Department of Medicine, 550083University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
Baystate Medical Center Office of Research, Springfield, MA, USA.
Am J Hosp Palliat Care. 2021 Apr;38(4):371-375. doi: 10.1177/1049909121995603.
Frailty has important implications for the care of the elderly and how their needs are met.
To assess clinicians' acknowledgement of frailty in the electronic medical records (EMR) and the impact of frailty recognition on advance care planning (ACP).
We performed a retrospective study on 119 patients 65 years or older with moderate or severe frailty assessed using a validated frailty scale. We reviewed notes to determine if primary team identified frailty and obtained data regarding ACP planning. We present the characteristics and outcomes of patients who were identified as frail and compared them with patients whose frailty was unrecognized in EMR.
Among the 119 frail patients, one third were ≥85 years and one-year mortality was 25.4%. Most patients were taking ≥5 medications and only 14.3% rated their health as excellent or good prior to hospitalization. Only 15 patients (12.6%) were identified as frail in the EMR. The only significant differences between those recognized versus unrecognized frail were body mass index (23.4 vs 28.6, p = 0.02) and reported weight loss in the 3 months prior to admission (93.3% vs 59.6%, p = 0.009). Geriatric or palliative care consults, and changes in code status to do-not resuscitate were more frequent among those recognized vs not. (33.3% vs 11.5%; 13.3% vs 1.9% respectively).
Documentation of frailty in the EMR was rare and it was associated with a lower likelihood of providing advance care planning. These findings suggest a need for consistent frailty assessment, which might promote patient-centered care.
虚弱对老年人的护理和满足他们的需求具有重要意义。
评估临床医生在电子病历（EMR）中对虚弱的认识，以及虚弱识别对预先护理计划（ACP）的影响。
我们对 119 名年龄在 65 岁或以上、使用经过验证的虚弱量表评估为中度或重度虚弱的患者进行了回顾性研究。我们查阅了病历，以确定主要团队是否识别出虚弱，并获取了关于 ACP 计划的数据。我们介绍了被确定为虚弱的患者的特征和结果，并将其与 EMR 中未识别出虚弱的患者进行了比较。
在 119 名虚弱患者中，有三分之一的患者年龄在 85 岁以上，一年死亡率为 25.4%。大多数患者正在服用 5 种以上药物，只有 14.3%的患者在住院前将自己的健康状况评为优秀或良好。只有 15 名患者（12.6%）在 EMR 中被识别为虚弱。在那些被识别为虚弱和未被识别为虚弱的患者之间，只有身体质量指数（23.4 与 28.6，p=0.02）和入院前 3 个月报告的体重减轻（93.3%与 59.6%，p=0.009）存在显著差异。在那些被识别为虚弱的患者中，接受老年或姑息治疗咨询以及更改复苏代码的情况更为频繁（分别为 33.3%与 11.5%；13.3%与 1.9%）。
在 EMR 中记录虚弱的情况很少见，这与提供预先护理计划的可能性较低有关。这些发现表明需要进行一致的虚弱评估，这可能会促进以患者为中心的护理。
