Impact of Acute Functional Decline on Frailty and Mortality in Acutely Hospitalized Older Persons

Older persons are often referred to emergency departments due to acute functional decline, that is, reduced activities of daily living occurring in the days before hospitalization, frequently driven by acute medical conditions. We aimed to describe frailty in the oldest hospitalized patients presenting with acute functional decline and evaluate predictors of death, severe frailty and nursing home admission after 3-6 months.

We included 119 persons with acute functional decline, aged ≥ 80 years, ≥ 5 systemic diagnoses, ≥ 5 drugs daily, from an acute geriatric ward and reassessed after 3-6 months. All were evaluated with comprehensive geriatric assessment. Severe frailty was defined as Clinical Frailty Scale 7-8.

Forty-one (34.4%) were free from severe frailty at baseline and 32 (48.5%) at follow-up. Male sex (adjusted OR 11.820, 95% confidence interval [CI] 3.670-38.120), Clinical Dementia Rating (CDR) ≥ 0.5 (adjusted OR 3.920, 95% CI 1.020-15.100), severe frailty at baseline (adjusted OR 6.930, 95% CI 1.830-26.210), type 2 diabetes (adjusted OR 7.460, 95% CI 2.040-27.250), and cancer (adjusted OR 5.640, 95% CI 1.040-30.690) were associated with death at follow-up. Hearing impairment (adjusted OR 7.060, 95% CI 1.430-34.760), CDR ≥ 0.5 (adjusted OR 5.390, 95% CI 1.260-23.070), and nursing home living before admission (adjusted OR 4.260, 95% CI 1.010-17.920) were associated with severe frailty at follow-up.

Many persons with acute functional decline have severe frailty. Male sex, cognitive impairment, diabetes mellitus type 2, cancer, hearing impairment, and nursing home living seem to increase the risk of severe frailty or death and should be considered when person-centered care is planned for hospitalized older people.