays. Mortality at 90 days was 32%; frailty was associated with the risk of dying, odds ratio 1.4. 21% of patients were readmitted at 30 days, and 33% at 90 days, but frailty was not predictive.

Discussion: Moderate-severe frailty in people aged 70+ was common and was predictive of higher mortality, but did not appear to predict admission, length of stay or readmission.

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