Association between clinical frailty, illness severity and post-discharge survival: a prospective cohort study of older medical inpatients in Norway

Andreas Engvig, Torgeir Bruun Wyller, Eva Skovlund, Marc Vali Ahmed, Trygve Sundby Hall, Kenneth Rockwood, Anne Mette Njaastad, Bjørn Erik Neerland

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)

Abstract

Purpose: Study associations between frailty, illness severity and post-discharge survival in older adults admitted to medical wards with acute clinical conditions. Methods: Prospective cohort study of 195 individuals (mean age 86; 63% females) admitted to two medical wards with acute illness, followed up for all-cause mortality for 20 months after discharge. Ward physicians screened for frailty and quantified its degree from one to eight using Clinical Frailty Scale (CFS), while clinical illness severity was estimated by New Early Warning Score 2 (NEWS2) and laboratory illness severity was calculated by a frailty index (FI-lab) using routine blood tests. Results: CFS, NEWS2 and FI-lab scores were independently associated with post-discharge survival in an adjusted Cox proportional hazards model with age, ward category (acute geriatric and general medical) and comorbidity as covariates. Adjusted hazard ratios and 95% confidence intervals were 1.54 (1.24–1.91) for CFS, 1.12 (1.03–1.23) for NEWS2, and 1.02 (1.00–1.05) for FI-lab. A frailty × illness severity category interaction effect (p = 0.003), suggested that the impact of frailty on survival was greater in those experiencing higher levels of illness severity. Among patients with at least moderate frailty (CFS six to eight) and high illness severity according to both NEWS2 and FI-lab, two (13%) were alive at follow-up. Conclusion: Frailty screening aided prognostication of survival following discharge in older acutely ill persons admitted to medical wards. The prognostic value of frailty increased when combined with readily available illness severity markers acquired during admission.

Original languageEnglish
Pages (from-to)453-461
Number of pages9
JournalEuropean Geriatric Medicine
Volume13
Issue number2
DOIs
Publication statusPublished - Apr 2022

Bibliographical note

Funding Information:
Andreas Engvig received a writing grant from associate professor Morten Mowé, University of Oslo. There were no other external sources of funding.

Publisher Copyright:
© 2021, The Author(s).

ASJC Scopus Subject Areas

  • Gerontology
  • Geriatrics and Gerontology

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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