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Letters
Open Access

Delayed discharge and frailty, delirium and functional decline

George A. Heckman, Stella Arthur and Andrew P. Costa
CMAJ February 08, 2021 193 (6) E221; DOI: https://doi.org/10.1503/cmaj.77712
George A. Heckman
Schlegel Research Chair in Geriatric Medicine, Schlegel Research Institute for Aging, and University of Waterloo, Waterloo, Ont.
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Stella Arthur
University of Waterloo, Waterloo, Ont.
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Andrew P. Costa
Assistant professor and Schlegel Research Chair in Clinical Epidemiology and Aging, McMaster University, Hamilton, Ont.
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We commend Jerath and colleagues on their recent article, particularly for their robust methodology, but were disappointed that they did not address the concepts of frailty, iatrogenic delirium and functional decline.1

The lack of adequate data on the concepts of frailty and geriatric syndromes in our acute care national data repositories highlights the existence of major gaps in Canada’s health information infrastructure. First, the lack of meaningful data on frailty, delirium and functional decline reduces these key concepts to “nonmedical reasons” for delayed discharge. Clearly, they are not. Frailty, irrespective of how it is operationalized, has repeatedly been shown to be a more robust predictor of major adverse postoperative outcomes than chronological age.2 Delirium and functional decline among surgical patients are often iatrogenic and thus preventable, and delayed discharge can be avoided.3,4 Second, the lack of meaningful data on frailty, delirium and functional decline leads to the interpretation that “downstream” interventions and resources are required to improve the “flow of patients,” although practices that consider the needs of older adults, to prevent iatrogenic complications in the first place, would be far more efficient. The principles of management rest on systematic screening and assessment of at-risk patients, followed by multidisciplinary nonpharmacological interventions.3,4

It is possible to include concepts of frailty, delirium and functional decline in our acute care national data repositories. Standardized information on these syndromes is available in the databases for home care and long-term care, curated by the Canadian Institute for Health Information. These databases have been shown to be highly useful at characterizing hospital patients awaiting institutional placement.5 It is high time that Canadian acute care hospitals implement standardized information systems compatible with those in home care and long-term care.

Footnotes

  • Competing interests: None declared.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

References

  1. ↵
    1. Jerath A,
    2. Sutherland J,
    3. Austin PC,
    4. et al
    . Delayed discharge after major surgical procedures in Ontario, Canada: a population-based cohort study. CMAJ 2020;192:E1440–52.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Cunha AIL,
    2. Veronese N,
    3. de Melo Borges S,
    4. et al
    . Frailty as a predictor of adverse outcomes in hospitalized older adults: a systematic review and meta-analysis. Ageing Res Rev 2019; 56:100960.
    OpenUrlPubMed
  3. ↵
    1. Oh ES,
    2. Fong TG,
    3. Hshieh TT,
    4. et al
    . Delirium in older persons: advances in diagnosis and treatment. JAMA 2017;318:1161–74.
    OpenUrl
  4. ↵
    1. Patel JN,
    2. Klein DS,
    3. Sreekumar S,
    4. et al
    . Outcomes in multidisciplinary team-based approach in geriatric hip fracture care: a systematic review. J Am Acad Orthop Surg 2020;28:128–33.
    OpenUrl
  5. ↵
    1. Costa AP,
    2. Hirdes JP
    . Clinical characteristics and service needs of alternate-level-of-care patients waiting for long-term care in Ontario hospitals. Healthc Policy 2010;6:32–46.
    OpenUrlPubMed
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Canadian Medical Association Journal: 193 (6)
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Vol. 193, Issue 6
8 Feb 2021
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Delayed discharge and frailty, delirium and functional decline
George A. Heckman, Stella Arthur, Andrew P. Costa
CMAJ Feb 2021, 193 (6) E221; DOI: 10.1503/cmaj.77712

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Delayed discharge and frailty, delirium and functional decline
George A. Heckman, Stella Arthur, Andrew P. Costa
CMAJ Feb 2021, 193 (6) E221; DOI: 10.1503/cmaj.77712
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