Impact of multimorbidity and frailty on adverse outcomes among older delayed discharge patients: Implications for healthcare policy

OBJECTIVE: To assess the impacts of multiple chronic conditions (MCC) and frailty on 30-day post-discharge readmission and mortality among older patients with delayed discharge. DATA SOURCE/EXTRACTION: We used a retrospective cohort of older patients in the Discharge Abstract Database (DAD) between 2004 and 2017 in Ontario, Canada. We extracted data on patients aged ≥ 65 who experienced delayed discharge during hospitalization (N = 353,106). STUDY DESIGN: We measured MCC and frailty using the Elixhauser Comorbidity Index (ECI) and the Hospital Frailty Risk Score (HFRS), respectively. We used multinomial logistic regression to model the main and interactive effects of MCC and frailty on the adverse outcomes. PRINCIPAL FINDINGS: After adjusting for sex, discharge destination, urban/rural residency, wait time for alternative care, and socioeconomic status, the coexistence of MCC and high frailty increased the relative risk of 30-day mortality and readmission when compared to the references group, i.e., non-MCC patients with low-to-moderate frailty. CONCLUSIONS: Multimorbidity and frailty each provide unique information about adverse outcomes among older patients with delayed discharge but are most informative when examined in unison. IMPLICATIONS FOR HEALTH POLICY: To minimize the risk of adverse outcomes among older delayed discharge patients, discharge planning must be tailored to their concurrent multimorbidity and frailty status.