Which factors predict frailty in subacute geriatric patients?

Frailty, which is prevalent in the subacute geriatric inpatient population, is independently associated with age, hand grip strength (HGS) at discharge, serum albumin, and urinary incontinence, according to a Singapore study.

“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.

A cross-sectional study of 167 participants was conducted between June 2018 and June 2019. The researchers obtained baseline demographics and Mini Nutritional Assessment, Geriatric Depression Scale, Mini Mental State Examination, Charlson’s Comorbidity Index, and LACE (length of stay, acuity of admission, Charlson’s comorbidity index, and number of emergency department visits in preceding 6 months) index scores. They also obtained functional measurements such as modified Barthel’s Index scores and HGS.

The Clinical Frailty Scale (CFS) and the FRAIL score were used to assess frailty. Finally, the researchers collected data on history of healthcare utilization, medications, length of stay, selected blood investigations, and presence of geriatric syndromes.

Prefrailty (CFS 4) and frailty (CFS ≥5) prevalence rates were 16.2 percent and 63.4 percent, respectively. [Singapore Med J 2023;64:196-202]

CFS showed significant associations 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 percent CI, 0.82‒0.99; p=0.025), serum albumin (frail vs nonfrail: OR, 0.90, 95 percent CI, 0.82‒0.99; p=0.035), and presence of urinary incontinence (frail vs nonfrail: OR, 3.03, 95 percent CI< 1.19‒7.77; p=0.021).

Independent factors

“Age [ha]s a well-known association with frailty,” the researchers said. “With increasing age, biomedical and psychosocial deficits are accumulated, reducing the individual’s functional and reserve capacity.” [Clin Interv Aging 2019;14:2249-2259; J Nutr Health Aging 2019;23:442-450; Medicine (Baltimore) 2018;97:e0581]

HGS, on the other hand, is a marker of muscle strength and can be easily measured and used as an independent predictor of frailty in the inpatient setting. [Aging Clin Exp Res 2013;25:633-636; Curr Opin Clin Nutr Metab Care 2015;18:465-470]

Serum albumin can also be used as a marker of nutritional status, which is closely associated with frailty. Older adults who are frail often experience unintentional weight loss, suggesting malnutrition or being at risk of malnutrition. [Clin Interv Aging 2019;14:2249-2259; Clin Interv Aging 2019;14:105-111]

In addition, previous studies have reported the relation of frailty with urinary incontinence, which is also a component of FRAIL-NH (Fatigue, Resistance, Ambulation, Incontinence, Illness, Loss of Weight, Nutritional Approach altered, Help with Dressing), a frailty tool used in nursing homes. [Rejuvenation Res 2017;20:111-117; J Am Med Dir Assoc 2018;19:422-427; J Am Med Dir Assoc 2015;16:87-89]

The current study was limited by its small sample size, so future studies can benefit from using larger sample sizes and exploring associations with clinical outcomes, according to the researchers.

“Future studies could also include clinical data of referrals to postdischarge services or the type of frailty-targeted interventions implemented,” they added.