The Role of Frailty in Predicting 3 and 6 Months Functional Decline in Hospitalized Older Adults: Findings from a Secondary Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Aims
2.2. Design
2.3. Study Setting and Sample
2.4. Variables
2.4.1. Primary Outcomes
2.4.2. Secondary Outcomes
2.4.3. Explanatory Variables
2.5. Procedure
2.6. Analysis
3. Results
3.1. Outcomes
3.2. Multivariable Logistic Regression
3.2.1. Functional Decline: Baseline to Discharge
3.2.2. Functional Decline: Baseline to 3 Months Post-Discharge
3.2.3. Functional Decline: Baseline to 6 Months Post-Discharge
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Sociodemographic Categorization | FIcat | FIcont | |||
---|---|---|---|---|---|
Non-Frail (n = 43) N (%) | Frail (n = 58) N (%) | Statistical Result | M ± SD | Statistical Result | |
Gender | |||||
Male (n = 47) | 24 (51.1%) | 23 (48.9%) | X2(1) = 1.983 p = 0.159 | 0.23 ± 0.11 | F(1;99) = 4.767 p = 0.031 |
Female (n = 54) | 19 (35.2%) | 35 (64.8%) | 0.27 ± 0.10 | ||
Age | |||||
70–79 years (n = 35) | 22 (62.9%) | 13 (37.1%) | X2(2) = 9.797 p = 0.007 | 0.21 ± 0.11 | F(2;98) = 5.327 p = 0.007 |
80–89 years (n = 52) | 18 (34.6%) | 34 (65.4%) | 0.26 ± 0.10 | ||
+90 (n = 14) | 3 (21.4%) | 11 (78.6%) | 0.32 ± 0.10 | ||
Education Level | |||||
<basic education (n = 58) | 19 (32.8%) | 39 (67.2%) | X2(1) = 4.467 p = 0.035 | 0.27 ± 0.11 | F(1;99) = 4.416 p = 0.038 |
≥basic education (n = 43) | 24 (55.8%) | 19 (44.2%) | 0.22 ± 0.11 | ||
Marital status | |||||
Married (n = 46) | 24 (52.2%) | 22 (47.8%) | X2(1) = 2.888 p = 0.089 | 0.22 ± 0.11 | F(1;98) = 6.535 p = 0.012 |
Not married (n = 54) | 18 (33.3%) | 36 (66.7%) | 0.28 ± 0.11 | ||
Living status (baseline) | |||||
Spouse (n = 36) | 20 (55.6%) | 16 (44.4%) | X2(3) = 7.900 p = 0.048 | 0.21 ± 0.10 | F(1;82) = 4.679 p = 0.004 |
Alone (n = 13) | 7 (53.8%) | 6 (46.2%) | 0.22 ± 0.11 | ||
Extended family (n = 35) | 13 (37.1%) | 22 (62.9%) | 0.27 ± 0.10 | ||
Nursing home (n = 17) | 3 (17.6%) | 14 (82.4%) | 0.32 ± 0.11 | ||
Social support (Baseline) | |||||
With (n = 19) | 7 (36.8%) | 12 (63.2%) | X2(1) = 0.653 p = 0.419 | 0.27 ± 0.11 | F(1;99) = 3.048 p = 0.085 |
Without (n = 65) | 33 (50.8%) | 32 (49.2%) | 0.23 ± 0.10 | ||
Social support (at discharge) | |||||
With (n = 59) | 27 (45.8%) | 32 (54.2%) | X2(1) = 2.757 p = 0.097 | 0.25 ± 0.10 | F(1;67) = 8.941 p = 0.004 |
Without (n = 10) | 8 (80.0%) | 2 (20.0%) | 0.15 ± 0.08 | ||
Multimorbidity | |||||
With (n = 52) | 14 (26.9%) | 38 (73.1%) | X2(1) = 9.460 p = 0.002 | 0.28 ± 0.10 | F(1;99) = 9.841 p = 0.002 |
Without (n = 49) | 29 (59.2%) | 20 (40.8%) | 0.22 ± 0.11 | ||
Previous Hospitalization | |||||
