204 A prospective study using the Irish Hip Fracture Database developed Frailty Index to predict delirium and prolonged length of stay

Abstract Background Hip fracture in older adults is associated with life changing disability and mortality and those with frailty are at greatest risk. The National Office of Clinical Audit, in collaboration with the Irish Hip Fracture Database (IHFD) has developed a Frailty Index specific to this population. A retrospective review of Hospital Inpatient Enquiry (HIPE) and IHFD data demonstrated an association between frailty index and adverse outcomes. In this study, we evaluate the use of this tool prospectively to predict delirium and prolonged Length of Stay (LoS) in older hip fracture patients. Methods Data was collected prospectively on an acute inpatient orthopaedic ward from October 2022 to May 2023. We excluded patients aged <60 years and those with periprosthetic or atypical femoral fractures. The Frailty index (a 21-item scale based on comorbidities and premorbid functional status) was calculated and delirium identified by a 4AT score ≥ 4 or a documented clinical diagnosis. Logistic regression was used to evaluate the potential relationship between frailty index and outcomes of delirium and delirium prolonged LoS (≥30 days). Results There were 92 patients, of whom 68.5% were female with a mean age of 79.5 ± 9.1 years. Delirium developed in 29.3% of patients and 19.5% had a length of stay of ≥30 days. A 4AT score was calculated in 45.7% of patients. Patients with versus without delirium had a lower frailty index (0.13 vs 0.21). Frailty index was also associated with delirium (p = 0.04) and prolonged LoS (p = 0.04) independent of age and gender. Conclusion The IHFD Frailty Index is effective in predicting delirium and prolonged length of stay in older hip fracture patients. Using a frailty index may help identify frail patients who are at greater risk of adverse outcomes and may benefit from early targeted interventions and orthogeriatric review.