title: The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment.
abstract: BACKGROUND
  prognostication for frail older adults is complex, especially when they become seriously ill.
  
  
  OBJECTIVE
  to test the measurement properties, especially the predictive validity, of a frailty index based on a comprehensive geriatric assessment (FI-CGA) in an acute care setting in relation to the risk of death, length of stay and discharge destination.
  
  
  METHODS
  prospective cohort study. Inpatient medical units in a teaching, acute care hospital.
  
  
  METHODS
  individuals on inpatient medical units in a hospital, n = 752, aged 75+ years, were evaluated on their first hospital day; to test reliability, a subsample (n = 231) was seen again on Day 3.
  
  
  METHODS
  all frailty data collected routinely as part of a CGA were used to create the FI-CGA. Mortality data were reviewed from hospital records, claims data, Social Security Death Index and interviews with Discharge Managers.
  
  
  RESULTS
  thirty-day mortality was 93 (12.4%; 95% confidence interval (CI) = 10-15%) of whom 52 died in hospital. The risk of dying increased with each 0.01 increment in the FI-CGA: hazard ratio (HR) = 1.05, (95% CI = 1.04-1.07). People who were discharged home had the lowest admitting mean FI-CGA = 0.38 (±standard deviation 0.11) compared with those who died, FI-CGA = 0.51 (±0.12) or were discharged to nursing home, FI-CGA = 0.49 (±0.11). Likewise, increasing FI-CGA values on admission were significantly associated with a longer length of hospital stay.
  
  
  CONCLUSIONS
  frailty, measured by the FI-CGA, was independently associated with a higher risk of death and other adverse outcomes in older people admitted to an acute care hospital.
authors.affiliation: Catholic Health System, Catholic Health System of Western New York, Buffalo, NY, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Evans
authors.forename: Margaret
authors.initials: M
authors.lastname: Sayers
authors.forename: Arnold
authors.initials: A
authors.lastname: Mitnitski
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D003661:Decision Support Techniques; D005240:Feasibility Studies; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006760:Hospitalization; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: acute care; age; frailty index based on a comprehensive geriatric assessment; mortality; older people; prognosis