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Frailty risk in hospitalised older adults with and without diabetes mellitus
Author(s) -
Lekan Deborah A.,
McCoy Thomas P.
Publication year - 2018
Publication title -
journal of clinical nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.94
H-Index - 102
eISSN - 1365-2702
pISSN - 0962-1067
DOI - 10.1111/jocn.14529
Subject(s) - medicine , odds , logistic regression , diabetes mellitus , retrospective cohort study , odds ratio , proportional hazards model , propensity score matching , cohort , cohort study , gerontology , endocrinology
Background Research indicates that diabetes mellitus ( DM ) may be a risk factor for frailty and individuals with DM are more likely to be frail than individuals without DM ; however, there is limited research in hospitalised older adults. Objectives To determine the extent of frailty in hospitalised older adults with and without DM using a 16‐item Frailty Risk Score ( FRS ) and assess the role of frailty in predicting 30‐day rehospitalisation, discharge to an institution and in‐hospital mortality. Methods The study was a retrospective, cohort, correlational design and secondary analysis of a data set consisting of electronic health record data. The sample was older adults hospitalised on medicine units. Logistic regression was performed for 30‐day rehospitalisation and discharge location. Cox proportional hazards regression was used to analyse time to in‐hospital death and weighted using propensity scores. Results Of 278 hospitalised older adults, 49% had DM , and the mean FRS was not significantly different by DM status (9.6 vs. 9.1, p = 0.07). For 30‐day rehospitalisation, increased FRS was associated with significantly increased odds of rehospitalisation ( AOR = 1.24, 95% CI [1.01, 1.51], p = 0.04). Although 81% were admitted from home, 57% were discharged home and 43% to an institution. An increased FRS was associated with increased odds of discharge to an institution ( AOR = 1.48, 95% CI [1.26, 1.74], p < 0.001). The FRS was not significantly associated with increased risk of in‐hospital death ( p = 0.17), but DM was associated with a 484% increase in the instantaneous risk of death ( AHR = 5.84, 95% CI [1.71, 19.9], p = 0.005). Conclusion Diabetes mellitus and frailty were highly prevalent; the mean FRS was not significantly different by DM status. Although increased frailty was significantly associated with rehospitalisation and discharge to an institution, only DM was significantly associated with in‐hospital mortality. Relevance to clinical practice Frailty assessment may augment clinical assessment and facilitate tailoring care and determining optimal outcomes in patients with and without DM .