Search Results (18)

Background: Malnutrition contributes to frailty dementia, intensifying adverse health outcomes including mortality risk. Objectives: We aim to investigate the impact of malnutrition risk in those with frailty and functional decline on short-term mortality among older adults with dementia and/or cognitive impairment. Methods: We conducted a retrospective cohort study involving 2677 hospitalized patients aged ≥65 years with a diagnosis of dementia or cognitive impairment discharged between March 2022 and December 2023. Information was obtained from electronic medical records. Frailty was assessed using the Clinical Frailty Scale (CFS) and Hospital Frailty Risk Score (HFRS), functional status using premorbid activity of daily living (ADL) scores, and malnutritional risk using the 3-Minute Nutrition Screening (3-Min NS) tool. Associations with 30- and 90-day mortality were examined using Kaplan–Meier analysis and multivariate logistic regression models. Results: A total of 29.2% were at risk of malnutrition, highest in the old-old (37.1%). Thirty-day mortality was significantly associated with CFS (aOR = 1.498, 95% CI: 1.349–1.664, p < 0.001), HFRS (aOR = 1.020, 95% CI: 1.001–1.040, p = 0.038), and ADL (aOR = 0.819, 95% CI: 0.753–0.890, p < 0.001). Malnutrition risk demonstrated the strongest association across all models (ADL: aOR = 2.573, 95% CI: 1.922–3.443, p < 0.001; CFS: aOR = 2.348, 95% CI: 1.738–3.156, p < 0.001; HFRS: aOR = 2.944, 95% CI: 2.210–3.922, p < 0.001). Associations between 90-day mortality and malnutrition risk remained significant across all models, including those adjusted for CFS and ADL. Notably, interactions between malnutrition and CFS further amplified mortality risk among the old-old (30-day: aOR = 1.435, 95% CI: 1.082–1.902, p = 0.012; 90-day: aOR = 1.263, 95% CI: 1.005–1.588, p = 0.045). Conclusions: Risk of malnutrition independently predicted short-term mortality in older adults with dementia or cognitive impairment, particularly among those with frailty, functional decline, and of advanced age. Full article

Background/Objectives: Data on the prognostic value of frailty in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is limited. This study aimed to evaluate the association between frailty and in-hospital complications in patients undergoing CTO-PCI. Methods: We conducted a retrospective cohort study using administrative data from the National Inpatient Sample (2016–2019). Frailty was assessed using the Hospital Frailty Risk Score (HFRS) and categorized into three groups: low risk (<5), intermediate risk (5–15), and high risk (>15). Logistic regression models were applied to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for in-hospital complications. Results: A total of 46,695 patients undergoing CTO-PCI were included. In the adjusted models, patients at high risk of frailty had higher odds of in-hospital mortality (OR 9.51, 95% CI 3.49–26.00), blood transfusion (OR 4.78, 95% CI 1.72–13.20), pericardial complication (OR 16.0, 95% CI 4.85–52.90), and renal replacement therapy (OR 3.83, 95% CI 1.22–12.00) compared to the low-risk group. Intermediate-risk patients also experienced higher odds of most outcomes. Conclusions: Frailty was a significant predictor of in-hospital complications in patients undergoing PCI for CTO. Incorporating frailty assessment into routine clinical practice could enhance risk stratification and enable tailored care strategies for this high-risk population. Full article

Introduction: Frailty is increasingly recognized as a critical predictor of adverse outcomes in older adults, particularly those with cancer. However, the role of frailty—distinct from comorbidity burden—has not been fully characterized in older adults hospitalized with cholangiocarcinoma (CCA), a rare but aggressive malignancy with rising incidence in the aging population. Methodology: A retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) 2019–2022 was performed. Adult inpatients aged ≥ 65 with CCA-related ICD-10 codes were identified. Patients were stratified into frailty categories based on the Hospital Frailty Risk Score (HFRS). Multivariable regression models were used to assess associations with in-hospital mortality, length of stay (LOS), and hospital charges. Results: Among 18,785 hospitalizations, the in-hospital mortality rate was 7.18%. High frailty conferred an eight-fold increased risk of mortality, a 70% longer LOS, and 52% higher charges compared to low frailty. Elixhauser comorbidity scores were not significantly associated with outcomes. Discussion: These findings support the use of frailty screening to guide inpatient care planning and optimize outcomes in older adults with CCA. Full article

