The Association of Frailty With Post‐Hospital Discharge Location and Health Outcomes

Background Post‐acute care (PAC) is designed to help older adults recover functional independence following hospitalization. Frailty is a predictor of adverse health outcomes in hospitalized older adults, but the impact on PAC remains unclear. The objective of this study was to investigate whether (1) frailty is associated with hospital discharge location and (2) the impact of frailty and discharge location on health outcomes. Methods We conducted a retrospective cohort study from a single US‐based healthcare system from January 2021 to September 2023 of adults aged ≥ 65 years with an electronic frailty index (eFI) frailty score and hospital admission for at least 24 h. We evaluated the odds of hospital discharge location (home, home health services [HHS], and skilled nursing facility [SNF]) and health outcomes including hospital readmission and mortality, using logistic regression and Cox‐regression models adjusted for demographics and healthcare system factors. Results A cohort of 23,407 older adult patients was included, with a mean age of 76.7 years (SD 7.7), 53% female sex, and 19% non‐White race/ethnicity. Participant frailty was categorized as 22% non‐frail, 46% pre‐frail, 23% frail, and 8% severely frail. Patients with a higher degree of frailty were more likely to discharge with PAC (SNF or HHS) compared to home, adjusted odds ratio OR [95% CI], frail: OR 1.20 [1.09–1.33]. Frailty was a risk factor for 90‐day hospital readmissions (OR 1.91 [1.67–2.20], p < 0.001) and mortality (HR 2.56 [2.10–3.13], p < 0.001) compared to non‐frail individuals. In addition, patients discharged to SNF had higher mortality (HR 5.46 [4.43–6.73], p < 0.001), but did not have increased readmissions compared to individuals discharged home without HHS. Conclusions Frailty in older adults was a risk factor for discharge to PAC, higher mortality, and readmissions. Automated frailty assessment can be used to identify high‐risk patients, facilitating targeted interventions across the PAC continuum.