Frailty, gaps in care coordination, and preventable adverse events

• Published in: BMC geriatrics Vol. 22; no. 1; p. 476
• Main Authors: Akinyelure, Oluwasegun P, Colvin, Calvin L, Sterling, Madeline R, Safford, Monika M, Muntner, Paul, Colantonio, Lisandro D, Kern, Lisa M
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02-06-2022; BioMed Central; BMC
• Subjects: Activities of daily living; Adult; Adverse events; Aged; Body mass index; Cardiac arrhythmia; Care and treatment; Chronic illnesses; Continuity of care; Cross-Sectional Studies; Diabetes; Drug interaction; Emergency medical care; Frail Elderly; Frailty; Frailty - diagnosis; Frailty - epidemiology; Frailty - therapy; Gaps in care coordination; Geriatrics; Health aspects; Health care disparities; Heart attacks; Humans; Hypertension; Independent Living; Middle Aged; Mortality; Older people; Patient safety; Prevalence; Preventable emergency department visit; Preventable hospitalization; Race; Risk factors; Stroke; Surveys; United States; United States > US; Preventable emergency department visit; Frailty; Preventable hospitalization; Adverse events; Gaps in care coordination
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-022-03164-7

Older US adults often receive care from multiple ambulatory providers. Seeing multiple providers may be clinically appropriate but creates challenges for communication. Whether frailty is a risk factor for gaps in communication among older adults and subsequent preventable adverse events is unknown.
We conducted a cross-sectional analysis of community-dwelling US adults ≥ 65 years of age in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who attended an in-home study examination in 2013-2016 and completed a survey on experiences with healthcare in 2017-2018 (n = 5,024). Using 5 frailty indicators (low body mass index, exhaustion, slow walk, weakness, and history of falls), we characterized participants into 3 mutually exclusive groups: not frail (0 indicators), intermediate-frail (1-2 indicators), and frail (3-5 indicators). We used survey data on self-reported gaps in care coordination and self-reported adverse events that participants attributed to poor communication among providers (a drug-drug interaction, repeat testing, an emergency department visit, or a hospital admission).
Overall, 2,398 (47.7%) participants were not frail, 2,436 (48.5%) were intermediate-frail, and 190 (3.8%) were frail. The prevalence of any gap in care coordination was 37.0%, 40.8%, and 51.1% among participants who were not frail, intermediate-frail and frail, respectively. The adjusted prevalence ratio (PR) for any gap in care coordination among intermediate-frail and frail versus not frail participants was 1.09 (95% confidence interval [95%CI] 1.02-1.18) and 1.34 (95%CI 1.15-1.56), respectively. The prevalence of any preventable adverse event was 7.0%, 11.3% and 20.0% among participants who were not frail, intermediate-frail and frail, respectively. The adjusted PR for any preventable adverse event among those who were intermediate-frail and frail versus not frail was 1.47 (95%CI 1.22-1.77) and 2.24 (95%CI 1.60-3.14), respectively.
Among older adults, frailty is associated with an increased prevalence for self-reported gaps in care coordination and preventable adverse events. Targeted interventions to address patient-reported concerns regarding care coordination among intermediate-frail and frail older adults may be warranted.