The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment
Abstract
BACKGROUND: prognostication for frail older adults is complex, especially when they become seriously ill. OBJECTIVES: to test the measurement properties, especially the predictive validity, of a frailty index based on a comprehensive geriatric assessment (FI-CGA) in an acute care setting in relation to the risk of death, length of stay and discharge destination. DESIGN AND SETTING: prospective cohort study. Inpatient medical units in a teaching, acute care hospital. SUBJECTS: individuals on inpatient medical units in a hospital, n = 752, aged 75+ years, were evaluated on their first hospital day; to test reliability, a subsample (n = 231) was seen again on Day 3. MEASUREMENTS: all frailty data collected routinely as part of a CGA were used to create the FI-CGA. Mortality data were reviewed from hospital records, claims data, Social Security Death Index and interviews with Discharge Managers. RESULTS: thirty-day mortality was 93 (12.4%; 95% confidence interval (CI) = 10-15%) of whom 52 died in hospital. The risk of dying increased with each 0.01 increment in the FI-CGA: hazard ratio (HR) = 1.05, (95% CI = 1.04-1.07). People who were discharged home had the lowest admitting mean FI-CGA = 0.38 (±standard deviation 0.11) compared with those who died, FI-CGA = 0.51 (±0.12) or were discharged to nursing home, FI-CGA = 0.49 (±0.11). Likewise, increasing FI-CGA values on admission were significantly associated with a longer length of hospital stay. CONCLUSIONS: frailty, measured by the FI-CGA, was independently associated with a higher risk of death and other adverse outcomes in older people admitted to an acute care hospital.
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The level of frailty in this cohort is substantially lower than that reported for hospitalized older patients.
“our level of frailty is substantially lower than that reported for hospitalized older patients (13,24).”
From Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy (2016) · cites this paper as [13]
The lower frailty prevalence in this cohort may reflect selection bias toward healthier patients chosen for treatment.
“This may reflect a selection bias in choosing the healthiest appearing patients for treatment since our level of frailty is substantially lower than that reported for hospitalized older patients (13,24).”
From Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy (2016) · cites this paper as [13]
The Frailty Index was initially operationalized from a CGA by Jones et al and a standard procedure by Searle et al, and predicts death, length of stay, and discharge to long-term care in hospitalized older patients.
“The Frailty Index was initially operationalized from a CGA by Jones et al and a standard procedure for creating a Frailty Index as described by Searle et al in 2008 (12,14), and shown to predict the risk of death, length of stay, and discharge to long term care in hospitalized older patients.(13)”
From Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy (2016) · cites this paper as [13]
A Frailty Index can be calculated from a CGA in non-cancer patients and predicts length of stay, functional status, and mortality.
“Rockwood and colleagues have shown that a Frailty Index based on a deficits accumulation principle (i.e. using information from a substantial number of indicators of a person’s health) can be calculated from information in a CGA in non-cancer patients, and used to predict subsequent events such as length of stay, functional status and mortality.(12,13)”
From Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy (2016) · cites this paper as [13]
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- Authors
- Evans, S. J., Sayers, M., Mitnitski, A., & Rockwood, K.
- Affiliations
- Dalhousie University (CA)
- Corresponding author
- Rockwood, Kenneth
- Venue
- Age and Ageing
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-01
- Volume
- 43
- Issue
- 1
- Pages
- 127-132
- ISSN
- 0002-0729 (ISSN-L)
- 1468-2834
- OpenAlex
- W2133979095
- Cited by
- 219
- References
- 31
- Citations by year
- 2026: 2 · 2025: 12 · 2024: 12 · 2023: 14 · 2022: 13 · 2021: 18 · 2020: 22 · 2019: 18 · 2018: 26 · 2017: 19 · 2016: 26 · 2015: 25 · 2014: 11 · 2013: 1
- FWCI
- 9.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Age and Ageing (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- frailty index, comprehensive geriatric assessment, frailty, older adults, hospitalized older adults, mortality, length of hospital stay, discharge disposition, nursing home discharge, outcome prediction, predictive validity, acute care
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Aging, Decision Support Techniques, Feasibility Studies, Female, Hospitalization, Hospitals, Teaching, Humans, Length of Stay, Male, Patient Discharge, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Time Factors, