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

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.