Background/objectives: Depression is a common complication of cancer and is associated with distress and reduced participation in medical care. The prevalence is still uncertain in advanced cancer due to methodological problems. Our aim was to study depression in the last year of life and related variables. Methods: We used an administrative database and analyzed clinically verified diagnoses of depression during the last year of life for 27,343 persons (nursing home residents excluded) and related the data to age, sex, socioeconomic status on an area level (Mosaic system), and frailty risk as calculated by the Hospital Frailty Risk Score (HFRS). T-tests, chi-2 tests, and binary logistic regression models were used. Results: During the last year of life, a clinical diagnosis of depression was found in 1168/27,343 (4.3%) cases and more frequently seen in women (4.8% vs. 3.8%, p = 0.001), in the elderly aged 80 years or more, p = 0.03, and especially in persons with a frailty risk according to the HFRS, with rates of 3.3%, 5.3% and 7.8% in the low-risk, intermediate and high-risk groups, respectively (p < 0.001), whereas no differences were found based on socioeconomic status. In a multiple logistic regression model, being female (aOR 1.30, 95% CI 1.16–1.46) or having an intermediate (1.66, 1.46–1.88) or high frailty risk (2.57, 2.10–3.14) retained the predictive value (p < 0.001, respectively). Conclusions: Depression is more common in women and, above all, in people with multimorbidity. Depression affects the amount of health care needed, including the need for psychiatric care. Therefore, it should be included in clinical decision-making, especially as depression is associated with poorer prognosis in cancer. Full article

Background/Objectives: The demographic change raises concerns about the provision of adequate, long-term healthcare. Our study was driven by the decision to test other studies’ findings about how patients’ age and comorbidities are significantly increasing in German intensive care units (ICUs) over time. The goal of this study was to analyze the age and age-related characteristics, e.g., comorbidities and frailty, in ICU populations from 86 hospitals in the German Helios Group over a period of 6 years. Methods: For this retrospective observational study, we derived two different definitions of ICU cases, with (i) CodeBased ICU cases being defined by typical ICU procedures (e.g., OPS 8-980, 8-98f and/or duration of ventilation > 0 h) derived from the German administrative dataset of claims data according to the German Hospital Remuneration Act and (ii) BedBased ICU cases being based on the actual presence of a patient on a designated ICU bed; this was taken from the Helios hospital bed classification system. For each ICU definition, the size of the respective ICU population, age, Elixhauser Comorbidity Index (ECI) and Hospital Frailty Risk Score (HFR) were analyzed. Further patient characteristics, treatments and outcomes are reported. Trends in cases with and without COVID-19 were analyzed separately. Results: We analyzed a total of 6,204,093 hospital cases, of which 281,537 met the criteria for the CodeBased ICU definition and 457,717 for the BedBased ICU definition. A key finding of our study is that a change in age in absolute and relative terms is observable and statistically significant: the mean age of CodeBased ICU cases, 68.7 (14.4/−0.06), is marginally decreasing, and that of BedBased ICU cases, 69.1 (15.9/0.07) (both with a p-value of <0.001), is marginally increasing. Age analysis excluding COVID-19 cases does not change this key finding. A longitudinal analysis shows a continuously decreasing number of ICU admissions and a marginally positive trend of patients who are 60–69 and ≥80 years old: CodeBased ICU, 1.04/1.02; BedBased ICU, 1.03/1.03, all with a p-value of <0.001. A severity analysis based on the ECI and HFS shows that both are higher in CodeBased ICU cases (2021 ECI:18.0 (12.9); HFS: 10.7 (7.3); both p-values < 0.001) than in BedBased ICU cases (2021 ECI: 12.3 (12.4); HFS: 7.4 (7.1); p-values of 0.3 and 0.12). Further testing results per definition are reported. Conclusions: The observed age-related trends suggest that there has been a further increase in demand for intensive care from a frailer population. We recommend further studies to critically evaluate the increasing frailty within the ICU population and to test the associated presumed need for increased ICU capacities. Full article

