Frailty highly prevalent in geriatric ward in Singapore

The prevalence of frailty is high in the subacute geriatric inpatient population and is associated independently with age, handgrip strength (HGS) at discharge, serum albumin, and urinary incontinence, results of a Singapore study have shown.

“This has implications for future resource allocation for frail older inpatients and may help direct further research to study the effectiveness of frailty-targeted interventions,” the researchers said.

Some 167 individuals participated in this cross-sectional study between June 2018 and June 2019. The following data were obtained from the participants: baseline demographics and Mini Nutritional Assessment, Geriatric Depression Scale, Mini Mental State Examination, Charlson’s Comorbidity Index, and LACE index score.

The researchers took functional measurements, such as modified Barthel’s Index scores and HGS, and assessed frailty using the Clinical Frailty Scale (CFS) and the FRAIL scale. They also collected data on history of healthcare utilization, medications, length of stay, selected blood investigations, and presence of geriatric syndromes.

The prevalence of prefrailty (CFS 4) was 16.2 percent and frailty (CFS ≥5) 63.4 percent. [Singapore Med J 2022;doi:10.11622/smedj.2022020]

CFS was significantly associated with age (prefrail vs nonfrail: odds ratio [OR], 1.14, 95 percent confidence interval [CI], 1.04‒1.25; p=0.006; frail vs nonfrail: OR, 1.08, 95 percent CI, 1.01‒1.15; p=0.021), HGS at discharge (frail vs nonfrail: OR, 0.90, 95 precent CI, 0.82‒0.99; p=0.025) serum albumin (frail vs nonfrail: OR, 0.90, 95 percent CI, 0.82‒0.99; p=0.35), and the presence of urinary incontinence (frail vs nonfrail: OR, 3.03, 95 percent CI, 1.19‒7.77; p=0.021).

“The high prevalence of frailty was expected because these patients often had complex medical and functional issues,” the researchers said. “Our study revealed several independent associations with frailty, which were consistent with a number of other studies.” [Clin Interv Aging 2019;14:2249-2259; J Nutr Health Aging 2019;23:442-450; J Am Geriatr Soc 2018;66:559-564; Ann Acad Med Singapore 2019;48:171-180; Medicine (Baltimore) 2018;97:e0581]

Frailty-targeted programs

Moreover, the current study provided a better understanding of this group of patients with largely different characteristics from a more heterogeneous population in the acute inpatient setting. These patients had much longer hospitalization and more intensive use of hospital resources, which could possibly lead to higher healthcare costs.

Identifying possible reversible associated factors and how to manage these, as well as implementing frailty-targeted initiatives, could help improve frailty status and reduce the risk of adverse outcomes in this population. [Lancet 2019;394:1365-1375; Lancet 2019;394:1376-1386]

“This knowledge may have future implications for the design of healthcare systems and delivery as well as resource allocation, because such patients have more complex needs,” the researchers said. “Severely and very severely frail elderly may also benefit from palliative care, including initiating discussions on the preferred plan of care.”

The present study was limited by its small sample size and cross-sectional design.

“Cost-effectiveness studies could further explore the burden of managing frail subacute patients to better inform resource allocation and improvements to healthcare delivery in a rapidly ageing population,” the researchers said. [Lancet 2019;394:1376-1386]