Association between patient-reported frailty and nonhome discharge among older patients with acute stroke: A prospective study

Objective To investigate the association between prestroke frailty and nonhome discharge, prolonged length of stay as well as functional outcomes. Design Prospective observational study. Setting Single urban teaching hospital in Guangzhou, China. Participants Consecutive sample of 271 older patients admitted with acute stroke. Intervention N/A. Main measures A five-item FRAIL scale (0∼5 points) and the stroke severity at onset were measured. The primary outcome of interest was nonhome discharge, with secondary outcomes including prolonged length of stay and worse short-term prognosis. Multivariable logistic regression adjusting for confounding factors was used to determine the association between patient-reported frailty and nonhome discharge, prolonged length of stay, worse short-term prognosis. Results The population had a median age of 68 [interquartile range (IQR), 64∼74)]years, with 50 individuals (18.5%) identified as frail. After adjusting for age, sex, Barthel index, National Institutes of Health Stroke Scale, and Mini-Mental Status Exam score at admission, patients with self-reported frailty were significantly likely to experience nonhome discharge (Odds Ratio [ OR] = 4.788; 95% confidence interval [CI] = 1.272∼18.017; p = .021), prolonged length of stay ( OR = 4.76; 95% CI = 1.80∼12.56; p = .002), mRS scores at 30 days ( OR = 6.72;95% CI = 1.79∼25.20; p = .005) and three months postdischarge and three-month ( OR = 8.94; 95% CI = 2.10∼38.08; p = .003). Conclusions In older adults with stroke, frailty is associated with nonhome discharge, prolonged length of stay, and worse short-term prognosis, regardless of the stroke severity, cognition, and Barthel index score at admission. FRAIL scale can be used as a practical screening tool in acute care setting by multidisciplinary team in supporting discharge process.