Soong J, Poots A J, Scott S, Donald K, Woodcock T, Lovett D, Bell D
NIHR CLAHRC Northwest London, Imperial College London, London, UK Royal College of Physicians, London, UK.
NIHR CLAHRC Northwest London, Imperial College London, London, UK.
BMJ Open. 2015 Oct 21;5(10):e008456. doi: 10.1136/bmjopen-2015-008456.
OBJECTIVES: 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). SETTING: National English Secondary Care Administrative Data HES. PARTICIPANTS: All 50,540,141 patient spells for patients over 65 years admitted to acute provider hospitals in England (January 2005-March 2013) within HES. PRIMARY AND SECONDARY OUTCOME MEASURES: 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.
目标：人口老龄化与慢性疾病共病、功能依赖、残疾增加以及更高的医疗保健成本相关。衰弱综合征被提议作为一种界定老年人群体的方式。我们探讨衰弱综合征是否是一种在医院环境中量化具有临床意义的衰弱的可靠方法，并利用英国二级医疗数据集医院事件统计（HES）来衡量趋势和地理空间差异。 设置：英国国家二级医疗管理数据HES。 参与者：HES中2005年1月至2013年3月期间英格兰急性病医院收治的所有65岁以上患者的50,540,141个住院病例。 主要和次要结局指标：我们探讨按《国际疾病、损伤和死因分类》（ICD - 10）编码的衰弱综合征随时间的患病率及其在英格兰的地理分布。我们研究住院病例、住院死亡率和30天再入院率的全国趋势。 结果：2005年1月至2013年3月期间住院病例呈上升趋势（每月日均入院人数从2000多人增至4000多人）。编码的衰弱总体患病率在增加（2005年1月为64,559例，到2013年1月为150,085例）。大多数患者编码有一种衰弱综合征（10.2%，而总负担为13.9%）。认知障碍和跌倒（包括严重骨折）是HES中编码最常见的衰弱综合征。衰弱负担的地理差异与英国老年人口患病率的已知分布以及国民保健服务（NHS）急性病医疗机构的位置一致。随着时间推移，住院死亡率有所下降（>65岁），而再入院率有所上升（尤其是>85岁）。 结论：本研究提供了一种可靠量化具有临床意义的衰弱的新方法。应用包括评估随时间推移的医疗服务改善、风险分层和服务优化。
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