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dc.contributor.authorRomero-Ortuno, Romanen
dc.contributor.authorWallis, Stephenen
dc.contributor.authorBiram, Richarden
dc.contributor.authorKeevil, Victoriaen
dc.date.accessioned2016-10-24T16:47:22Z
dc.date.available2016-10-24T16:47:22Z
dc.date.issued2016-09-02en
dc.identifier.issn0953-6205
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/260887
dc.description.abstract$\textbf{Aim:}$ Frail individuals may be at higher risk of death from a given acute illness severity (AIS), but this relationship has not been studied in an English National Health Service (NHS) acute hospital setting. $\textbf{Methods:}$ This was a retrospective observational study in a large university NHS hospital in England. We analyzed all first non-elective inpatient episodes of people aged ≥75 years (all specialties) between October 2014 and October 2015. Pre-admission frailty was assessed with the Clinical Frailty Scale (CFS) of the Canadian Study on Health & Aging, and AIS in the Emergency Department was measured with a Modified Early Warning Score (ED-MEWS<4 was considered as low acuity, and ED-MEWS≥4 as high acuity). A survival analysis compared times to 30-day inpatient death between CFS categories (1-4: very fit to vulnerable, 5: mildly frail, 6: moderately frail, and 7-8: severely or very severely frail). $\textbf{Results:}$ There were 12282 non-elective patient episodes (8202 first episodes, of which complete data was available for 5505). In a Cox proportional hazards model controlling for age, gender, Charlson Comorbidity Index, history of dementia, current cognitive concern, and discharging specialty (medical versus surgical), ED-MEWS≥4 (HR=2.87, 95% CI: 2.27-3.62, p<0.001), and CFS 7-8 (compared to CFS 1-4, HR=2.10, 95% CI: 1.52-2.92, p<0.001) were independent predictors of survival time. $\textbf{Conclusions:}$ We found frailty and AIS independently associated with inpatient mortality after adjustment for confounders. Hospitals may find it informative to undertake large scale assessment of frailty (vulnerability), as well as AIS (stressor), in older patients admitted to hospital as emergencies.
dc.languageEnglishen
dc.language.isoenen
dc.publisherElsevier
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectfrail elderlyen
dc.subjecthospital medicineen
dc.subjectmortalityen
dc.subjectpatient acuityen
dc.subjectsurvival analysisen
dc.titleClinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: An observational studyen
dc.typeArticle
dc.description.versionThis is the final version of the article. It first appeared from Elsevier via https://doi.org/ 10.1016/j.ejim.2016.08.033en
prism.endingPage34
prism.publicationDate2016en
prism.publicationNameEuropean Journal of Internal Medicineen
prism.startingPage24
prism.volume35en
dc.identifier.doi10.17863/CAM.6060
dcterms.dateAccepted2016-08-29en
rioxxterms.versionofrecord10.1016/j.ejim.2016.08.033en
rioxxterms.versionVoRen
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en
rioxxterms.licenseref.startdate2016-09-02en
dc.contributor.orcidRomero-Ortuno, Roman [0000-0002-3882-7447]
dc.contributor.orcidKeevil, Victoria [0000-0001-6148-0640]
dc.identifier.eissn1879-0828
rioxxterms.typeJournal Article/Reviewen
rioxxterms.freetoread.startdate2017-09-02


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Attribution-NonCommercial-NoDerivatives 4.0 International
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