Frailty among older patients receiving home care services.

BACKGROUND

It is a policy objective for older people in need of care to be able to live at home for as long as possible and receive healthcare services outside of institutions. The degree of frailty in this group and consequent risk of emergency hospitalisation and death have not been widely studied. The objective of this project was to study these questions over a period of two years in a medium-sized Norwegian municipality.

MATERIAL AND METHOD

A sample of patients aged 65 years or older who received home care nursing services on a weekly basis were included. The patients underwent geriatric assessment in their own home every six months over two years. Their degree of frailty was measured using the Frailty Index. Deaths and emergency hospitalisations were recorded over two years.

RESULTS

Of the 271 patients who were asked to participate, 210 were included. Altogether 160 patients (76 %) were classified as moderately or severely frail. During the observation period, 307 hospital admissions were recorded, amounting to a total of 1 235 hospitalisation days. When compared to severely frail patients, those with mild degrees of frailty were less frequently hospitalised (hazard ratio (HR) 0.33; 95 % confidence interval (CI) 0.19-0.60). During the two-year observation period, 63 (30 %) patients died. The mortality rate was highest in patients with severe frailty. In an adjusted Cox regression, increasing age was associated with a higher risk of death, but not with acute hospitalisation.

INTERPRETATION

Older patients with home care nursing services have a high degree of frailty, and a high degree of frailty is associated with increased risk of hospitalisation and death.