Background: Frailty, with a high prevalence of 40–80% in heart failure, may have a significant bearing on outcomes in patients. This study utilizes the Hospital Frailty Risk Score (HFRS), a validated tool derived from the administrative International Classification of Diseases, 10th Revision, Clinical Modifications (ICD-10-CM) codes, in investigating the mortality, morbidity, and healthcare resource utilization among heart failure hospitalizations using the Nationwide Inpatient Sample (NIS). Methods: A retrospective analysis of the 2021 NIS database was assessed to identify adult patients hospitalized with heart failure. These patients were stratified by the HFRS into three groups: low frailty (LF: <5), intermediate frailty (IF: 5–15), and high frailty (HF: >15). The outcomes analyzed included inpatient mortality, length of stay (LOS), hospitalization charges, and complications including cardiogenic shock, cardiac arrest, acute kidney injury, and acute respiratory failure. These outcomes were adjusted for age, race, gender, the Charlson comorbidity score, hospital location, region, and teaching status. Multivariate logistic and linear regression analyses were used to assess the association between frailty and clinical outcomes. STATA/MP 18.0 was used for statistical analysis. Results: Among 1,198,988 heart failure admissions, 47.5% patients were in the LF group, whereas the IF and HF groups had 51.1% and 1.4% patients, respectively. Compared to the LF group, the IF group showed a 4-fold higher (adjusted OR = 4.60, p < 0.01), and the HF group had an 11-fold higher (adjusted OR 10.90, p < 0.01) mortality. Frail patients were more likely to have a longer length of stay (4.24 days, 7.18 days, and 12.1 days in the LF, IF, and HF groups) and higher hospitalization charges (USD 49,081, USD 84,472, and USD 129,516 in the LF, IF, and HF groups). Complications were also noticed to be significantly (p < 0.01) higher with increasing frailty from the LF to HF groups. These included cardiogenic shock (1.65% vs. 4.78% vs. 6.82%), cardiac arrest (0.37% vs. 1.61% vs. 3.16%), acute kidney injury (19.2% vs. 54.9% vs. 74.6%), and acute respiratory failure (29.6% vs. 51.2% vs. 60.3%). Conclusions: This study demonstrates the application of HFRS in a national dataset as a predictor of outcome and resource utilization measures in heart failure admissions. Stratifying patients based on HFRS can help in holistic assessment, aid prognostication, and guide targeted interventions in heart failure. Full article

Background/Objectives: Community-acquired pneumonia (CAP) is a leading cause of hospitalisations worldwide. Micronutrient deficiencies may influence CAP risk and severity, but their impact on CAP outcomes remains unclear. This study investigated the influence of multivitamin use on hospital length of stay (LOS), intensive care unit (ICU) admission, in-hospital mortality, and 30-day readmissions in hospitalised CAP patients. Methods: This retrospective cohort study included all CAP admissions, identified using ICD-10-AM codes, at two tertiary hospitals in Australia between 2018 and 2023. Pneumonia severity was determined using the CURB65 score, while frailty and nutritional status were assessed using the Hospital Frailty Risk Score (HFRS) and the Malnutrition Universal Screening Tool (MUST). Multivitamin use at admission was identified through the hospital pharmacy database. Propensity score matching (PSM) controlled for 22 confounders and the average treatment effect on the treated (ATET) was determined to evaluate clinical outcomes. Results: The mean (SD) age of the 8162 CAP cases was 75.3 (17.5) years, with 54.7% males. The mean (SD) CURB65 score was 1.9 (1.0), with 29.2% having severe CAP (CURB65 ≥ 3). On admission, 563 patients (6.9%) were on multivitamin supplements. Multivitamin users were younger, had more comorbidities, higher frailty, and higher socioeconomic status than non-users (p < 0.05). The ATET analysis found no significant differences in LOS (aOR 0.14, 95% CI 0.03–5.98, p = 0.307), in-hospital mortality (aOR 1.04, 95% CI 0.97–1.11, p = 0.239), or other outcomes. Conclusions: Multivitamin use was documented in 6.9% of CAP patients and was associated with multimorbidity and frailty but not with improved clinical outcomes. Further research is needed to determine if specific vitamin supplements may offer benefits in this population. Full article

