Psychosocial factors modify the association of frailty with adverse outcomes: a prospective study of hospitalised older peopleReportar como inadecuado




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BMC Geriatrics

, 14:108

Health services research

Abstract

BackgroundFrailty increases the risk of adverse outcomes in older people. The impact of psychosocial factors on frailty and adverse clinical outcomes associated with frailty has not yet been examined in the hospital setting. The aims of this study were to: i investigate the association between psychosocial factors and frailty, and ii to establish whether psychosocial factors impact on the association between frailty and adverse outcomes.

MethodsData was collected from a Geriatric Evaluation and Management Unit GEMU in Australia. Frailty was identified using Fried’s frailty criteria. Psychosocial factors included wellbeing, sense of control mastery, social activities, home-neighbourhood satisfaction, social relationships, anxiety and depression. Outcome measures were: mortality at 12 months, long length of GEMU stay LOS, 1-month emergency rehospitalisation, and a higher level of care needed on discharge. Covariates adjusted for were age, gender and comorbidity.

ResultsThe mean SD age of participants n = 172 at admission was 85.2 6.4 years, with 129 75% female patients. 96 56% patients were classified as frail, with 64 37% pre-frail and 12 7% robust. Frail patients had an increased likelihood of 12-month mortality HR, 95% CI = 3.16, 1.36–7.33, discharge to a higher level of care OR, 95% CI = 2.40, 1.21–4.78, long LOS OR, 95% CI = 2.04, 1.07–3.88 and 1-month emergency rehospitalisation OR, 95% CI = 2.53, 1.10–5.82. Psychosocial factors associated with frailty included poor wellbeing, anxiety, depression, and a low sense of control. Several psychosocial factors increased the likelihood of adverse outcomes associated with frailty, including anxiety and low ratings for: wellbeing, sense of control, social activities and home-neighbourhood satisfaction.

ConclusionsOur results indicate that frail older adults with low psychosocial resources had an elevated risk of mortality, discharge to higher level care, long LOS and rehospitalisation. Consideration of psychosocial factors in comprehensive geriatric assessments will assist in patient care planning.

KeywordsFrail elderly Psychosocial factors Geriatric assessment-methods Hospitalisation Electronic supplementary materialThe online version of this article doi:10.1186-1471-2318-14-108 contains supplementary material, which is available to authorized users.

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Autor: Elsa Dent - Emiel O Hoogendijk

Fuente: https://link.springer.com/



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