IS FRAILTY STATUS A TRIGGER FOR GOALS OF CARE DOCUMENTATION IN OLDER PATIENTS ADMITTED TO THE HOSPITAL?

Abstract

TYPE: Abstract Publication TOPIC: Critical Care PURPOSE: Goals of care (GOC) are important clinical documents, that should be documented early, to avoid futile or unwarranted interventions in the event of clinical deterioration in frail older patients. It is unclear whether frailty is associated with such documentations. To assess associations between frailty, as measured by Hospital Frailty Risk Score (HFRS), and GOC documentation in newly admitted older patients and outcomes. METHODS: Retrospective single-centre study of patients aged ≥80 years admitted to the study hospital between 1/3/2015 and 31/8/2015. Primary outcome was GOC documentation within 72-hours in frail (HFRS ≥5) and non-frail (HFRS <5) patients. Secondary outcomes included documentation during hospital stay, in-hospital mortality, rapid response calls (RRC), discharge destination, and 28-day readmission rate. RESULTS: 529 (47.3%) of the 1,118 patients were frail. 604 patients (54%) had GOC documented during their hospitalization (60.1% vs. 48.6%; p<0.001); 92.5% of these within 72-hours (53.5% vs. 46.9%; p<0.027; OR 1.05 [1.03–1.08]), commony in frail patients. RRC frequented frail patients (12.5% vs. 5.4%, p<0.001), as was in-hospital mortality (10.8% vs 3.6%, p<0.001, OR 1.08 [1.04–1.13]). Frail patients had longer hospitalisations (median 5.3 vs 2.9 days, p<0.001) and less likely to be discharged to their usual accommodations (32.3% vs 57.7%; p<0.001) than non-frail patients. No difference in 28-days readmission rates (6.6% vs. 8.5%; p=0.238). CONCLUSIONS: Older frail patients were found to be significantly more likely to have timely goals of care documented than older non-frail patients. Frail patients had more RRC, longer hospitalisation and increased hospital mortality. CLINICAL IMPLICATIONS: Just over 50% of older frail patients have goals of care documented Frail patients have worse outcomes DISCLOSURE: No significant relationships. KEYWORDS: Goals of care, Frailty, Hospital frailty risk score