1970. Frailty Hinders Recovery From Acute Respiratory Illness in Older Adults
Session: Poster Abstract Session: Clinical: Respiratory Track
Saturday, October 7, 2017
Room: Poster Hall CD
Background: Influenza vaccination programs aim to prevent serious outcomes. Given that frailty may impact recovery from influenza, we examined frailty as a predictor of recovery in older adults hospitalized with acute respiratory illness.

Methods: Data came from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network during the 2011/12, 2012/13, and 2013/14 influenza seasons; all patients were aged 65+. Frailty was measured using a previously validated Frailty Index (FI) of health and functional deficits; baseline frailty was categorized using published cutoffs (0-.1 non-frail, >.1-.21 pre-frail, >.21-.45 frail, >.45 most frail). Recovery was operationalized as being alive 30 days post-discharge with less than two additional health/functional deficits (<=0.06 FI increase). Logistic regression was used to examine the change in odds of recovery for every 0.1 increase in baseline FI, controlling for age, sex, season, lab-confirmed influenza status, and seasonal influenza vaccination status.

Results: Of 5125 hospitalized older adults, 15% were non-frail, 39% pre-frail, 40% frail, and 6% most frail. 11% died, and poor recovery was experienced by 520/4544=11% of survivors. Poor recovery was inversely associated with baseline frailty (11% non-frail, 17% pre-frail, 28% frail, 38% most frail; p<.001). Frailty was associated with lower odds of recovery in all three seasons [2011/12 (OR=0.71; 95% CI 0.60-0.85), 2012/13 (OR=0.72; 0.66–0.78), 2013/14 (OR=0.76; 0.70–0.82)] though results varied by season, influenza status, and vaccination status. In 2011/12, frailty was associated with poor recovery in unvaccinated (OR=0.46. 95%CI=0.32-0.67) but not vaccinated older patients (OR=0.83, 95% CI=0.68-1.02).

Conclusion: Increasing frailty was consistently associated with lower odds of recovery in older adults admitted with influenza and other acute respiratory illnesses; depending on seasonal factors, vaccination may offer some buffering of this impact. Understanding frailty and functional status is important, both because frailty is predictive of poor recovery and because persistence of new health/functional deficits is an adverse outcome with important implications for patients, families and health systems.

Melissa K Andrew, MD, PhD1,2, Caitlin Lees, MD, MA1,2, Judith Godin, PhD1,2, Karen Black, BSc1,2, Janet McElhaney, MD3, Ardith Ambrose, RN1, Guy Boivin, MD, MSc4, William R. Bowie, MD, FRCPC, FIDSA5, May Elsherif, MD1, Karen Green, MSc, RN6, Scott A. Halperin, MD1, Todd Hatchette, MD FRCPC7, Jennie Johnstone, MD8, Kevin Katz, MD, CM, MSc, FRCPC9, Joanne M. Langley, MD, FRCPC, FSHEA1, Jason Leblanc, PhD1, Philippe Lagace-Wiens, MD10, Mark Loeb, MD, MSc8, Donna Mackinnon-Cameron, MMath1, Anne Mccarthy, MD, MSc11, Allison Mcgeer, MD, MSc6, Jeff Powis, MD, MSc, FRCPC12, David Richardson, MD13, Makeda Semret, MD14, Stephanie Smith, MD15, Daniel Smyth, MD, FRCPC16, Geoffrey Taylor, MD, FSHEA17, Sylvie Trottier, MD, PhD4, Louis Valiquette, MD, MSc, FRCPC18, Duncan Webster, MD19, Lingyun Ye, MSc1 and Shelly McNeil, MD, FRCPC, FIDSA1, (1)Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada, (2)Division of Geriatrics, Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, NS, Canada, (3)Health Sciences North Research Institute, Sudbury, ON, Canada, (4)Centre Hospitalier Universitaire de Quebec, Quebec City, QC, Canada, (5)Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada, (6)Mount Sinai Hospital, Toronto, ON, Canada, (7)Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada, (8)McMaster University, Hamilton, ON, Canada, (9)North York General Hospital, Toronto, ON, Canada, (10)St. Boniface Hospital, Winnipeg, MB, Canada, (11)The Ottawa Hospital, Ottawa, ON, Canada, (12)Michael Garron Hospital, Toronto, ON, Canada, (13)William Osler Health System, Brampton, ON, Canada, (14)McGill University, Montreal, QC, Canada, (15)Division of Infectious Diseases, Department of Medicine, University of Alberta Hospital, Edmonton, AB, Canada, (16)The Moncton Hospital, Moncton, NB, Canada, (17)Division of Infectious Diseases, University of Alberta Hospital, Edmonton, AB, Canada, (18)Microbiology and Infectious Disease, Université de Sherbrooke, Sherbrooke, QC, Canada, (19)Saint John Regional Hospital, Dalhousie University, Saint John, NB, Canada

Disclosures:

M. K. Andrew, GSK: Grant Investigator , Research grant
Pfizer: Grant Investigator , Research grant
Sanofi-Pasteur: Grant Investigator , Research grant

C. Lees, None

J. Godin, None

K. Black, None

J. McElhaney, GSK Vaccines: Scientific Advisor , Speaker honorarium

A. Ambrose, None

G. Boivin, None

W. R. Bowie, None

M. Elsherif, Canadian Institutes of Health Research: Investigator , Research grant
Public Health Agency of Canada: Investigator , Research grant
GSK: Investigator , Research grant

K. Green, None

S. A. Halperin, GSK: Scientific Advisor , Consulting fee
GSK: Grant Investigator , Research grant

T. Hatchette, GSK: Grant Investigator , Grant recipient
Pfizer: Grant Investigator , Grant recipient
Abbvie: Speaker for a talk on biologics and risk of TB reactivation , Speaker honorarium

J. Johnstone, None

K. Katz, None

J. M. Langley, GSK: Investigator , Research grant
Canadian Institutes of Health Research: Investigator , Research grant

J. Leblanc, None

P. Lagace-Wiens, None

M. Loeb, None

D. Mackinnon-Cameron, None

A. Mccarthy, None

A. Mcgeer, Hoffman La Roche: Investigator , Research grant
GSK: Investigator , Research grant
Sanofi Pasteur: Investigator , Research grant

J. Powis, Merck: Grant Investigator , Research grant
GSK: Grant Investigator , Research grant
Roche: Grant Investigator , Research grant
Synthetic Biologicals: Investigator , Research grant

D. Richardson, None

M. Semret, GSK: Investigator , Research grant
Pfizer: Investigator , Research grant

S. Smith, None

D. Smyth, None

G. Taylor, None

S. Trottier, Canadian Institutes of Health Research: Investigator , Research grant

L. Valiquette, GSK: Investigator , Research grant

D. Webster, None

L. Ye, None

S. McNeil, GSK: Contract Clinical Trials and Grant Investigator , Research grant
Merck: Contract Clinical Trials and Speaker's Bureau , Speaker honorarium
Novartis: Contract Clinical Trials , No personal renumeration
Sanofi Pasteur: Contract Clinical Trials , No personal renumeration

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