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Background: multidisciplinary rehabilitation is of proven benefit in the management of older inpatients. However, the identification of patients who will do well with rehabilitation currently lacks a strong evidence base.Objectives: the aims of this study were to compare the importance of chorological age, gender, co-morbidities and frailty in the prediction of adverse outcomes for patients admitted to an acute geriatric rehabilitation ward.Design: prospective observational cohort study.Subjects and setting: two hundred and sixty-five patients admitted consecutively to an acute geriatric rehabilitation ward at a tertiary care teaching hospital.Methods: frailty status was measured by an index of accumulated deficits, giving a potential score from 0 (no deficits) to 1.0 (all 40 deficits present). Patients were stratified into three outcomes: good (discharged to original residence within 28 days), intermediate (discharged to original residence but longer hospital stay) and poor (newly institutionalised or died).Results: patients were old (82.6 ± 8.6 years) and frail (mean frailty index (FI) 0.34 ± 0.09). Frailty status correlated significantly with length of stay and was a predictor of poor functional gain. The odds ratio of intermediate and poor outcome relative to a good outcome was 4.95 (95% CI = 3.21, 7.59; P < 0.001) per unit increase in FI. Chronological age, gender and co-morbidity showed no significant association with outcomes.Conclusion: frailty is associated with adverse rehabilitation outcomes. The FI may have clinical utility, augmenting clinical judgement in the management of older inpatients. [ABSTRACT FROM AUTHOR]

Provides information on a study that determined whether access to critical care beds in south Wales is related to age. Methodology of the study; Results and discussion on the study.

Background: delirium and frailty are common among hospitalised older people but delirium is often missed and frailty considered difficult to measure in clinical practice., Objective: to explore the relationship between delirium and frailty in older inpatients and determine their impact on survival., Design and Setting: the prospective cohort study of 273 patients aged ≥75 years., Measures: patients were screened for delirium at presentation and on alternate days throughout their hospital stay. Frailty status was measured by an index of accumulated deficits (FI), giving a potential score from 0 (no deficits) to 1.0 (all 33 deficits), with 0.25 used as the cut-off between 'fit' and 'frail'., Results: delirium was detected in 102 patients (mean FI: 0.33) and excluded in 171 (mean FI: 0.18) (P < 0.005); 111 patients were frail. Among patients with delirium, the median survival in fit patients was 359 days (95% CI: 118-600) compared with 88 days for those who were frail (95% CI: 5-171; P < 0.05)., Conclusion: delirium was associated with higher levels of frailty: the identification of frail patients may help to target those at a greatest risk of delirium. Survival following delirium was poor with the combination of frailty and delirium conferring a particularly bleak prognosis.

Background: Comprehensive geriatric assessment and multidisciplinary intervention are of proven benefit in the care of older people., Objective: To determine whether patients' multidisciplinary needs in hospital can be met by current service provision., Design: A comprehensive census assessing the multidisciplinary needs of an entire inpatient population compared to available multidisciplinary therapy time., Setting: A large teaching hospital Trust, comprising six hospital sites., Methods: On census day, the age, Barthel Index score and multidisciplinary needs of all adult inpatients were documented. Each therapist completed a questionnaire regarding their direct patient contact time on census day., Results: 889 of 1,324 eligible patients (69%) had multidisciplinary needs on census day. These patients were scattered throughout all 46 acute wards, 14 rehabilitation and 4 continuing care settings. Mean age was 65.3 years in acute wards, 73.5 in rehabilitation wards and 80.8 in continuing care. Age correlated inversely with Barthel Index score (r -0.255, P <0.01). The percentage of patients with multidisciplinary need increased with increasing age. The calculated number of minutes of therapy time per day available to each patient varied between therapies and across sites. Mean physiotherapy time available per patient needing physiotherapy on census day ranged from 17 minutes 41 seconds in acute wards to 26 minutes 24 seconds in rehabilitation wards., Conclusions: A high proportion of inpatients, particularly older patients, across all care settings have multidisciplinary needs. This needs to be expressly considered in the planning of future health services if multidisciplinary needs of older people in hospital are to be met.