Yes (n = 35) | 9 (25.7) | 26 (74.3) | X2(1) = 6.564 p = 0.012 | 0.29 ± 0.95 | F(1;98) = 8.564 p = 0.004 |
No (65) | 34 (52.3) | 31 (47.7) | 0.23 ± 0.11 | ||
Delirium at admission | |||||
With (n = 9) | 2 (22.2%) | 7 (77.8%) | X2(1) = 0.885 p = 0.347 | 0.31 ± 0.08 | F(1;99) = 3.109 p = 0.081 |
Without (n = 92) | 41 (44.6%) | 51 (55.4%) | 0.24 ± 0.11 | ||
ISAR-HP | |||||
Normal (n = 24) | 22 (91.7%) | 2 (8.3%) | X2(1) = 28.455 p < 0.001 | 0.14 ± 0.06 | F(1;99) = 46.310 p < 0.001 |
At risk (n = 77) | 21 (27.3%) | 56 (72.7%) | 0.28 ± 0.10 | ||
M ± SD | M ± SD | Statistical result | Correlation coefficient | ||
Age | 79.49 ± 5.93 | 84.67 ±6.19 | F(1;99) = 17.97 p < 0.001 | 0.390 p< 0.001 | |
ISAR-HP | 1.95 ± 1.56 | 4.16 ± 1.18 | F(1;99) = 65.29 p < 0.001 | 0.676 p< 0.001 | |
Length of stay | 9.23 ±6.52 | 10.52 ±7.38 | F(1;99) = 0.825 p = 0.366 | 0.136 p = 0.174 | |
Number of medications | 5.70 ± 3.57 | 8.57 ± 3.79 | F(1;99) = 14.910 p < 0.001 | 0.444 p < 0.001 |
3 Months Follow Up | FIcat | FIcont | |||
---|---|---|---|---|---|
Non-Frail (n = 41) N (%) | Frail (n = 52) N (%) | Statistical Result | M ± SD | Statistical Result | |
Functional Decline | |||||
Discharge—Baseline | |||||
Decline (n = 55) | 17 (30.9%) | 37 (69.1%) | X2(1) = 6.721 p = 0.010 | 0.29 ± 0.10 | F(1;98) = 13.170 p < 0.001 |
No decline (n = 46) | 26 (56.5%) | 20 (43.5%) | 0.21 ± 0.11 | ||
3 m follow-up Discharge | |||||
Decline (n = 19) | 3 (15.8%) | 16 (84.2%) | X2(1) = 6.381 p = 0.012 | 0.32 ± 0.08 | F(1;91) = 8.322 p = 0.005 |
No decline (n = 74) | 38 (51.4%) | 36 (48.6%) | 0.23 ± 0.11 | ||
3 m follow-up—Baseline | |||||
Decline (n = 33) | 9 (26.5%) | 24 (73.5%) | X2(1) = 5.322 p = 0.021 | 0.29 ± 0.09 | F(1;92) = 10.060 p = 0.002 |
No decline (n = 60) | 32 (53.3%) | 28 (46.7%) | 0.22 ± 0.11 | ||
Hospital readmission (90 days) | |||||
Yes (n = 20) | 3 (15.0%) | 17 (85.0%) | X2(1) = 6.651 p = 0.010 | 0.31 ± 0.09 | F(1;94) = 7.402 p = 0.008 |
No (n = 76) | 38 (50.0%) | 38 (50.0%) | 0.24 ± 0.11 | ||
ED visit | |||||
Yes (n = 38) | 14 (36.8%) | 19 (63.2%) | X2(1) = 0.532 p = 0.466 | 0.27 ± 0.11 | F(1;57) = 1.371 p = 0.245 |
No (n = 58) | 24 (46.6%) | 31 (53.4%) | 0.24 ± 0.11 | ||
Social Support | |||||
Yes (n = 47) | 22 (46.8%) | 25 (53.2%) | X2(1) = 0.885 p = 0.347 | 0.24 ± 0.10 | F(1;57) = 12.170 p < 0.001 |
No (n = 12) | 11 (91.7%) | 1 (8.3%) | 0.13 ± 0.06 |
6 Months Follow Up | FIcat | FIcont | |||
---|---|---|---|---|---|
Non-Frail (n = 38) N (%) | Frail (n = 49) N (%) | Statistical Result | M ± SD | Statistical Result | |
Functional Decline | |||||
6 m follow-up—Baseline | |||||
Decline (n = 33) | 9 (27.3%) | 24 (72.7%) | X2(1) = 4.792 p = 0.029 | 0.28 ± 0.09 | F(1;85) = 15.358 p = 0.023 |
