An exploration of the relationship between frailty in the older adult and recurrence of Clostridium difficile

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Anna W. Boone (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
Laurie Kennedy-Malone

Abstract: The purpose of this retrospective cohort research study was to explore the relationship between frailty and recurrent Clostridium difficile (CDI) in adults 55 years and older hospitalized between December 31, 2013 through December 31, 2015, with data extracted from 2012 to 2016 to identify initial and recurrent admission for CDI. A researcher-derived frailty index, based on the Accumulation of Deficits framework by Mitnitski, Mogilner, and Rockwood (2001), was created after careful review of the components contributing to frailty and following the guidance by Searle, Mitnitski, Gahbauer, Gill, and Rockwood (2008). As per Searle et al. (2008), the FI-CDI was constructed by following the method of selecting variables that are associated with health, increase with age, do not present early in the aging process, cover a wide representation of organ systems and not just one system, and items for the index remain unchanged when performing serial measurements in the sample. Variables for the FI-CDI included laboratory abnormalities, chronic diseases, functional status, and psychosocial indicators. The deficits were coded as “1” for present and “0” for absent, calculating the FI-CDI by dividing the number of deficits in an individual by the total number of deficits measured (36 in this study) as per the standard procedure for calculating the frailty index (Searle et al., 2008). Based on the derived FI-CDI, frailty was defined as = 0.25. The initial sample for the inclusion criteria consisted of 871 patients with CDI. Only 450 patients had complete data on admission to calculate the FI-CDI for the 36 deficits. The overall sample (n=871) had a recurrence rate of 23.9% (n=208) for the study period. The average age for the overall sample was 73.6 years (SD=10.7), with 9.1% of the sample expiring during first hospitalization over the study period. Caucasian females comprised over half of the sample. Almost two-thirds (n=576, 66.1%) resided in a private residence prior to initial admission, followed by skilled nursing facility (n=125, 14.4%). About one-third of the patients were discharged to either home/self-care (n=279, 32.0%) or a skilled nursing facility (n=261, 30.0%) after initial admission. CDI recurrence was more prevalent for those discharged to a skilled nursing facility (37.5% vs. 27.6% with no recurrence) and with home health care services (24.5% vs. 15.2% no recurrence) (p<0.001). The average frailty score for the FI-CDI sample (n=450) was 0.37 (SD=0.10) on admission. The age group of 55 to 64 was significantly associated with recurrent CDI admission for both bivariate and logistic regression analyses. The chronic diseases found to be significantly more prevalent in recurrent CDI included hypertension (88.0% vs. 78.4%; p=0.003), heart failure (36.1% vs. 25.6%; p=0.005), and chronic kidney disease (34.1% vs 24.9%: p=0.011). Frailty prevalence, as measured by the FI-CDI (n=450) was 89.1% on admission as indicated by a FI-CDI score of = 0.25. The FI-CDI scores on admission were significantly related to CDI recurrence, adjusting for sociodemographics. Proton pump inhibitor (PPI) use prior to initial admission was significantly associated with frailty in bivariate analysis, but PPI use was not associated with recurrent CDI. Evidence from this study bridges a knowledge gap that exists regarding frailty and recurrent CDI. Limited research has been explored with frailty and recurrent CDI, and this study provides a foundation for prospective studies. The FI-CDI could be used with existing medical record data at time of hospitalization, assessing frailty and allowing iv opportunities for intervention. The hospitalized frail older adult is vulnerable, with CDI as a stressor that can result in prolonged recovery time and possible recurrence. Recognition of frailty in this population through already existing medical record data can guide interventions to address the underpinnings contributing to frailty and decrease readmissions, recurrence, morbidity, and mortality.

Additional Information

Language: English
Date: 2018
Clostridium difficile, Frailty, Frailty Index, Hospitalization, Older Adult, Recurrence Clostridium difficile
Clostridium difficile
Older people
Hospital utilization $x Length of stay

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