The impact of frailty and polypharmacy on adverse outcomes in older inpatients

Background\ud \ud Older people are at significant risk of adverse outcomes\ud as a result of changes in physiology, frailty, co-morbidity and\ud polypharmacy.1 Timely identification of high-risk patients may facilitate\ud the optimization of medication and reduce the incidence of\ud adverse outcomes. The aims of this study were to evaluate in older\ud inpatients the relationships between risk factors, including frailty and\ud polypharmacy, and adverse health outcomes.\ud \ud Methods\ud \ud This is a prospective study of 1418 patients, aged 70\ud and older, admitted to general medical units in 11 acute care hospitals\ud across Australia. The interRAI Acute Care (interRAI AC)\ud assessment tool was used for data collection. Frailty status was measured\ud using a Frailty Index (FI), adding each individual’s deficits and\ud dividing by the total number of deficits considered. Adverse health\ud outcomes included falls in hospital, delirium, in-hospital functional\ud and cognitive decline, discharge to a higher level of care and inpatient\ud mortality.\ud \ud Results\ud \ud Patients had a mean age 81 ± 6.8 years with a median\ud length of hospital stay of 6 days (interquartile range 4 to 11 days);\ud 701 (50%) experienced at least one adverse outcome. Polypharmacy\ud (5-9 drugs per day) was observed in almost half of the study population\ud (n=695, 49%) and hyper-polypharmacy (≥10 drugs) observed in\ud about one-third of patients (n=490, 34.6%). Cognitive impairment\ud was shown to be associated with the lower rate of prescribing. FI\ud had a significant association with all adverse outcomes studied (p =\ud