No decline (n = 54) | 29 (53.7%) | 25 (46.3%) | 0.23 ± 0.12 | ||
6 m follow-up—Discharge | |||||
Decline (n = 21) | 4 (19.0%) | 17 (81.0%) | X2(1) = 5.571 p = 0.019 | 0.30 ± 0.09 | F(1;85) = 6.195 p = 0.015 |
No decline (n = 66) | 34 (51.5%) | 32 (48.5%) | 0.23 ± 0.11 | ||
6 m and 3 m follow up | |||||
Decline (n = 20) | 4 (20.0%) | 16 (80.0%) | X2(1) = 4.735 p = 0.030 | 0.30 ± 0.09 | F(1;85) = 6.093 p = 0.016 |
No decline (n = 67) | 34 (50.7%) | 33 (49.3%) | 0.23 ± 0.11 | ||
Hospital readmission (180 days) | |||||
Yes (n = 21) | 8 (38.1%) | 13 (61.9%) | X2(1) = 0.734 p = 0.115 | 0.26 ± 0.13 | F(1;85) = 0.199 p = 0.657 |
No (n = 66) | 30 (45.5%) | 36 (54.5%) | 0.25 ± 0.11 | ||
ED visit | |||||
Yes (n = 33) | 14 (42.4%) | 19 (57.6%) | X2(1) ≈ 0 p ≈ 1 | 0.25 ± 0.12 | F(1;85) = 0.103 p = 0.749 |
No (n = 54) | 24 (44.4%) | 30 (55.6%) | 0.25 ± 0.11 | ||
Social Support | |||||
Yes (n = 42) | 21 (50.0%) | 21 (50.0%) | X2(1) = 4.997 p = 0.025 | 0.24 ± 0.11 | F(1;48) = 9.787 p = 0.003 |
No (n = 8) | 8 (100.0%) | 0 (0.0%) | 0.12 ± 0.04 |
FD between Discharge and Baseline | Univariable Models | Multivariable Model (n = 82) | ||||
---|---|---|---|---|---|---|
No Decline | Decline | OR | [95% CI] | OR | [95% CI] | |
FIcat * | ||||||
Non-frail (ref) | 26 (60.5) | 17 (39.5) | 1 | - | - | - |
Frail | 20 (34.5) | 38 (65.5) | 2.91 | [1.29–6.69] | - | - |
FIcont [0–100] | 21.0 ± 11.1 | 28.4 ± 9.7 | 1.07 | [1.03–1.12] | 1.07 | [1.02–1.14] |
Gender | ||||||
Masculine (ref) | 27 (57.4) | 20 (42.6) | 1 | - | 1 | - |
Feminine | 19 (35.2) | 35 (64.8) | 2.49 | [1.12–5.63] | 1.32 | [0.51–3.47] |
Level of education | ||||||
<Basic Education (ref) | 24 (41.4) | 34 (58.6) | 1 | - | - | - |
≥Basic Education | 22 (51.2) | 21 (48.8) | 0.67 | [0.30–1.49] | - | - |
Marital status | ||||||
Married (ref) | 29 (63.0) | 17 (37.0) | 1 | - | 1 | - |
Not married | 17 (31.5) | 37 (68.5) | 3.71 | [1.64–8.69] | 5.12 | [1.79–16.23] |
Living condition (baseline) | ||||||
Alone (ref) | 4 (30.8) | 9 (69.2) | 1 | - | - | - |
Spouse | 24 (66.7) | 12 (33.3) | 0.22 | [0.05–0.83] | - | - |
Extended family | 11 (31.4) | 24 (68.6) | 0.97 | [0.22–3.72] | - | - |
Nursing home | 7 (41.2) | 10 (58.8) | 0.63 | [0.13–2.86] | - | - |
Social support (baseline) | ||||||
Without (ref) | 35 (53.8) | 30 (46.2) | 1 | - | 1 | - |
With | 5 (26.3) | 14 (73.7) | 3.27 | [1.11–11.01] | 2.79 | [0.92–9.31] |
Multimorbidity | ||||||
Without (ref) | 22 (44.9) | 27 (55.1) | 1 | - | - | - |
With | 24 (46.2) | 28 (53.8) | 0.95 | [0.43–2.08] | - | - |
Delirium (baseline) | ||||||
Without (ref) | 46 (50.0) | 46 (50.0) | 1 | - | - | - |
With | 0 (0.0) | 9 (100) | n.a. | - | - | - |
Previous hospitalization | ||||||
