Frailty and pre-frailty can significantly impact older adults who get admitted to hospital, influencing their treatment outcomes, quality of life, healthcare use and mortality rates.
But this situation is even more alarming for people who have had cancer, and may lead to them having additional treatment complications, including malnutrition – which can contribute to longer stays in hospital.
Dr Chad Han from Flinders University’s Caring Futures Institute, together with Professors Michelle Miller and Raymond Chan, Dr Alison Yaxley and Associate Professors Claire Baldwin and Yogesh Sharma, recently published research that examined people with cancer who also have pre-frailty and frailty, finding that they have significantly elevated risk of polypharmacy (when a patient takes five or more different medications) and malnutrition, and that the length of their stay in hospital increases by 24%, when compared to people who have not had cancer.
“There is a huge cohort of older adults who have had cancer, so we examined them to find out the reasons why they are admitted to the acute medical unit of hospitals – often for matters not related to their cancer – and then stay longer than other patients,” explains Dr Han.
The study aimed to expand the limited knowledge of characteristics related to pre-frailty and frailty and cancer by describing and comparing the frailty status and patient characteristics between older adults with a history of cancer, or active cancers, and those without cancer who are admitted to a hospital’s acute medical unit.
The researchers conducted an observational study of 329 hospitalised adults aged 65 years or older, with about one-fifth of these patients having a history of cancer. Of these people, 58% had a prevalence of pre-frailty or frailty. These same patients had 8 times higher likelihood of experiencing polypharmacy and 9 times higher likelihood of experiencing malnutrition than other hospital patients.
The risk of having a longer stay in hospital was 24% higher in older adults with a history of cancer than those without.
“The research affirmed our hypothesis that there isn’t a significant difference in frailty statuses between older adults with and without a history of cancer in the acute medical unit, and that those with a history of cancer may have a longer hospital stay,” says Dr Han.
“Clinicians will be able to use this information to heighten their alertness about pre-frailty and frailty, what this can do to affect the health of patents, and to make early and appropriate interventions – such as improved nutrition and exercise programs to improve a patient’s health outcomes.
“These can be started when the patient is in hospital, and we would like to think it will help shorten a person’s hospital stay. We conducted a pilot intervention on older adults – including those who have a history of cancers – with the input of a dietician, physiotherapist and general medical physicians, and it showed that active care in nutrition and exercise can reduce frailty in this cohort, although this has not yet been extensively tested and proven.”
Dr Han is confident the research findings will also help improve understanding of the impact that a patient’s history of cancer has on clinical outcomes during their stay in hospital.
“Ultimately, the value in identifying pre-frailty and frailty early and acting on it will hopefully help reduce demands on hospital services, by identifying patients who can be treated differently.”
The research – “Pre-Frailty and Frailty in Hospitalized Older Adults: A Comparison Study in People with and without a History of Cancer in an Acute Medical Unit”, by Chad Han, Raymond Chan, Huah Shin Ng, Yogesh Sharma, Alison Yaxley, Claire Baldwin and Michelle Miller – has been published in Cancers journal.
While the results of this research are revealing, Dr Han says further investigations are warranted to guide improved systematic assessments that can best identify those patients at risk and provide interventions that best meet the complex needs of this vulnerable population.