Irish Hip Fracture Database Frailty Index Predicts Delirium Incidence and Length of Stay in Older Adults Admitted with Hip Fractures

Abstract

Abstract Background The Irish Hip Fracture Database (IHFD) Frailty Index was developed with the National Office for Clinical Audit has been shown to predict adverse outcomes in older adults with fractures in retrospective review of national data. Here we examined the tool prospectively in clinical practice and its ability to predict delirium and length of stay. Methods We prospectively collected data on all hip fracture patients admitted to an acute orthopaedic floor from October 2022 to May 2024. Patients aged < 60 years or those with atypical femoral or peri-prosthetic fractures were excluded. The 21-item frailty index was applied to all eligible patients. Delirium diagnosis was based on a composite of clinical diagnosis and a 4AT score ≥ 4. Regression analysis was used to examine the relationship between delirium and length of stay with Frailty Index, age and sex. Results A total of 260 patients were included in the study, of whom 72% were female. The mean age was 80 ± 10 years, and 7.7% were nursing home residents. Additionally, 24.2% of patients were discharged directly home, while 40.3% were discharged to rehabilitation. Delirium developed in 24.6% of patients, and 24.9% of patients had a LOS exceeding 30 days. Higher frailty index scores were significantly associated with both LOS (p = 0.001) and delirium (p = 0.013) in both unadjusted and adjusted analyses. There was no significant association between age or sex and LOS or delirium in adjusted analysis. Conclusion The IHFD Frailty Index facilitates a pro-active risk stratification that is based on comorbidities and functional status. IHFD Frailty index independently predicted delirium and length of stay while age did not. Further studies integrating this tool into everyday practice in the care of older patients with hip fractures is warranted.