Frailty as a Predictor of Discharge Destination and Long-Term Function in Older Adults with Burn Injury

Background: The older adult population is at increased risk for burn injury due to normal age-related physiological changes. This population experiences higher rates of mortality, increased length of stay, and greater complications compared to younger patients. The goal of this study was to examine how frailty impacts acute care discharge location and long-term functional outcomes following burn injury. Methods: A prospective study was performed at a single U.S. ABA-verified burn center. Patients >55 years old admitted from September 2019 to 2021 were enrolled. Patient and injury demographics, including the Clinical Frailty Scale (CFS), were collected. Discharge disposition was recorded. Long-term functional status was assessed via the Barthel Index and a functional questionnaire completed at 6 months to 1.5 years post-discharge. Results: Fifty patients were enrolled, with average age of 71 (SD 10.44) years and an average Total Body Surface Area (TBSA) of 7.44% (SD 13.22). Mean CFS score was 3.4 (SD 1.65). Patients discharged to a Skilled Nursing Facility (SNF) had significantly higher mean CFS scores (5.0, SD 0.94) compared to those discharged to Home (2.2, SD 1.2) or to Inpatient Rehabilitation Facility (IRF) (3.0, SD 1.3), with a statistically significant difference across groups (F = 15.97; P < .0001). At follow-up, 90% (n=30) of patients returned to self-reported baseline and prior living environment. Conclusions: Frailty can be used as a predictor of discharge destination and outcomes in the older adult burn population. A higher CFS was associated with discharge to a higher level of care (SNF), even in patients who were younger and had a smaller TBSA compared to those discharging to IRF. The CFS can be a valuable tool for burn providers in prognostication, setting realistic expectations, and guiding discharge planning.