验证医院衰弱风险评分预测老年人住院的效果：来自澳大利亚女性健康纵向研究的证据。

Validation of hospital frailty risk score to predict hospital use in older people: Evidence from the Australian Longitudinal Study on Women's Health.

机构信息

Research Centre for Generational Health and Ageing (RCGHA), Faculty of Health and Medicine, The University of Newcastle, NSW, Australia; Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, 2308, Australia; Research Assets Division, SAX Institute, Level 3, 30C Wentworth Street, Glebe, NSW, 2037, Australia.

出版信息

Arch Gerontol Geriatr. 2021 Jan-Feb;92:104282. doi: 10.1016/j.archger.2020.104282. Epub 2020 Oct 16.

DOI:10.1016/j.archger.2020.104282

PMID:33147534

Abstract

BACKGROUND

Frailty is among the most serious global public health challenges due to the rapid increase in the ageing population and age-associated declines in health. We aimed to validate hospital frailty risk score (HFRS) for its ability to predict prolonged hospital length of stay, 28-day unplanned readmission, repeated admission, and mortality in older people over a 15-year follow-up period.

METHODS

We linked data from the Australian Longitudinal Study on Women's Health (ALSWH) with hospital admission and National Death Index datasets to identify admitted patients and death dates. This study included patients with an index unplanned admission resulting in an overnight hospital stay in 2001-2016 and aged 75-95 years at the time of admission. HFRS and Charlson comorbidity index (CCI) were calculated from the hospital data using the International Statistical Classification of Diseases, Australia Modification (ICD-10-AM) diagnostic codes.

RESULTS

Of 2740 older women aged 75 years and over with unplanned admission, the proportions of patients with low, intermediate, and high frailty risks were 77.15 % (n = 2114), 20.95 % (n = 574), and 1.90 % (n = 52), respectively. The 15-year follow-up revealed that high frailty risk patients increased 5-fold in 2015 (15.67 % patients, mean age = 92.26 years) compared to 2001 (2.56 % patients, mean age = 77.96 years). Prolonged hospital length of stay was higher in the intermediate (AOR = 2.86, 95 %CI: 2.26, 3.62) and high frailty risk group (AOR = 4.26, 95 %CI: 2.32, 7.63) compared to the low frailty risk group. Frailty risk was not associated with unplanned or repeated hospital admission. However, the intermediate frailty risk group (AHR = 1.78, 95 %CI: 1.47, 2.17) and the high frailty risk group (AHR = 4.17, 95 %CI: 2.00, 8.66) had a significant risk of mortality compared to the low frailty risk group.

CONCLUSIONS

This study confirms the ability of HFRS to identify older, frail people at higher risk of prolonged hospital length of stay and increased mortality risk. However, we did not observe a significant association between HFRS and 28-day unplanned readmission or repeated hospital admission.

摘要

背景

由于人口老龄化的快速增长和与年龄相关的健康状况下降，虚弱是全球最严重的公共卫生挑战之一。我们旨在验证医院虚弱风险评分（HFRS）在预测老年人 15 年随访期间延长住院时间、28 天非计划性再入院、再次入院和死亡率方面的能力。

方法

我们将澳大利亚女性健康纵向研究（ALSWH）的数据与住院和国家死亡指数数据集相链接，以确定入院患者和死亡日期。本研究纳入了 2001-2016 年因计划外入院导致住院过夜的 75-95 岁患者。HFRS 和 Charlson 合并症指数（CCI）是根据国际疾病分类、澳大利亚修订版（ICD-10-AM）诊断代码从住院数据中计算出来的。

结果

在 2740 名 75 岁以上的老年女性中，低、中、高虚弱风险患者的比例分别为 77.15%（n=2114）、20.95%（n=574）和 1.90%（n=52）。15 年随访显示，与 2001 年相比，2015 年高虚弱风险患者增加了 5 倍（15.67%的患者，平均年龄为 92.26 岁），而 2001 年为 2.56%的患者（平均年龄为 77.96 岁）。与低虚弱风险组相比，中危（AOR=2.86，95%CI：2.26，3.62）和高危（AOR=4.26，95%CI：2.32，7.63）组的住院时间延长风险更高。虚弱风险与非计划性或重复住院无相关性。然而，中危（AHR=1.78，95%CI：1.47，2.17）和高危（AHR=4.17，95%CI：2.00，8.66）组与低危组相比，死亡风险显著增加。