Sandha, S.

Longitudinal association between frailty and health-related quality of life among patients discharged from tertiary care
Sandha, S., Al Sayah F., Ohinmaa A., McAlister F., Johnson J. A.

Frailty is reportedly associated with increased risk for falls, hospitalization, need for long-term care, and mortality. There is evidence to suggest an association between frailty and health-related quality of life (HRQL. However, evidence is mostly based on cross-sectional studies or those focused on intensive care or surgical populations. The objective of this study is to explore the longitudinal association between frailty and HRQL in adult patients from discharge from internal medicine wards to 90 days post-discharge.

We used data from the "prospective assessment of hospital discharge characteristics that may impact post-discharge outcomes and events" (PROACTIVE) study. The EQ-5D-3L and Clinical Frailty Scale were used to measure HRQL and frailty, respectively. Multinomial regression and multiple linear regression analyses adjusting for age, sex, HRQL at discharge, and comorbidities were conducted using STATA.

382 patients with completed frailty and HRQL data were included in this analysis. Compared to non-frail patients, frail patients were less likely to improve in the mobility dimension (adjusted RRR = 0.36; p = 0.004) from the time of discharge to 90-days post discharge. Frail patients were less likely to improve (RRR = 0.26; p = 0.004) and more likely to deteriorate (RRR = 5.53; p < 0.001) in the self-care dimension compared to non-frail patients from the time of discharge to 90 days post-discharge. Frail patients were less likely to improve (RRR = 0.35; p = 0.002) and more likely to deteriorate (RRR = 3.52; p = 0.003) in the usual activities dimension. In the pain/discomfort dimension, frailty was only positively associated with deterioration (RRR = 3.35; p < 0.001). Frailty was not associated with improvement or deterioration in the anxiety/depression dimension.

Overall, frailty, compared to non-frailty, is associated with significantly more negative changes in the physical dimensions of HRQL from the time of discharge to 90 days post-discharge.