Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger Associations and predictions of readmission or death in acutely admitted older medical patients using self-reported frailty and functional measures. A Danish cohort study Jane Andreasen a,b, ⁎ , Mette Aadahl c,d , Erik Elgaard Sørensen b,e , Helle Højmark Eriksen f , Hans Lund g , Kim Overvad h,i a Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark b Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark c Research Centre for Prevention and Health, The Capital Region of Denmark, Rigshospitalet- Glostrup Hospital, Ndr. Ringvej 57, Afsnit 84/85, 2600, Glostrup, Denmark d Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Denmark e Clinical Nursing Research Unit, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark f Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark g Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Inndalsveien 28, Postbox 7030, N-5020, Bergen, Norway h Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark i Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus C, Denmark ARTICLE INFO Keywords: Frailty Tilburg frailty indicator Acutely admitted older medical patients Readmission or death Timed-Up-and-Go Grip strength Prediction ABSTRACT Objective: To assess whether frailty in acutely admitted older medical patients, assessed by a self-report ques- tionnaire and evaluation of functional level at discharge, was associated with readmission or death within 6 months after discharge. A second objective was to assess the predictive performance of models including frailty, functional level, and known risk factors. Methods: A cohort study including acutely admitted older patients 65+ from seven medical and two acute medical units. The Tilburg Frailty Indicator (TFI), Timed-Up-and-Go (TUG), and grip strength (GS) exposure variables were measured. Associations were assessed using Cox regression with first unplanned readmission or death (all-causes) as the outcome. Prediction models including the three exposure variables and known risk factors were modelled using logistic regression and C-statistics. Results: Of 1328 included patients, 50% were readmitted or died within 6 months. When adjusted for gender and age, there was an 88% higher risk of readmission or death if the TFI scores were 8–13 points compared to 0–1 points (HR 1.88, CI 1.38;2.58). Likewise, higher TUG and lower GS scores were associated with higher risk of readmission or death. The area under the curve for the prediction models ranged from 0.64 (0.60;0.68) to 0.72 (0.68;0.76). Conclusion: In acutely admitted older medical patients, higher frailty assessed by TFI, TUG, and GS was asso- ciated with a higher risk of readmission or death within 6 months after discharge. The performance of the prediction models was mediocre, and the models cannot stand alone as risk stratification tools in clinical practice. 1. Introduction Frailty is associated with higher risk of hospitalisation, re-hospita- lisation, and death and, therefore, also with high healthcare-related costs (Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013; Covinsky et al., 2003; Gill, Gahbauer, Han, & Allore, 2010; Gobbens & van Assen, 2012; Pilotto et al., 2012; Wong & Miller, 2008). The number of frail older people is increasing worldwide and underscores the necessity of prioritising and ensuring effective trajectories in and between health- care sectors (OECD, 2013). Frailty is considered a manageable condi- tion if identified, and it seems possible to prevent or delay adverse consequences of frailty (De Lepeleire, Iliffe, Mann, & Degryse, 2009; Morley et al., 2013). Acutely admitted older medical patients are characterised by high https://doi.org/10.1016/j.archger.2018.01.013 Received 2 September 2017; Received in revised form 25 January 2018; Accepted 29 January 2018 ⁎ Corresponding author at: Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Hobrovej 18–22, 9000 Aalborg, Denmark. E-mail addresses: jaan@rn.dk (J. Andreasen), mette.aadahl@regionh.dk (M. Aadahl), ees@rn.dk (E.E. Sørensen), helle.e@rn.dk (H.H. Eriksen), Hans.Lund@hvl.no (H. Lund), ko@ph.au.dk (K. Overvad). Archives of Gerontology and Geriatrics 76 (2018) 65–72 Available online 13 February 2018 0167-4943/ © 2018 Elsevier B.V. All rights reserved. T