Impact of Frailty on Healthcare Utilization in Older Patients Admitted to Medical Wards: A Study from a Large Medical School in a Middle-income Setting

Patumporn Suraarunsumrit; Pacha Sinthornkasem; Ponnapa Petchthai; Supawadee Sainimnuan; Rinrada  Preedachitkul; Varalak  Srinonprasert

doi:10.33192/smj.v77i1.271497

Authors

Patumporn Suraarunsumrit Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Pacha Sinthornkasem Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Ponnapa Petchthai Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Supawadee Sainimnuan Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Rinrada Preedachitkul Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Varalak Srinonprasert Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/smj.v77i1.271497

Keywords:

Frailty, Length of hospital stay, Health care cost, Mortality, Older patients

Abstract

Objective: The study aimed to evaluate healthcare utilization and mortality in patients stratified by frailty status and explore the factors associated with a prolonged length of hospital stay (LOS).

Materials and Methods: This retrospective cohort study included medical inpatients aged ≥60 years old. They were classified into robust, prefrail, and frail groups using the FRAIL Scale. The primary outcome was LOS, while the secondary outcomes were hospital costs, in-hospital mortality, and factors associated with a prolonged LOS. Multivariate analysis was used to explore the factors that influenced the prolonged LOS, and the results were expressed using an adjusted odds ratio (AOR).

Results: Of the 603 enrolled participants, 269 (44.6%) were classified as frail, 256 (42.5%) as prefrail, and 78 (12.9%) as robust. The frail group had longer hospital stays than the robust group (8 days [1,58] vs. 6 days [1,36]; p=0.003). Healthcare costs in the frail and prefrail groups were higher than in the robust group (1264.6 USD [128.9, 30216.0], 1051.7 USD [154.3, 37615.7], and 937.7 USD [174.8, 18539.8], respectively; p=0.001). Frail and prefrail patients were also more likely to die in hospital than the robust ones (7.1% vs. 0.0%, p=0.010; 6.3% vs. 0.0%, p =0.028, respectively). The multivariate analysis also revealed that frailty was associated with a prolonged LOS [AOR of 2.21(95%CI, 1.07–4.56); p=0.031].

Conclusion: Frailty leads to increased healthcare utilization by patients and higher mortality. Identifying frail older patients with an aim to provide appropriate care might reduce the negative outcomes associated with frailty.

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