Without(ref) | 37 (56.9) | 28 (43.1) | 1 | - | 1 | - |
With | 9 (25.7) | 26 (74.3) | 3.82 | [1.59–9.82] | 7.90 | [2.71–26.78] |
Age (years) | 81.0 ± 6.1 | 83.6 ± 6.8 | 1.07 | [1.00–1.14] | 1.01 | [0.94–1.10] |
Length of stay (days) | 9.0 ± 5.5 | 10.8 ± 8.0 | 1.04 | [0.98–1.11] | - | - |
Number of medications | 6.8 ± 3.9 | 7.7 ± 4.0 | 1.07 | [0.97–1.19] | - | - |
AUC = 0.73 |
FD between 3 Months Follow-Up and Baseline | Univariable Models | Multivariable Models (n = 93) | ||||
---|---|---|---|---|---|---|
No Decline | Decline | OR | 95% CI | OR | 95% CI | |
FIcat * | ||||||
Non-frail (ref) | 32 (78.0) | 9 (22.0) | 1 | - | - | - |
Frail | 28 (53.8) | 24 (46.2) | 3.04 | [1.25–7.95] | - | - |
FIcont [0–100] | 22.2 ± 11.4 | 29.5 ± 8.7 | 1.07 | [1.02–1.12] | 1.05 | [1.01–1.09] |
Gender | ||||||
Masculine (ref) | 27 (61.4) | 17 (38.6) | 1 | - | - | - |
Feminine | 33 (67.3) | 16 (32.7) | 0.77 | [0.33–1.81] | - | - |
Level of education | ||||||
<Basic Education (ref) | 32 (59.3) | 22 (40.7) | 1 | - | - | - |
≥Basic Education | 28 (71.8) | 11 (28.2) | 0.57 | [0.23–1.36] | - | - |
Marital status | ||||||
Married (ref) | 28 (66.7) | 14 (33.3) | 1 | - | - | - |
Not married | 31 (62.0) | 19 (38.0) | 1.23 | [0.52–2.93] | - | - |
Living status (admission) | ||||||
Alone (ref) | 8 (66.7) | 4 (33.3) | 1 | - | - | - |
Spouse | 24 (72.7) | 9 (27.3) | 0.75 | [0.18–3.36] | - | - |
Extended family | 18 (56.3) | 14 (43.8) | 1.56 | [0.40–6.82] | - | - |
Nursing home | 10 (62.5) | 6 (37.5) | 1.20 | [0.25–6.12] | - | - |
Social support (baseline) | ||||||
Without (ref) | 42 (70.0) | 18 (30.0) | 1 | - | - | - |
With | 9 (53.9) | 8 (47.1) | 2.07 | [0.68–6.30] | - | - |
Multimorbidity | ||||||
Without (ref) | 31 (70.5) | 13 (29.5) | 1 | - | - | - |
With | 29 (59.2) | 20 (40.8) | 1.64 | [0.70–3.96] | - | - |
Delirium (baseline) | ||||||
Without (ref) | 54 (64.3) | 30 (35.7) | 1 | - | - | - |
With | 6 (66.7) | 3 (33.3) | 0.90 | [0.18–3.67] | - | - |
Previous hospitalization | ||||||
Without (ref) | 43 (70.5) | 18 (29.5) | 1 | - | - | - |
With | 17 (54.8) | 14 (45.2) | 1.97 | [0.80–4.86] | - | - |
Age (years) | 80.4 ± 6.3 | 85.4 ± 6.0 | 1.14 | [1.06–1.24] | 1.11 | [1.04–1.20] |
Length of stay (days) | 8.5 ± 5.7 | 10.2 ± 6.3 | 1.05 | [0.98–1.13] | - | - |
Number of medications | 7.0 ± 4.0 | 7.9 ± 3.8 | 1.06 | [0.95–1.19] | - | - |
AUC = 0.68 |
FD between 6 Months Follow-Up and Baseline | Univariable Models | Multivariable Model (n = 71) | ||||
---|---|---|---|---|---|---|
No Decline | Decline | OR | 95% CI | OR | 95% CI | |
FIcat * | ||||||
Non-frail (ref) | 29 (76.3) | 9 (23.7) | 1 | - | - | - |
Frail | 25 (51.0) | 24 (49.0) | 3.09 | [1.25–8.19] | - | - |
