title: Frailty and Geriatric Syndromes in Vascular Surgical Ward Patients.
abstract: BACKGROUND
  Preoperative frailty is an important predictor of poor outcomes but the relationship between frailty and geriatric syndromes is less clear. The aims of this study were to describe the prevalence of frailty and incidence of geriatric syndromes in a cohort of older vascular surgical ward patients, and investigate the association of frailty and other key risk factors with the occurrence of one or more geriatric syndromes (delirium, functional decline, falls, and/or pressure ulcers) and two hospital outcomes (acute length of stay and discharge destination).
  
  
  METHODS
  This prospective cohort study was conducted in a vascular surgical ward in a tertiary teaching hospital in Brisbane, Australia. Consecutive patients aged ≥65 years, admitted for ≥72 hr, were eligible for inclusion. Frailty was defined as one or more of functional dependency, cognitive impairment, or nutritional impairment at admission. Delirium was identified using the Confusion Assessment Method and a validated chart extraction tool. Functional decline from admission to discharge was identified from daily nursing documentation of activities of daily living. Falls were identified according to documentation in the medical record cross-checked with the incident reporting system. Pressure ulcers, acute length of stay, and discharge destination were identified by documentation in the medical record. Risk factors associated with geriatric syndromes, acute length of stay, and discharge destination were assessed using multivariable logistic regression models.
  
  
  RESULTS
  Of 110 participants, 43 (39%) patients were frail and geriatric syndromes occurred in 40 (36%). Functional decline occurred in 25% of participants, followed by delirium (20%), pressure ulcers (12%), and falls (4%). In multivariable logistic analysis, frailty [odds ratio (OR) 6.7, 95% confidence interval (CI) 2.0-22.1, P = 0.002], nonelective admission (OR 7.2, 95% CI 2.2-25.3, P = 0.002), higher physiological severity (OR 5.5, 95% CI 1.1-26.8, P = 0.03), and operative severity (OR 4.6, 95% CI 1.2-17.7, P = 0.03) increased the likelihood of any geriatric syndrome. Frailty was an important predictor of longer length of stay (OR 2.6, 95% CI 1.0-6.8, P = 0.06) and discharge destination (OR 4.2, 95% CI 1.2-13.8, P = 0.02). Nonelective admission significantly increased the likelihood of discharge to a higher level of care (OR 5.3, 95% CI 1.3-21.6, P = 0.02).
  
  
  CONCLUSIONS
  Frailty and geriatric syndromes were common in elderly vascular surgical ward patients. Frail patients and nonelective admissions were more likely to develop geriatric syndromes, have a longer length of stay, and be discharged to a higher level of care.
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Brisbane, Queensland, Australia. Electronic address: Prue.McRae@health.qld.gov.au.
authors.forename: Prudence J
authors.initials: PJ
authors.lastname: McRae
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Discipline of Surgery and Centre for Clinical Research, Brisbane, Queensland, Australia.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Walker
authors.affiliation: The University of Queensland School of Medicine, Centre for Research in Geriatric Medicine, Brisbane, Queensland, Australia.
authors.forename: Nancye M
authors.initials: NM
authors.lastname: Peel
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Brisbane, Queensland, Australia.
authors.forename: Denise
authors.initials: D
authors.lastname: Hobson
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Parsonson
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Brisbane, Queensland, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Donovan
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Burns, Trauma and Critical Care Research Centre, Brisbane, Queensland, Australia.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Reade
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Marquart
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland School of Medicine, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Mudge
mesh_terms: D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D016009:Chi-Square Distribution; D003071:Cognition; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006757:Hospital Units; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D016017:Odds Ratio; D010351:Patient Discharge; D003668:Pressure Ulcer / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors; D013577:Syndrome; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects