The hospitalized older patient: the function of a quick multidimensional assessment tool in identifying patients at increased risk

Background and objectives. The use of Comprehensive Geriatric Assessment (GCA) reduces the adverse outcomes of hospitalization in the elderly. However. GCA utilizes "time-consuming" tools, which are unsuitable for an acute-care setting. We tested a new quick multidimensional assessment tool for older patients (ARM-A). We derived a Frailty Index (FI) by associating the items about the medical history and the 3-months mortality after discharge. The aim of the study was to verify the association between FI and the clinical complexity of the patients and between FI and the different outcomes of the hospitalization. Methods. We performed a prospective, cohort study in the Emergency Department of the Istituto Clinico Humanitas in Rozzano (Milan, Italy). We tested with ARM-A 60 patients aged 65 years or more. ARM-A is composed of 35 binary standardized items, which are defined by simple boolean algorithms, divided into 3 groups (Medical History, Marker of clinical complexity, Functional Dependence). We made a bivariable analysis, then a multivariable analysis to obtain the FI. Results. The main prognostic factors associated with 3-months mortality are active cancer, severe heart failure and disability in the IADL. The FI identifies patients with complex care needs, patients with an increased risk of functional decline [OR = 3.0; 95% IC = 1.5-6.2], and patients with an increased risk of institutionalization after discharge [OR = 3.3; 95% IC = 1.2-9.4]. Conclusions. ARM-A and the FI can be useful in identifying patients at increased risk and to improve the appropriateness of individual care.