Background/Objectives: We assessed the impact of frailty on outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Methods: The National Readmission Database (2016–2020) was used to identify index and 30-day ERCP readmissions, which were categorized into low-frailty, intermediate-frailty, and high-frailty groups based on the Hospital Frailty Risk Score (HFRS). Outcomes were then compared. Results: Of 885,416 index admissions, 9.9% were readmitted within 30 days of ERCP. The odds of 30-day readmission were higher in the intermediate-frailty group (12.59% vs. 8.2%, odds ratio [OR] 1.67, 95% confidence interval [CI] 1.64–1.71, p < 0.001) and the high-frailty group (10.57% vs. 8.2%, OR 1.62, 95% CI 1.52–1.73, p < 0.001) compared to the low-frailty group. On readmission, a higher HFRS also increased mean length of stay (intermediate-frailty vs. low-frailty: 8.49 vs. 4.22 days, mean difference (MD) 4.26, 95% CI 4.19–4.34, p < 0.001; high-frailty vs. low-frailty: 10.9 vs. 4.22 days, MD 10.9 days, 95% CI 10.52–11.28, p < 0.001) and mean total hospitalization charges (intermediate-frailty vs. low-frailty: $118,996 vs. $68,034, MD $50,962, 95% CI 48, 854–53,069, p < 0.001; high-frailty vs. low-frailty: $195,584 vs. $68,034, MD $127,550, 95% CI 120,581–134,519, p < 0.001). The odds of inpatient mortality were also higher for the intermediate-frailty and high-frailty compared to the low-frailty subgroup. Conclusions: Frailty was associated with worse clinical outcomes after ERCP. Full article

Primary endocrine therapy (PET) offers non-surgical treatment for older women with early-stage breast cancer who are unsuitable for surgery due to frailty or comorbidity. This research assessed all-cause and breast cancer-specific mortality of PET vs. surgery in older women (≥70 years) with oestrogen-receptor-positive early-stage breast cancer by frailty and comorbidity levels. This study used UK secondary data to analyse older female patients from 2000 to 2016. Patients were censored until 31 May 2019 and grouped by the Charlson comorbidity index (CCI) and hospital frailty risk score (HFRS). Cox regression models compared all-cause and breast cancer-specific mortality between PET and surgery within each group, adjusting for patient preferences and covariates. Sensitivity analyses accounted for competing risks. There were 23,109 patients included. The hazard ratio (HR) comparing PET to surgery for overall survival decreased significantly from 2.1 (95%CI: 2.0, 2.2) to 1.2 (95%CI: 1.1, 1.5) with increasing HFRS and from 2.1 (95%CI: 2.0, 2.2) to 1.4 (95%CI 1.2, 1.7) with rising CCI. However, there was no difference in BCSM for frail older women (HR: 1.2; 0.9, 1.9). There were no differences in competing risk profiles between other causes of death and breast cancer-specific mortality with PET versus surgery, with a subdistribution hazard ratio of 1.1 (0.9, 1.4) for high-level HFRS (p = 0.261) and CCI (p = 0.093). Given limited survival gains from surgery for older patients, PET shows potential as an effective option for frail older women with early-stage breast cancer. Despite surgery outperforming PET, surgery loses its edge as frailty increases, with negligible differences in the very frail. Full article

Background. Eastern Cooperative Oncology Group (ECOG) performance status is used in decision-making to identify fragile patients, despite the development of new and possibly more reliable measures. This study aimed to examine the impact of frailty on end-of-life healthcare utilization in deceased cancer patients. Method. Hospital Frailty Risk Scores (HFRS) were calculated based on 109 weighted International Classification of Diseases 10th revision (ICD-10) diagnoses, and HFRS was related to (a) receipt of specialized palliative care, (b) unplanned emergency room (ER) visits during the last month of life, and (c) acute hospital deaths. Results. A total of 20,431 deceased cancer patients in ordinary accommodations were studied (nursing home residents were excluded). Frailty, as defined by the HFRS, was more common in men than in women (42% vs. 38%, p < 0.001) and in people residing in less affluent residential areas (42% vs. 39%, p < 0.001). Patients with frailty were older (74.1 years vs. 70.4 years, p < 0.001). They received specialized palliative care (SPC) less often (76% vs. 81%, p < 0.001) but had more unplanned ER visits (50% vs. 35%, p < 0.001), and died more often in acute hospital settings (22% vs. 15%, p < 0.001). In multiple logistic regression models, the odds ratio (OR) was higher for frail people concerning ER visits (OR 1.81 (1.71–1.92), p < 0.001) and hospital deaths (OR 1.66 (1.51–1.81), p < 0.001), also in adjusted models, when controlled for age, sex, socioeconomic status at the area level, and for receipt of SPC. Conclusion. Frailty, as measured by the HFRS, significantly affects end-of-life cancer patients and should be considered in oncologic decision-making. Full article

