Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital

Area of Science:

• Gerontology
• Clinical Medicine
• Public Health

Background:

• Frailty is a decline in physiological function, increasing vulnerability to adverse events like falls, hospitalization, and mortality.
• Understanding the comparative mortality risk between frailty and pre-frailty is crucial for clinical practice.

Purpose of the Study:

• To determine if frailty is associated with increased mortality compared to pre-frailty.
• To identify specific variables linked to a higher risk of mortality in frail and pre-frail individuals.

Main Methods:

• Two cohorts (frail and pre-frail) were assessed using the Fried phenotype.
• Data on frailty, cognition, comorbidities, and medications were collected via electronic health records (EHR).
• Survival probabilities were analyzed using Kaplan-Meier estimates and log-rank tests; Cox regression identified mortality risk factors.

Main Results:

• Frailty demonstrated significantly greater two-year mortality than pre-frailty (log-rank test, p < 0.0001).
• Common mortality risk factors included male sex, advanced age, lower weight, and proton-pump inhibitor (PPI) use.
• Specific high-risk factors varied, with readmission, SPPB sit and stand, heart failure, antiplatelet use, and quetiapine in the frail group, and various functional, cognitive, and comorbidity indicators in the pre-frail group.

Conclusions:

• Frailty is a significant predictor of increased two-year mortality compared to pre-frailty.
• Frailty is a systemic syndrome linked to comorbidities and polypharmacy, with certain medications strongly associated with mortality.
• Coordinated care is essential for frail patients, addressing treatment interactions across diverse medical specialists.