The Clinical Frailty Scale predicts inpatient mortality in older hospitalised patients with idiopathic Parkinson's disease.

UNLABELLED: Parkinson's disease and frailty are both common conditions affecting older people. Little is known regarding the association of the Clinical Frailty Scale with hospital outcomes in idiopathic Parkinson's disease patients admitted to the acute hospital. We aimed to test whether frailty status was an independent predictor of short-term mortality and other hospital outcomes in older inpatients with idiopathic Parkinson's disease. METHOD: We conducted an observational retrospective study in a large tertiary university hospital between October 2014 and October 2016. Routinely measured patient characteristics included demographics (age and sex), Clinical Frailty Scale, acute illness severity (Emergency Department Modified Early Warning Score), the Charlson Comorbidity Index, discharge specialty, history of dementia, history of depression and the presence of a new cognitive impairment. Outcomes studied were inpatient mortality, death within 30 days of discharge, new institutionalisation, length of stay ≥ 7 days and readmission within 30 days to the same hospital. RESULTS: There were 393 first admission episodes of idiopathic Parkinson's disease patients aged 75 years or more; 166 (42.2%) were female. The mean age (standard deviation) was 82.8 (5.0) years. The mean Clinical Frailty Scale was 5.9 (1.4) and the mean Charlson Comorbidity Index was 1.3 (1.5). After adjustment for covariates, frailty and acute illness severity were independent predictors of inpatient mortality; odds ratio for severely/very severely frail or terminally ill = 8.1, 95% confidence interval 1.0-63.5, p = 0.045 and odds ratio for acute illness severity: 1.3, 95% confidence interval 1.1-1.6, p = 0.005). The Clinical Frailty Scale did not significantly predict other hospital outcomes. CONCLUSIONS: The Clinical Frailty Scale was a significant predictor of inpatient mortality in idiopathic Parkinson's disease patients admitted to the acute hospital and it may be useful as a marker of risk in this vulnerable population

Frailty, the determinants of health and the new evidence base.

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Association of the clinical frailty scale with hospital outcomes.

BACKGROUND: The clinical frailty scale (CFS) was validated as a predictor of adverse outcomes in community-dwelling older people. In our hospital, the use of the CFS in emergency admissions of people aged ≥ 75 years was introduced under the Commissioning for Quality and Innovation payment framework. AIM: We retrospectively studied the association of the CFS with patient characteristics and outcomes. DESIGN: Retrospective observational study in a large tertiary university National Health Service hospital in UK. METHODS: The CFS was correlated with transfer to specialist Geriatric ward, length of stay (LOS), in-patient mortality and 30-day readmission rate. RESULTS: Between 1st August 2013 and 31st July 2014, there were 11 271 emergency admission episodes of people aged ≥ 75 years (all specialties), corresponding to 7532 unique patients (first admissions); of those, 5764 had the CFS measured by the admitting team (81% of them within 72 hr of admission). After adjustment for age, gender, Charlson comorbidity index and history of dementia and/or current cognitive concern, the CFS was an independent predictor of in-patient mortality [odds ratio (OR) = 1.60, 95% confidence interval (CI): 1.48 to 1.74, P < 0.001], transfer to Geriatric ward (OR = 1.33, 95% CI: 1.24 to 1.42, P < 0.001) and LOS ≥ 10 days (OR = 1.19, 95% CI: 1.14 to 1.23, P < 0.001). The CFS was not a multivariate predictor of 30-day readmission. CONCLUSIONS: The CFS may help predict in-patient mortality and target specialist geriatric resources within the hospital. Usual hospital metrics such as mortality and LOS should take into account measurable patient complexity.This is the author accepted manuscript. The final version is available via OUP at http://dx.doi.org/10.1093/qjmed/hcv06

Care home residents admitted to hospital through the emergency pathway: characteristics and associations with inpatient mortality.

