Quantifying the prevalence of frailty in English hospitals.
OBJECTIVE
Population ageing has been associated with an increase in comorbid chronic disease, functional dependence, disability and associated higher health care costs. Frailty Syndromes have been proposed as a way to define this group within older persons. We explore whether frailty syndromes are a reliable methodology to quantify clinically significant frailty within hospital settings, and measure trends and geospatial variation using English secondary care data set Hospital Episode Statistics (HES).


METHODS
National English Secondary Care Administrative Data HES.


METHODS
All 50,540,141 patient spells for patients over 65 years admitted to acute provider hospitals in England (January 2005-March 2013) within HES.


METHODS
We explore the prevalence of Frailty Syndromes as coded by International Statistical Classification of Diseases, Injuries and Causes of Death (ICD-10) over time, and their geographic distribution across England. We examine national trends for admission spells, inpatient mortality and 30-day readmission.


RESULTS
A rising trend of admission spells was noted from January 2005 to March 2013 (daily average admissions for month rising from over 2000 to over 4000). The overall prevalence of coded frailty is increasing (64,559 spells in January 2005 to 150,085 spells by Jan 2013). The majority of patients had a single frailty syndrome coded (10.2% vs total burden of 13.9%). Cognitive impairment and falls (including significant fracture) are the most common frailty syndromes coded within HES. Geographic variation in frailty burden was in keeping with known distribution of prevalence of the English elderly population and location of National Health Service (NHS) acute provider sites. Overtime, in-hospital mortality has decreased (>65 years) whereas readmission rates have increased (esp.>85 years).


CONCLUSIONS
This study provides a novel methodology to reliably quantify clinically significant frailty. Applications include evaluation of health service improvement over time, risk stratification and optimisation of services.
NIHR CLAHRC Northwest London, Imperial College London, London, UK Royal College of Physicians, London, UK.
J
J
Soong
NIHR CLAHRC Northwest London, Imperial College London, London, UK.
A J
http://orcid.org/0000-0002-2331-0904
AJ
Poots
Oliver Wyman, London, UK.
S
S
Scott
Oliver Wyman, London, UK.
K
K
Donald
NIHR CLAHRC Northwest London, Imperial College London, London, UK.
T
http://orcid.org/0000-0002-4735-4856
T
Woodcock
NIHR CLAHRC Northwest London, Imperial College London, London, UK.
D
D
Lovett
NIHR CLAHRC Northwest London, Imperial College London, London, UK.
D
http://orcid.org/0000-0002-9944-1097
D
Bell
D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D059019:Clinical Coding; D003072:Cognition Disorders; D016208:Databases, Factual; D004739:England / Q000453:epidemiology; D005260:Female; D016330:Frail Elderly / Q000523:psychology / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D010343:Patient Admission / Q000639:trends*; D012189:Retrospective Studies
Acute; Ageing; England; Frailty; HES; Prevalence