Frailty and Diabetes in Older Hospitalized Adults: The Case for Routine Frailty Assessment

Abstract

ObjectivesDiabetes is common among older hospitalized adults; however, the effect of a diabetes diagnosis, frailty and blood glucose on mortality and hospital length of stay (LOS) has not been well described, nor is frailty routinely assessed in inpatients. MethodsThis study included patients ≥65 years of age consulted to internal medicine through the emergency department at a Canadian tertiary care hospital. An internist-geriatrician determined their frailty status using the Clinical Frailty Scale. Inpatient mortality rates and LOS were obtained from a hospital administrative database. Admission glucose (fasting or random) and hemoglobin A1C were performed within 1 and 92 days of the comprehensive geriatric assessment. ResultsThis study included 400 patients (mean age, 81.4±8.1 years), 79.3% were frail (Clinical Frailty Scale score ≥5) and 35.3% had diabetes. The inpatient mortality rate was 19.7%, and among those who were discharged from the hospital, mean LOS was 23.7±36.5 days. Patients with diabetes were more likely to be frail than patients without diabetes. Diabetes status was not associated with LOS or mortality, but frailty was associated with both outcomes in multivariate regression analysis adjusted for age, sex and admission glucose. In patients with diabetes, mean admission glucose decreased with increasing frailty. ConclusionsFrailty was more common in patients with diabetes. Frailty, not diabetes, was associated with increased mortality and LOS in multivariate analysis. In patients with diabetes, admission glucose was lower with higher frailty. Frailty should be routinely assessed in all inpatients with diabetes because it is associated with hospital outcomes.