BACKGROUND: Routinely collected hospital information could help to understand the characteristics and outcomes of care home residents admitted to hospital as an emergency. METHODS: This retrospective 2-year service evaluation included first emergency admissions of any older adult (≥75 years) presenting to Cambridge University Hospital. Routinely collected patient variables were captured by an electronic patient record system. Care home status was established using an official register of care homes. RESULTS: 7.7% of 14,777 admissions were care home residents. They were older, frailer, more likely to be women and have cognitive impairment than those admitted from their own homes. Additionally, 42% presented with an Emergency Department Modified Early Warning Score above the threshold triggering urgent review, compared to 26% of older adults from their own homes. Admission from a care home was associated with higher 30-day inpatient mortality (11.1 vs 5.7%), which persisted after multivariable adjustment (hazard ratio: 1.42; 95% confidence interval: 1.09-1.83; p = 0.008). CONCLUSION: Care home residents admitted to hospital as an emergency have high illness acuity and inpatient mortality

The association between clinical frailty and walking speed in older hospitalized medical patients: A retrospective observational study

$\textbf{Introduction}$ This study aims to further evaluate the use of the clinical frailty scale (CFS) by assessing its correlation with usual walking speed (UWS) in older medical inpatients. $\textbf{Methods}$ Retrospective observational study in an English tertiary university hospital. We analysed all admission episodes of people admitted to the Department of Medicine for the Elderly wards during a 3-month period. We excluded those who died or had a CFS score of 9, indicating terminal illness. The CFS was recorded on admission and 6 meter UWS was measured on the day of hospital discharge. Other variables collected were: age, sex, the four-item version of the Abbreviated Metal Test (AMT4), and the Emergency Department Modified Early Warning Score. $\textbf{Results}$ There were 1022 patients admitted over the study period, of which 741 met inclusion criteria and had both CFS and walking speed data available. Five hundred and seventy were able to mobilise at least 6 m. The median UWS was 0.33 (0.21–0.50) m/s. Logistic ordinal regression showed that lower CFS, being male and higher score in the AMT4 were associated with higher odds of being in a higher walking speed category (odds ratio for CFS after covariable adjustment: 0.57 [95% CI, 0.50 to 0.65]). $\textbf{Conclusions}$ We observed a strong association between higher admission CFS and lower discharge UWS. This association was not explained by variation in age, sex, presence of cognitive impairment or illness acuity and provides further evidence that the CFS maybe a valid measure of frailty in acute clinical settings.The study was conducted during a research training fellowship for Peter Hartley funded by Addenbrooke's Charitable Trust and the Cambridge Biomedical Research Centre

Impairments in Hemodynamic Responses to Orthostasis Associated with Frailty: Results from TILDA

Background: Dysregulated homeostatic response to stressors may underlie frailty in older adults. Orthostatic hypotension results from impairments in cardiovascular homeostasis and is implicated in falls and other adverse outcomes. This study aimed to characterise the relationships between orthostatic BP and heart rate recovery and frailty in an older population. Design: Cross-sectional study. Setting: Two health centres in the Republic of Ireland. Participants: 4334 adults aged 50 and older enrolled in The Irish Longitudinal Study on Ageing. Measurements: Continuous non-invasive blood pressure (BP) responses during active standing were captured by Finometer®. Frailty was assessed using the Cardiovascular Health Study criteria. Linear mixed models (random intercept) with piecewise splines were used to model differences in the rate of BP and heart rate recovery. Results: 93 (2.2%) participants were frail and 1366 (31.5%) were prefrail. Adjusting for age and sex, frailty was associated with a reduced rate of systolic BP recovery between 10-20 seconds post stand (frailty*time = -4.12 95%CI: -5.53 - -2.72) and with subsequent deficits in BP between 20-50 seconds. Similar results were seen for diastolic BP and heart rate. Further adjustment for health behaviours, morbidities, and medications reduced, but did not attenuate these associations. Of the 5 frailty criteria, only slow gait speed was consistently related to impaired BP and heart rate responses in the full models. Conclusions: Frailty, and particularly slow gait speed, was associated with reduced rate of recovery in BP and heart rate recovery following active standing. Impaired BP recovery may represent a marker of physiological frailty