NHS England and Improvement, London, UK.
University of Leicester, Leicester, UK.
Age Ageing. 2021 Feb 26;50(2):511-518. doi: 10.1093/ageing/afaa156.
Frailty is increasingly used to risk stratify older people, but across specialised services there is no standardised approach. The aim of this study was to assess if the Hospital Frailty Risk Score (HFRS) could describe outcomes for older people within English specialised services.
A retrospective cohort study was performed using the Secondary Uses Service (SUS) electronic database for people aged 75 or older admitted between April 2017 and March 2018.
Based on HFRS, the populations were risk stratified into mild, moderate and severe frailty risk. The relationships with length of stay, readmission rate, mortality and some selected condition specific treatment complications were quantified using descriptive statistics.
Very few individuals (<2%) could not be risk stratified for frailty risk. Frailty was differentially distributed across the specialties; around one-third had mild frailty; another third had moderate frailty and one-quarter severe frailty. Increasing frailty risk was associated with increased length of stay for the index admission, more days in hospital in the year following intervention and increased risk of dying in hospital. Severe frailty was a powerful discriminator of the risk of death; between 25 and 40% of those with severe frailty risk died at 30 months across all specialties.
This study demonstrates the first application of the HFRS to a national dataset to describe service outcomes and mortality for older people undergoing a range of specialised interventions. This information could be used to identify those that might benefit from holistic assessment, aid prognostication, commissioning and service planning.
衰弱越来越多地被用于对老年人进行风险分层，但在专门的服务中，没有标准化的方法。本研究的目的是评估医院衰弱风险评分（HFRS）是否可以描述英国专门服务中老年人的结局。
使用二级使用服务（SUS）电子数据库进行回顾性队列研究，纳入 2017 年 4 月至 2018 年 3 月期间 75 岁或以上的患者。
基于 HFRS，将人群按轻度、中度和重度衰弱风险进行分层。使用描述性统计方法，定量评估与住院时间、再入院率、死亡率和一些选定的特定疾病治疗并发症的关系。
极少数（<2%）患者无法进行衰弱风险分层。衰弱在各专业之间的分布存在差异；大约三分之一的患者为轻度衰弱；另有三分之一为中度衰弱，四分之一为重度衰弱。衰弱风险增加与住院时间延长、干预后一年内住院天数增加和院内死亡风险增加相关。严重衰弱是死亡风险的有力预测指标；在所有专业中，25%至 40%的严重衰弱风险患者在 30 个月内死亡。
本研究首次将 HFRS 应用于全国性数据集，以描述老年人接受一系列专门干预后的服务结局和死亡率。这些信息可用于识别那些可能受益于整体评估、辅助预后、委托和服务规划的人群。
