Frailty status, timely goals of care documentation and clinical outcomes in older hospitalised medical patients

Objective: Hospitalised frail older patients are at risk of clinical deterioration. Early goals of care documentation (GOC) is vital to avoid futile/unwarranted interventions in the event of deterioration. We aimed to investigate the impact of frailty on timely GOC and its association with clinical outcomes in hospitalised older patients.

Design, setting, participants: Single-centre retrospective study of all medical patients aged ≥80 years admitted to acute medical unit between 1/3/2015 and 31/8/2015, with GOC derived from electronic records. Frailty was measured using Hospital Frailty Risk Score (HFRS) derived from hospital coding data.

Main outcome measures: Primary outcome compared proportions timely GOC within 72-h between frail (HFRS≥5) and non-frail (HFRS<5) patients. Exploratory secondary outcomes included in-hospital mortality, rapid response calls (RRCs), prolonged length of stay (LOS), and 28-day readmission rates.

Results: 529 (47.3%) of the 1118 admitted patients were frail. Timely GOC occurred in 50% (559/1118), more commonly in frail patients (283/529, 53.5%) than non-frail patients (276/589, 46.9%), p = 0.027. Frailty was positively associated with timely GOC independent of age and sex (OR = 1.28; 95%-CI = 1.01-163; p = 0.041). In univariable analyses, timely GOC was associated with greater in-hospital mortality, RRCs, and hospital LOS in both frail and non-frail patients (all p < 0.05); and greater 28-day readmissions only among frail patients (p = 0.028). Multivariable regression demonstrated timely GOC was associated only with in-hospital mortality in both frail and non-frail patients, independent of age and sex.

Conclusion: Older frail hospitalised patients were more likely to have timely GOC than older non-frail patients. Timely GOC in such patients may avoid burdensome treatments.