FIcont [0–100] | 22.8 ± 11.9 | 28.3 ± 8.8 | 1.05 | [1.01–1.10] | 1.03 | [0.99–1.09] |
Gender | ||||||
Masculine (ref) | 24 (58.5) | 17 (41.5) | 1 | - | - | - |
Feminine | 30 (65.2) | 16 (34.8) | 0.75 | [0.31–1.80] | - | - |
Level of education | ||||||
<Basic Education (ref) | 30 (60.0) | 20 (40.0) | 1 | - | - | - |
≥Basic Education | 24 (64.9) | 13 (35.1) | 0.81 | [0.33–1.95] | - | - |
Marital status | ||||||
Married (ref) | 24 (61.5) | 18 (38.3) | 1 | - | - | - |
Not married | 29 (61.7) | 18 (38.3) | 0.99 | [0.41–1.95] | - | - |
Living status (admission) | ||||||
Alone (ref) | 9 (75.0) | 3 (25.0) | 1 | - | - | - |
Spouse | 22 (71.0) | 9 (29.0) | 1.23 | [0.28–6.48] | - | - |
Nursing home | 13 (46.4) | 15 (53.6) | 3.46 | [0.83–18.19] | - | - |
Extended family | 10 (62.5) | 6 (37.5) | 1.80 | [0.36–10.60] | - | - |
Social support (baseline) | ||||||
Without (ref) | 39 (70.9) | 16 (29.1) | 1 | - | 1 | - |
With | 6 (37.5) | 10 (62.5) | 4.06 | [1.29–13.78] | 3.61 | [1.07–13.09] |
Multimorbidity | ||||||
Without (ref) | 27 (65.9) | 14 (66.7) | 1 | - | - | - |
With | 27 (58.7) | 19 (41.3) | 1.36 | [0.57–3.29] | - | - |
Delirium (baseline) | ||||||
Without (ref) | 51 (65.4) | 27 (34.6) | 1 | - | - | - |
With | 3 (33.3) | 6 (66.7) | 3.78 | [0.92–19.03] | - | - |
Previous hospitalization | ||||||
Without (ref) | 41 (68.3) | 19 (31.7) | 1 | - | - | - |
With | 13 (48.1) | 14 (51.9) | 2.32 | [0.92–5.98] | - | - |
Age (years) | 80.6 ± 6.3 | 83.9 ± 6.2 | 1.09 | [1.01–1.17] | 1.07 | [0.99–1.18] |
Length of stay (days) | 8.6 ± 5.6 | 10.2 ± 6.2 | 1.05 | [0.97–1.13] | - | - |
Number of medications | 6.8 ± 3.7 | 8.3 ± 4.4 | 1.10 | [0.99–1.23] | - | - |
AUC = 0.64 |
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Tavares, J.; Sa-Couto, P.; Reis, J.D.; Boltz, M.; Capezuti, E. The Role of Frailty in Predicting 3 and 6 Months Functional Decline in Hospitalized Older Adults: Findings from a Secondary Analysis. Int. J. Environ. Res. Public Health 2021, 18, 7126. https://doi.org/10.3390/ijerph18137126
Tavares J, Sa-Couto P, Reis JD, Boltz M, Capezuti E. The Role of Frailty in Predicting 3 and 6 Months Functional Decline in Hospitalized Older Adults: Findings from a Secondary Analysis. International Journal of Environmental Research and Public Health. 2021; 18(13):7126. https://doi.org/10.3390/ijerph18137126
Chicago/Turabian StyleTavares, João, Pedro Sa-Couto, João Duarte Reis, Marie Boltz, and Elizabeth Capezuti. 2021. "The Role of Frailty in Predicting 3 and 6 Months Functional Decline in Hospitalized Older Adults: Findings from a Secondary Analysis" International Journal of Environmental Research and Public Health 18, no. 13: 7126. https://doi.org/10.3390/ijerph18137126