With the increase in the elderly population, surgery in aged patients is seeing an exponential increase. In this population, sepsis is a major concern for perioperative care, especially in older and frail patients. We aim to investigate the incidence of sepsis in elderly patients receiving diverse types of surgical procedures and explore the predictive capacity of the Hospital Frailty Risk Score (HFRS) to identify patients at high risk of incidence of postoperative sepsis. This study relies on information from the Spanish Minimum Basic Data Set, including data from nearly 300 hospitals in Spain. We extracted records of 254,836 patients aged 76 years and older who underwent a series of surgical interventions within three consecutive years (2016–2018). The HFRS and Elixhauser comorbidity index were computed to determine the independent effect on the incidence of sepsis. Overall, the incidence of postoperative sepsis was 2645 (1.04%). The higher risk of sepsis was in major stomach, esophageal, and duodenal (7.62%), followed by major intestinal procedures (5.65%). Frail patients are at high risk of sepsis. HFRS demonstrated a high predictive capacity to identify patients with a risk of postoperative sepsis and can be a valid instrument for risk stratification and vigilant perioperative monitoring for the early identification of patients at high risk of sepsis. Full article

The aim of this study was to examine the association between frailty risk and outcomes in older patients with pneumonia. For this purpose, the JMDC multi-center database was used, and a historical cohort study was conducted to examine the association between the Hospital Frailty Risk Score (HFRS) and oral intake prognosis and length of hospital stay in older patients hospitalized with pneumonia. Patients were classified into low-risk (HFRS < 5), intermediate-risk (HFRS = 5–15), and high-risk (HFRS > 15) groups based on their HFRS scores, and outcomes were defined as the number of days from admission to the start of oral intake and length of hospital stay. A total of 98,420 patients with pneumonia (mean age 82.2 ± 7.2) were finally included. Of these patients, 72,207 (73.4%) were in the low-risk group, 23,136 (23.5%) were in the intermediate-risk group, and 3077 (3.1%) were in the high-risk group. The intermediate- and high-risk groups had a higher number of days to the start of oral intake than the low-risk group (intermediate-risk group: coefficient 0.705, 95% confidence interval [CI] 0.642–0.769; high-risk group: coefficient 0.889, 95% CI 0.740–1.038). In addition, the intermediate- and high-risk groups also had longer hospital stays than the low-risk group (intermediate-risk group: coefficient 5.743, 95% CI 5.305–6.180; high-risk group: coefficient 7.738, 95% CI 6.709–8.766). Overall, we found that HFRS is associated with delayed initiation of oral intake and prolonged hospital stay in older patients with pneumonia. Therefore, evaluation based on HFRS could be helpful in making clinical decisions regarding the selection of feeding strategies and when to discharge older patients with pneumonia. Full article

