Development of an electronic frailty index for hospitalized older adults in Sweden

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Two Years with COVID-19 : The Electronic Frailty Index Identifies High-Risk Patients in the Stockholm GeroCovid Study

INTRODUCTION: Frailty, a measure of biological aging, has been linked to worse COVID-19 outcomes. However, as the mortality differs across the COVID-19 waves, it is less clear whether a medical record-based electronic frailty index (eFI) that we have previously developed for older adults could be used for risk stratification in hospitalized COVID-19 patients. OBJECTIVES: The aim of the study was to examine the association of frailty with mortality, readmission, and length of stay in older COVID-19 patients and to compare the predictive accuracy of the eFI to other frailty and comorbidity measures. METHODS: This was a retrospective cohort study using electronic health records (EHRs) from nine geriatric clinics in Stockholm, Sweden, comprising 3,980 COVID-19 patients (mean age 81.6 years) admitted between March 2020 and March 2022. Frailty was assessed using a 48-item eFI developed for Swedish geriatric patients, the Clinical Frailty Scale, and the Hospital Frailty Risk Score. Comorbidity was measured using the Charlson Comorbidity Index. We analyzed in-hospital mortality and 30-day readmission using logistic regression, 30-day and 6-month mortality using Cox regression, and the length of stay using linear regression. Predictive accuracy of the logistic regression and Cox models was evaluated by area under the receiver operating characteristic curve (AUC) and Harrell's C-statistic, respectively. RESULTS: Across the study period, the in-hospital mortality rate decreased from 13.9% in the first wave to 3.6% in the latest (Omicron) wave. Controlling for age and sex, a 10% increment in the eFI was significantly associated with higher risks of in-hospital mortality (odds ratio = 2.95; 95% confidence interval = 2.42-3.62), 30-day mortality (hazard ratio [HR] = 2.39; 2.08-2.74), 6-month mortality (HR = 2.29; 2.04-2.56), and a longer length of stay (β-coefficient = 2.00; 1.65-2.34) but not with 30-day readmission. The association between the eFI and in-hospital mortality remained robust across the waves, even after the vaccination rollout. Among all measures, the eFI had the best discrimination for in-hospital (AUC = 0.780), 30-day (Harrell's C = 0.733), and 6-month mortality (Harrell's C = 0.719). CONCLUSION: An eFI based on routinely collected EHRs can be applied in identifying high-risk older COVID-19 patients during the continuing pandemic.publishedVersionPeer reviewe

Kvalitet i livets slutskede : avseende andel närvarande vid dödsögonblicket och förekomst av omvårdnadsmål i patienters individuella vårdplan.

Syfte: Syftet med studien är att studera i hur stor omfattning patienter är omgivna av andra i dödsögonblicket i palliativ vård och undersöka om det finns formulerade omvårdnadsmål i patienters IVP gällande vården i livets slutskede. Metod: Studien är kvantitativ retrospektiv med deskriptiv och analytisk design. I studien ingår samtliga cancerpatienter (n= 316), som vårdats och dött på en vårdavdelning och ASIH (avancerad sjukvård i hemmet) i Stockholm samt registrerats i Svenska palliativregistret (n=295). Resultat: Studien visade att i åldersgrupperna 75-84 år och 85 eller äldre var det fler som dog utan någon närvarande vid dödsögonblicket än i övriga åldersgrupper. Patienter dör utan att någon närvarande vid dödsögonblicket i ungefär lika stor omfattning i urvalet som på övriga palliativa enheter i Sverige. Resultatet visade att 62 % av de granskade journalerna hade omvårdnadsmål dokumenterade i IVP. Konklusion: Studien visar att närvaron vid dödsögonblicket sjunker när åldern stiger och att patienter dör utan någon närvarande vid dödsögonblicket i samma omfattning i urvalet som på övriga palliativa enheter i Sverige. Studien klarlägger även bristen på omvårdnadsmål i patienters IVP, vilket belyser ett förbättringsområde för att säkerställa kvaliteten på vården av patienter i livets slutskede.Aims: The aim was to study the extent to which patients were surrounded by others at the time of death in palliative care and examine whether there were individual care plans, (IVP) in the patients nursing documentation regarding End-of-Life Care. Method: The study is quantitative retrospective with descriptive and analytical design. And includes all cancer patients (n = 316) who received care and died on a palliative care unit ward and ASIH (advanced medical care at home) in Stockholm and was registered in the Swedish palliative registry (n = 295). Results: In the age groups 75-84 years and 85 years or older, patients are more likely to die without someone present than in the other age groups. Patients are dying without anyone present in the same extent as in other palliative care units around Sweden. Only 62% of the sample had nursing goals documented in the patients IVP. Conclusion: The study illustrates that patients are surrounded by others in the same extent as in other palliative care units around Sweden. The study clarifies the lack of nursing goals in patients IVP, which highlights an area for improvement to ensure the quality in the End-of-Life care

