2012 The long-term clinical outcomes of older adults with frailty following acute hospital admission in Tanzania

Abstract

Abstract Background Non-communicable disease, multimorbidity and frailty are posing considerable challenges as global populations age. Healthcare systems in Low- and Middle-Income Countries are having to rapidly adapt services to meet the needs of older people. Objective This study, the first of its kind in sub-Saharan Africa, aimed to establish whether screening older people for frailty on admission to hospital could be used to identify those at greatest risk of adverse outcomes. Methods At baseline assessment, 308 participants aged ≥60 years, admitted to medical wards at four hospitals in the Kilimanjaro Region of Tanzania, were screened for frailty using the Clinical Frailty Scale (CFS). After 10-12 months, participants, and their informants, were contacted by telephone to establish clinical outcomes. The primary outcome was all-cause mortality. Cox regression was used to estimate hazard ratios ( 95% confidence interval) for mortality, with dichotomised CFS frailty status (frail if ≥5) as the independent variable. Results Primary outcome data were obtained for 194 (63.0%) of the original participants after a mean follow-up period of 10.8 ( 0.9) months. Mean age was 75.1 years and 99 (51%) of respondents were female. A total of 100 (51.5%) respondents were deceased and hazard ratios for all-cause mortality demonstrate that those with frailty were at significantly greater risk of mortality (HR 2.27 [CI 1.39 – 3.69], p<0.01), an effect that persisted even after adjustment for age, baseline Barthel Index, education and number of chronic conditions. Conclusion For older people living in Tanzania, unplanned admission to hospital is associated with high mortality and frailty is a strong independent predicator. In accurately identifying which older people are at the greatest risk, frailty screening using the CFS could provide a starting point for the development of targeted care pathways and interventions.