We evaluated the utility of the Hospital Frailty Risk Score (HFRS) as a predictor of adverse events after hospitalization in a retrospective analysis of traumatic brain injury (TBI). This historical cohort study analyzed the data of patients hospitalized with TBI between April 2014 and August 2020 who were registered in the JMDC database. We used HFRS to classify the patients into the low- (HFRS < 5), intermediate- (HFRS5-15), and high- (HFRS > 15)-frailty risk groups. Outcomes were the length of hospital stay, the number of patients with Barthel Index score ≥ 95 on, Barthel Index gain, and in-hospital death. We used logistic and linear regression analyses to estimate the association between HFRS and outcome in TBI. We included 18,065 patients with TBI (mean age: 71.8 years). Among these patients, 10,139 (56.1%) were in the low-frailty risk group, 7388 (40.9%) were in the intermediate-frailty risk group, and 538 (3.0%) were in the high-frailty risk group. The intermediate- and high-frailty risk groups were characterized by longer hospital stays than the low-frailty risk group (intermediate-frailty risk group: coefficient 1.952, 95%; confidence interval (CI): 1.117–2.786; high-frailty risk group: coefficient 5.770; 95% CI: 3.160–8.379). The intermediate- and high-frailty risk groups were negatively associated with a Barthel Index score ≥ 95 on discharge (intermediate-frailty risk group: odds ratio 0.645; 95% CI: 0.595–0.699; high-frailty risk group: odds ratio 0.221; 95% CI: 0.157–0.311) and Barthel Index gain (intermediate-frailty risk group: coefficient −4.868, 95% CI: −5.599–−3.773; high-frailty risk group: coefficient −19.596, 95% CI: −22.242–−16.714). The intermediate- and high-frailty risk groups were not associated with in-hospital deaths (intermediate-frailty risk group: odds ratio 0.901; 95% CI: 0.766–1.061; high-frailty risk group: odds ratio 0.707; 95% CI: 0.459–1.091). We found that HFRS could predict adverse outcomes during hospitalization in TBI patients. Full article

Background: Frailty predisposes individuals to stressors, increasing morbidity and mortality risk. Therefore, this study examined the impact of frailty defined by the Hospital Frailty Risk Score (HFRS) and other characteristics in older hospitalized patients with Obstructive Sleep Apnea (OSA). Methods: We conducted a retrospective study using the National Inpatient Sample 2016 in patients ≥65 years old with OSA. Logistic regression was used to evaluate the impact of frailty on inpatient mortality. A Kaplan-Meier curve with a log-rank test was used to estimate survival time between frailty groups. Results: 182,174 discharge records of elderly OSA were included in the study. 54% of the cohort were determined to be a medium/high frailty risk, according to HFRS. In multivariable analysis, frailty was associated with a fourfold (medium frailty, adjusted odd ratio (aOR): 4.12, 95% Confidence Interval (CI): 3.76–4.53, p-value < 0.001) and sixfold (high frailty, OR: 6.38, 95% CI: 5.60–7.27, p-value < 0.001) increased odds of mortality. Hospital survival time was significantly different between the three frailty groups (Log-rank test, p < 0.0001). Comorbidity burden defined by Charlson comorbidity Index (CCI) was associated with increased mortality (p < 0.001). Conclusion: More than half of the whole cohort was determined to be at medium and high frailty risk. Frailty was a significant predictor of in-hospital deaths in hospitalized OSA patients. Frailty assessment may be applicable for risk stratification of older hospitalized OSA patients. Full article

Frailty is common in older hospitalised heart-failure (HF) patients but is not routinely assessed. The hospital frailty-risk score (HFRS) can be generated from administrative data, but it needs validation in Australian health-care settings. This study determined the HFRS scores at presentation to hospital in 5735 HF patients ≥ 75 years old, admitted over a period of 7 years, at two tertiary hospitals in Australia. Patients were classified into 3 frailty categories: HFRS < 5 (low risk), 5–15 (intermediate risk) and >15 (high risk). Multilevel multivariable regression analysis determined whether the HFRS predicts the following clinical outcomes: 30-day mortality, length of hospital stay (LOS) > 7 days, and 30-day readmissions; this was determined after adjustment for age, sex, Charlson index and socioeconomic status. The mean (SD) age was 76.1 (14.0) years, and 51.9% were female. When compared to the low-risk HFRS group, patients in the high-risk HFRS group had an increased risk of 30-day mortality and prolonged LOS (adjusted OR (aOR) 2.09; 95% CI 1.21–3.60) for 30-day mortality, and an aOR of 1.56 (95% CI 1.01–2.43) for prolonged LOS (c-statistics 0.730 and 0.682, respectively). Similarly, the 30-day readmission rate was significantly higher in the high-risk HFRS group when compared to the low-risk group (aOR 1.69; 95% CI 1.06–2.69; c-statistic = 0.643). The HFRS, derived at admission, can be used to predict ensuing clinical outcomes among older hospitalised HF patients. Full article