Discussion
death, Frailty, frailty syndrome, ’
STRESSFUL EVENTS
The benefits of interventions on frail hospital inpatients are far to be proven.This effect was observed when the treating physician followed the recommendations of the geriatric team. It is worthy to mention that, taking into account previous reports showing a low rate of compliant by the treating physician of the recommendations of a geriatric team,A Cochrane systematic review showed that the use of CGA in older adults admitted to hospital increases the likelihood of being ‘alive and in their own homes’ from 6 weeks to 12 months of follow‐up but did not find differences when mortality was treated as the only variable in the same period of follow‐up.There is a high disparity between tools in the identification of frail patients and this fluctuates between the settings of careIn our study, the greatest benefit is shown in the ER and in Cardiology. However, the aim of the study was not to assess differences among settings and because of that the sample size (and accordingly the power to detect differences) was calculated for the whole sample. As a consequence, there is a potential for additional differences that did not reach statistical significance in our analysis due to the above mentioned reason. Moreover, the marginal statistical significance of these findings in our study makes them less reliable and, indeed, merits further confirmation in future studies.Hospitalization is one of the most stressful events for older adults,To date, dozens of tools have been used to capture the frailty syndrome,The number of those admitted to care home was lower than forecasted, and did not allow us to run any type of analysis and, accordingly, of reaching any firm conclusion about this outcome.We must mention some limitations of our study. The intervention was implemented according to the means and professionals involved in every site and the local clinical pathways available in each one of them. In addition, we have not directly approached the issue of differences between countries, which was not among the purposes of the study and for which we did not have enough statistical power. However, we must take into account that the intervention was done added, but not instead of, to the usual care provided in every hospital. This fact supports that the benefits are accounted by the intervention, although differences in local practices cannot be absolutely excluded as a potential explanation for our findings, making sensible to replicate the study in countries with different organization of their health and social services.Moreover, co‐morbidity was higher in the IG than in the CG at baseline, a fact that could interfere with the results. To tackle with this potential source of bias, we have adjusted by co‐morbidity in the analysis and, in any case, the bias should be in the opposite address, as the group with the highest co‐morbidity (and potentially poorer results) is the intervention one. Another limitation that should be mentioned is the lack of information about functional status of the participants at discharge of the participants. Taking into account that the intervention started during hospitalization and that some studies have shown that indeed short‐term interventions during hospitalization can produce benefits on functional status,Finally, we could not perform a time‐sensitive analysis of the time to death because some logistical problems prevented to get these data from the centralized records available in one of the participating countries. However, the short time of follow‐up after discharge (3 months) makes less relevant this issue.Our results have been obtained using two frailty tools stemming from the ‘Frailty Phenotype’ model. Studies involving individuals with frailty identified through other frailty scales based on the ‘deficit accumulation’ model of frailty would be important to be undertaken in the future.Some contamination cannot be excluded, as the patients allocated to the CG were managed according to usual care, including the consultation with the liaison team of the Geriatric Department on demand from the treating physician. However, this contamination would lead to an underestimation of the effect, strengthening the relevance of our results.This study has important strengths. We have enrolled a randomized controlled clinical trial with an important amount of frail older people, a total of 821 subjects from three countries, providing a high consistency to our findings. Moreover, usual high‐risk clinical settings for frail older patients were evaluated