title: Frailty and functional decline indices predict poor outcomes in hospitalised older people.
abstract: BACKGROUND
  admission to a Geriatric Evaluation and Management Unit (GEMU) can optimise a patient's chance of functional recovery.
  
  
  OBJECTIVE
  to evaluate the ability of several commonly used frailty and functional decline indices to predict GEMU outcomes, both at discharge and at 6 months.
  
  
  METHODS
  prospective, observational study.
  
  
  METHODS
  consecutive GEMU patients aged ≥70 years.
  
  
  METHODS
  patients were classified as 'frail' or 'at high risk of functional decline' using several frailty and functional decline instruments. Predictive ability was evaulated using logistic regression and area under receiver operator characteristic (ROC) curves (auROC).
  
  
  RESULTS
  a total of 172 patients were included. Frailty prevalence varied from 24 to 94% depending on the instrument used. Several instruments predicted patients at risk of poor outcome, including the Frailty Index of Accumulative Deficits (FI-CD), Fried's Cardiovascular Health Study index, the Study of Osteoporotic Fractures index, an adapted Katz score of activities of daily living (ADL), Instrumental ADL, the Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie (SHERPA) and grip strength [odds ratio (OR) range of 2.06-6.47]. Adequate discriminatory power for discharge outcome was achieved by the FI-CD (auROC = 0.735, P < 0.001) and an adapted Katz score (auROC = 0.704, P = < 0.001). The FI-CD also showed adequate discriminatory power for a poor 6-month outcome (auROC = 0.702, P < 0.001).
  
  
  CONCLUSIONS
  frailty and functional decline instruments can predict older patients at risk of poor outcome. However, only the FI-CD showed adequate discriminatory power for outcome prediction at both follow-up time-points.
authors.affiliation: Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Elsa
authors.initials: E
authors.lastname: Dent
authors.affiliation: Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Chapman
authors.affiliation: Discipline of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Stuart
authors.initials: S
authors.lastname: Howell
authors.affiliation: Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Piantadosi
authors.affiliation: Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia Aged and Extended Care Services, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
authors.forename: Renuka
authors.initials: R
authors.lastname: Visvanathan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D064887:Observational Studies as Topic; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015996:Survival Rate
keywords: 80 and over; aged; frail elderly; geriatric assessment/methods; older people; prognosis