Temporal trends in hospitalizations and 30-day mortality in older patients during the COVID pandemic from March 2020 to July 2021.

BackgroundA reduction in mortality risk of COVID-19 throughout the first wave of the pandemic has been reported, but less is known about later waves. This study aimed to describe changes in hospitalizations and mortality of patients receiving inpatient geriatric care for COVID-19 or other causes during the pandemic.MethodsPatients 70 years and older hospitalized in geriatric hospitals in Stockholm for COVID-19 or other causes between March 2020-July 2021 were included. Data on the incidence of COVID-positive cases and 30-day mortality of the total ≥ 70-year-old population, in relation to weekly hospitalizations and mortality after hospital admissions were analyzed. Findings The total number of hospitalizations was 5,320 for COVID-19 and 32,243 for non-COVID-cases. In COVID-patients, the 30-day mortality rate was highest at the beginning of the first wave (29% in March-April 2020), reached 17% at the second wave peak (November-December) followed by 11-13% in the third wave (March-July 2021). The mortality in non-COVID geriatric patients showed a similar trend, but of lower magnitude (5-10%). During the incidence peaks, COVID-19 hospitalizations displaced non-COVID geriatric patients.InterpretationHospital admissions and 30-day mortality after hospitalizations for COVID-19 increased in periods of high community transmission, albeit with decreasing mortality rates from wave 1 to 3, with a probable vaccination effect in wave 3. Thus, the healthcare system could not compensate for the high community spread of COVID-19 during the pandemic peaks, which also led to displacing care for non-COVID geriatric patients

Decreased Mortality Over Time During the First Wave in Patients With COVID-19 in Geriatric Care : Data From the Stockholm GeroCovid Study.

OBJECTIVE: To describe temporal changes in treatment, care, and short-term mortality outcomes of geriatric patients during the first wave of the COVID-19 pandemic. DESIGN: Observational study. SETTING AND PARTICIPANTS: Altogether 1785 patients diagnosed with COVID-19 and 6744 hospitalized for non-COVID-19 causes at 7 geriatric clinics in Stockholm from March 6 to July 31, 2020, were included. METHODS: Across admission month, patient vital signs and pharmacological treatment in relationship to risk for in-hospital death were analyzed using the Poisson regression model. Incidence rates (IRs) and incidence rate ratios (IRRs) of death are presented. RESULTS: In patients with COVID-19, the IR of mortality were 27%, 17%, 10%, 8%, and 2% from March to July, respectively, after standardization for demographics and vital signs. Compared with patients admitted in March, the risk of in-hospital death decreased by 29% [IRR 0.71, 95% confidence interval (CI) 0.51-0.99] in April, 61% (0.39, 0.26-0.58) in May, 68% (0.32, 0.19-0.55) in June, and 86% (0.14, 0.03-0.58) in July. The proportion of patients admitted for geriatric care with oxygen saturation <90% decreased from 13% to 1%, which partly explains the improvement of COVID-19 patient survival. In non-COVID-19 patients during the pandemic, mortality rates remained relatively stable (IR 1.3%-2.3%). Compared with non-COVID-19 geriatric patients, the IRR of death declined from 11 times higher (IRR 11.7, 95% CI 6.11-22.3) to 1.6 times (2.61, 0.50-13.7) between March and July in patients with COVID-19. CONCLUSIONS AND IMPLICATIONS: Mortality risk in geriatric patients from the Stockholm region declined over time throughout the first pandemic wave of COVID-19. The improved survival rate over time was only partly related to improvement in saturation status at the admission of the patients hospitalized later throughout the pandemic. Lower incidence during the later months could have led to less severe hospitalized cases driving down mortality