The purpose of this study was to perform a secondary data analysis by applying a researcher-derived frailty index to hospitalized patients with clostridium difficile (CDI) ages 55 and older with an aim of investigating frailty index score and prediction of in-hospital mortality and re-admission for non-related CDI occurrences within one year of initial presentation.
Hospitalized frail older adults are at increased risk for mortality and acuity of care (Hatheway et al., 2017). The frailty index for CDI (FI-CDI) allows frailty recognition for interventions. Guided by the accumulation of deficits approach (Rockwood and Mitniski, 2011), the FI-CDI was created per standard guidelines (Searle et al., 2008). All admissions (24 hours or greater) were included for patients 55 and older hospitalized with CDI, indicated by ICD-9 and 10 codes.
The FI-CDI estimated frailty for adults ≥ 55 years hospitalized for CDI between December 2013 through December 2015. FI-CDI variables included laboratory abnormalities, diseases, functional status, and psychosocial indicators. Binary form was used to code deficits, with “1” identifying deficit presence and “0” identifying deficit absence. The FI-CDI was calculated by dividing number of deficits present in an individual by total number of deficits measured (39), with frailty defined as ≥ 0.25. The FI-CDI was applied to 454 patients who had complete admission data for the 39 deficits.
The average age of the 871 study patients with CDI was 73.6 years (SD=10.7) and 59% were female with 70% white. The average frailty score of 0.42 (SD=0.11), where prevalence (those with a score ≥ 0.25) of frailty on admission was 92.1% of the CDI patients. Preliminary modeling shows that FI-CDI 39 frailty scores were significantly higher in those with first CDI admission in-hospital mortality (M = 0.412 alive vs. M = 0.462 died; p = 0.018), but not significantly higher in those with non-CDI readmission within 1 year (M = 0.438 with readmission vs. M = 0.415 not readmitted; p = 0.331).
Timely frailty assessment to decrease mortality risk is imperative in older adults with CDI. Clinical data from the FI-CDI leads to targeted, multidisciplinary approaches with goal of decreasing morbidity and mortality risk.
Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
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