Intérêt de la prise en compte de la fragilité en HAD : étude prospective de 210 patients

The hospital-based home care (HBHC) entails the establishment of a treatment plan before the patient's admission. The French Health Authority (HAS) recommends screening for frailty to elaborate prevention strategies, particularly in geriatrics. This study aimed to compare preventive actions in this setting, as well as the frequency of intercurrent events according to different degrees of frailty. This was a prospective, single-center descriptive study of 210 patients over a 6-month period cared for under the HBHC system in Saint-Étienne, France, excluding perinatal care. Patients were classified into 2 groups according to their degree of frailty: not frail or not very frail, versus frail or very frail. Sixty-seven subjects classified as not frail or not very frail had significantly less need for social support (52 % vs 68 %, P < 0.05). No significant difference was found for the other parameters of polymedication, falls, nutrition or psychological distress. Among the 143 frail or very frail subjects, there were significantly more deaths (24 % versus 9 %, P = 0.01) and intercurrent events such as falls, rehospitalization or pressure sores (71 % vs 48 %, P < 0.01). After this first stage of research, it would be worthwhile exploring these parameters among terminally ill patients in palliative care, where issues are rather different, so as to assess the efforts still required in the area of prevention.