A Nomogram for Individualized Frailty Identification in Older Inpatients with Schizophrenia: Development and Internal Validation
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Published on: July 24, 2013
Xiulan Liu1,2,3,4, Xiashu Yan3, Huimin Zhou3
1School of Nursing, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
Objective:
To investigate the prevalence and associated factors of frailty among older inpatients with schizophrenia, and to develop and internally validate a nomogram for individualized identification of current frailty.
Methods:
Between May and September 2025, we enrolled 279 older inpatients with schizophrenia (aged ≥60 years) from a tertiary hospital in Guangzhou using convenience sampling. Data included electronic medical records, patient interviews, and the Fried frailty phenotype assessment. Variables with univariate P < 0.1 or pre-specified clinical importance were refined by least absolute shrinkage and selection operator (LASSO) (10-fold cross-validation, lambda.1se) and binary logistic regression. A nomogram was built and internally validated using bootstrap (1,000 iterations). Performance was evaluated by the area under the receiver operating characteristic curve (AUC; DeLong's method), calibration (Hosmer-Lemeshow test), and decision curve analysis (DCA). The study was approved by the Institutional Review Board of The Affiliated Brain Hospital of Guangzhou Medical University (Approval No: 2025-034). Written informed consent was obtained from all participants or their legal guardians for those with impaired capacity.
Results:
Frailty prevalence was 38.0% (≥3 Fried criteria). Five clinical factors (represented by six variables) were retained: age (OR = 1.070, 95% CI: 1.018-1.124), fall history (OR = 2.480, 95% CI: 1.027-5.987), walking aid (OR = 4.021, 95% CI: 0.996-16.228; borderline significance), sensory impairment (single: OR = 2.145, 95% CI: 1.051-4.377; dual: OR = 3.470, 95% CI: 1.562-7.708), and ADL (OR = 0.967, 95% CI: 0.936-0.999). The model showed acceptable discrimination (AUC 0.767, 95% CI: 0.708-0.826), good calibration (Hosmer-Lemeshow P = 0.552; Brier score 0.182; calibration slope 0.967). DCA showed positive net benefit at thresholds 0.1-0.4.
Conclusion:
The nomogram showed acceptable discrimination and good calibration for identifying frailty in older inpatients with schizophrenia. Prospective multicenter external validation is needed.
