103 The Characteristics of Frail Older Patients Admitted Through an Emergency Department, who Experience New Disability due to Acute Illness

Abstract

Abstract Background No current tool reliably predicts functional decline risk. The modified Barthel Index (mBI) is a validated measure of disability, ideal for use within an interdisciplinary assessment. The aim of this prospective cohort study was to determine the proportion and characteristics of newly admitted frail older patients who experience drops in their Barthel index, requiring intervention. Methods Consecutive acute emergency patients identified as Variable Indicative of Placement positive at triage, were assessed using an interdisciplinary assessment tool (IAT), from February 1st 2019 to March 31st 2019. Data was entered into an excel database on demographics, baseline mBI and inpatient (within 72 hours) mBI, frailty-associated co-morbidities and multi-disciplinary interventions and analysed using Student’s T-test. Results 150 consecutive patients were assessed with a mean age (mean (+/- SD)) of 83.1(+/- 7.4). mBI scores were recorded for 111(74%) of patients. Mean mBI prior to current illness was 15.4(+/- 4.9). Post-illness mBI was 12.5(+/- 5.3). 65(58.6%) patients experienced an mBI drop. Mean drop was 4.9 (+/- 2.8) points. There was no difference in age or baseline mobility between those who either did or did not experience an mBI drop. Patients with a drop had higher mean pre-illness mBI (16.2 vs. 14.2; p-value 0.017, 4AT score (1.98 vs. 1.11; p-value 0.035) and increased falls history (40 vs. 18 patients; p-value <0.01), compared to patients with no drop. They required more referrals to the multidisciplinary team (3.7 vs. 2.9, p-value 0.002). Conclusion Higher proportions of frail patients experienced a drop in function compared with studies where age is used as a cut-off. Within this small frail patient cohort, age was surprisingly not associated with mBI drops. Using frailty as the main determinant for assessment rather than age, results in a different cohort of patients, at risk of functional decline. Future predictive tools should focus on frailty rather than on age.