Introduction

The proportion of Canadians who are age 65 and older has been steadily growing, projected to make up 25% of the total population by 2068 [1]. According to recent hospital discharge data analysis, adults over 65 years of age accounted for over 40% of hospital discharge and 59% of hospital days between 2018-2019 [2].  Frail older Canadians utilize a disproportionate amount of acute care service with frequent transitions between home and hospitals.  After hospitalization, it is estimated that 30 to 60% of older persons will experience decline of their overall functional abilities, largely independent of their medical illness. [3].  

Hospitalized patients are at risk for developing frailty, a clinically recognizable syndrome characterized by age-associated declines in physiologic reserve and function across multiorgan systems, rendering individuals vulnerable to adverse health outcomes. In fact, frail hospitalized patients experience poor quality of life, disability, prolonged hospitalizations, frequent falls, depression, and cognitive impairment [4, 5]. Although frailty risk increases with age, it’s not an inevitable consequence of aging. However, the hospital environment traditionally designed for treating urgent or emergent episodes of illness is not always conducive to maintaining or enhancing patient function. As a risk indicator for increased mortality and morbidity, early identification of older individuals who are frail or at risk of becoming frail with appropriate subsequent evaluation and intervention is a crucial nursing role [6-8].  There is a growing body of evidence suggesting that interventions such as physical activity and dietary modifications may promote healthy ageing and reduce frailty [9, 10].  Understanding the risks for complications and targeting the care needs of older adults are urgent concerns to enhance hospital care. 

References

1. Statistics Canada. Table 17-10-0057-01  Projected population, by projection scenario, age and sex, as of July 1 (x 1,000)DOI: https://doi.org/10.25318/1710005701-eng
2. Canadian Institute for Health Information. Hospital Morbidity Database (HMDB) metadata. Accessed May 11, 2024.
3. de Saint-Hubert, M., Schoevaerdts, D., Poulain, G., Cornette, P., & Swine, C. (2009). Risk factors predicting later functional decline in older hospitalized patients. Acta Clinica Belgica, 64(3), 187–194. https://doi.org/10.1179/acb.2009.034
4. National Institute on Ageing. (2018). We Can’t Address What We Don’t Measure Consistently: Building Consensus on Frailty in Canada. Toronto, ON: National Institute on Ageing. 
5. O’Caoimh R, Morrison L, Costello M, Flannery A, Small C, O’Reilly L, Heffernan L, Mannion E, Waters R, O’Keeffe S. Frailty in an Adult Acute Hospital Population: Predictors, Prevalence, and Outcomes. Int J Environ Res Public Health. 2024 Feb 27;21(3):273. doi: 10.3390/ijerph21030273. PMID: 38541274; PMCID: PMC10970498.
6. Church S, Rogers E, Rockwood K, Theou O. A scoping review of the Clinical Frailty Scale. BMC Geriatr. 2020 Oct 7;20(1):393. doi: 10.1186/s12877-020-01801-7. PMID: 33028215; PMCID: PMC7540438.
7. Warnier RMJ, van Rossum E, Du Moulin MFMT, van Lottum M, Schols JMGA, Kempen GIJM. The opinions and experiences of nurses on frailty screening among older hospitalized patients. An exploratory study. BMC Geriatr. 2021 Nov 3;21(1):624. doi: 10.1186/s12877-021-02586-z. PMID: 34732153; PMCID: PMC8565044.
8. McIsaac DI, Taljaard M, Bryson GL, Beaulé PE, Gagné S, Hamilton G, Hladkowicz E, Huang A, Joanisse JA, Lavallée LT, MacDonald D, Moloo H, Thavorn K, van Walraven C, Yang H, Forster AJ. Frailty as a Predictor of Death or New Disability After Surgery: A Prospective Cohort Study. Ann Surg. 2020 Feb;271(2):283-289. doi: 10.1097/SLA.0000000000002967. PMID: 30048320.
9. Silva LGC, da Silva SLA, Freire JCG, Nascimento EDS, de Andrade PR, Pereira DS, Brito GEG. Exercise-based physiotherapeutic interventions in frailty syndrome: A systematic review and meta-analysis. Physiother Res Int. 2024 Jul;29(3):e2092. doi: 10.1002/pri.2092. PMID: 38704834.
10. Wilson N, Mullaney W. Frailty and nutrition. Br J Community Nurs. 2024 Mar 2;29(3):118-123. doi: 10.12968/bjcn.2024.29.3.118. PMID: 38421891.