The Association of Geriatric Syndromes with Hospital Outcomes.
Frailty, history of dementia (HoD), and acute confusional states (ACS) are common in older patients admitted to hospital.



To study the association of frailty (≥6 points in the Clinical Frailty Scale [CFS]), HoD, and ACS with hospital outcomes, controlling for age, gender, acute illness severity (measured by a Modified Early Warning Score in the emergency department), comorbidity (Charlson Comorbidity Index), and discharging specialty (general medicine, geriatric medicine, surgery).



Retrospective observational study.



Large university hospital in England.



We analyzed 8202 first nonelective inpatient episodes of people aged 75 years and older between October 2014 and October 2015.



The outcomes studied were prolonged length of stay (LOS ≥10 days), inpatient mortality, delayed discharge, institutionalization, and 30-day readmission. Statistical analyses were based on multivariate regression models.



Independently of controlling variables, prolonged LOS was predicted by CFS ≥6: odds ratio (OR) =1.55; 95% confidence interval [CI], 1.36-1.77; P ⟨ 0.001; HoD: OR = 2.16; 95% CI, 1.79-2.61; P ⟨ 0.001; and ACS: OR = 3.31; 95% CI, 2.64-4.15; P ⟨ 0.001. Inpatient mortality was predicted by CFS ≥6: OR = 2.29; 95% CI, 1.79-2.94; P ⟨ 0.001. Delayed discharge was predicted by CFS ≥6: OR = 1.46; 95% CI, 1.27-1.67; P ⟨ 0.001; HoD: OR = 2.17; 95% CI, 1.80-2.62; P ⟨ 0.001; and ACS: OR = 2.29; 95% CI: 1.83-2.85; P ⟨ 0.001. Institutionalization was predicted by CFS ≥6: OR = 2.56; 95% CI, 2.09-3.14; P ⟨ 0.001; HoD: OR = 2.51; 95% CI, 2.00-3.14; P ⟨ 0.001; and ACS: OR 1.93; 95% CI, 1.46-2.56; P ⟨ 0.001. Readmission was predicted by ACS: OR = 1.36; 95% CI, 1.09-1.71; P = 0.006.



Routine screening for frailty, HoD, and ACS in hospitals may aid the development of acute care pathways for older adults. Journal of Hospital Medicine 2017;12:83-89.
Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.|Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Roman
R
Romero-Ortuno
Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Duncan R
DR
Forsyth
Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Kathryn Jane
KJ
Wilson
Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Ewen
E
Cameron
Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Stephen
S
Wallis
Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Richard
R
Biram
Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.|Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Victoria
V
Keevil
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003221:Confusion / Q000523:psychology; D003704:Dementia / Q000523:psychology; D004739:England; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care / Q000639:trends*; D010359:Patient Readmission; D012189:Retrospective Studies; D011795:Surveys and Questionnaires