197Measuring Functional Homeostasis in an Acutely Unwell Frail Older Population

Abstract

Background: Functional homeostasis has been defined as the ability of an individual to withstand illness without loss of function. We set out to observe impaired functional homeostasis in a frail inpatient cohort, in addition to studying its impact on inpatient length of stay (LOS) and readmission. Methods: Over a 6-month period (July-December'17) data was collected prospectively on all consecutive acute medical admissions to a specialist frailty service in an Irish University Hospital. Variables included age, sex, length of stay (LOS), 30-day and 90-day readmission, and Rockwood Clinical Frailty Scale (CFS). Barthel Index (BI) were recorded at baseline and admission. Impaired functional homeostasis was defined as any reduction of BI on admission. Univariate and multivariate linear or logistic regression was carried out to model the impact of age, frailty and impairment in functional homeostasis on LOS and 30-day readmission respectively. Results: We analysed 135 consecutive admissions, 64% were female, median age was 84 (IQR:80-88). The majority of patients (93%) were admitted from home. All patients underwent Comprehensive Geriatric Assessment within 24-hours of admission. The median CFS was 5(IQR:4-6). The median difference in BI (baseline-admission) was 5 (IQR:2-7). The median LOS was 7 days (IQR:2-14). 76% of patients were discharged directly home. 16% and 27% of patients were readmitted within 30 and 90 days respectively. There was no significant relationship found between age, CFS at baseline, or impaired functional homeostasis and LOS or likelihood of readmission. Conclusion: High rates of impaired functional homeostasis were found in this frail cohort as a result of intercurrent medical illness. Access to CGA is essential in these patients. Frailty status, impaired functional homeostasis and age were not significant predictors of LOS or likelihood of 30-day readmission. This may be due to models of care within the frailty service.