Social Vulnerability and Frailty in Hospitalized Older Adults.

Background: Social vulnerability is the accumulation of disadvantageous social circumstances resulting in susceptibility to adverse health outcomes. Associated with increased mortality, cognitive decline, and disability, social vulnerability has primarily been studied in large population databases rather than frail hospitalized individuals. We examined how social vulnerability contributes to hospital outcomes and use of hospital resources for older adults presenting to the Emergency Department.
Methods: We analyzed patients 65 years of age or older admitted through the Emergency Department and consulted to internal medicine or geriatrics at a Canadian tertiary care hospital from July 2009 to September 2020. A 20-item social vulnerability index (SVI) and a 57-item frailty index (FI) were calculated, using a deficit accumulation approach. Outcomes were length of stay (LOS), extended hospital LOS designation, alternative level of care (ALC) designation, in-hospital mortality, and discharge to long-term care (LTC).
Results: In 1,146 patients (mean age 80.5±8.3, 54.0% female), mean SVI was 0.40±0.16 and FI was 0.44±0.14. The SVI scores were not associated with admission to hospital. Amongst those admitted, for every 0.1 unit increase in SVI, LOS increased by 1.15 days ( p <.001) after adjusting for age, sex and FI. SVI was associated with staying over the expected LOS (aOR: 1.19, 1.05 - 1.34, p =.009) and ALC status (aOR 1.39, 1.12 - 1.74, p <.004). SVI was not associated with in-hospital mortality, but was associated with incident discharge to LTC (aOR 1.03, 1.02 - 1.04, p <.001).
Conclusion: Independent of frailty, being socially vulnerable was associated with increased LOS, designation as ALC, and being discharged to LTC from hospital. Consideration of social vulnerability's influence on prolonged hospitalization and long-term care needs has implications for screening and hospital resources.
Competing Interests: CONFLICT OF INTEREST DISCLOSURES JCM’s graduate studies are supported by scholarships from the Pierre Elliot Trudeau Foundation, Dalhousie Medical Research Foundation’s Dr. Patrick Madore Scholarship, Dalhousie University’s Department of Medicine’s Killam Postgraduate Medical Scholarship & University Internal Medicine Research Foundation Fellowship. KR is President and Chief Science Officer of DGI Clinical, which in the last five years has contracts with pharma and device manufacturers on individualized outcome measurement. In 2019 he attended an advisory board meeting with Nutricia. Otherwise any personal fees are for invited guest lectures and academic symposia, received directly from event organizers, chiefly for presentations on frailty. He is Associate Director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes of Health Research, and with additional funding from the Alzheimer Society of Canada and several other charities. He receives career support from the Dalhousie Medical Research Foundation as the Kathryn Allen Weldon Professor of Alzheimer Research, and research support from the Canadian Institutes of Health Research, the QEII Health Science Centre Foundation, the Capital Health Research Fund and the Fountain Family Innovation Fund of the QEII Health Science Centre Foundation. KR has asserted copyright of the Clinical Frailty Scale through Dalhousie University. Use is free for research, education or not-for-profit care (users are asked not to change it or charge for its use). MKA reports grants from Canadian Consortium on Neurodegeneration in Aging (CCNA), with funding from Canadian Institutes of Health Research (CIHR). MKA reports grant funding and honoraria from Sanofi, GSK, Pfizer, Seqirus and the Canadian Frailty Network for work relating to frailty and vaccine preventable illness. All other authors declare that they have no competing interests.
(© 2023 Author(s).)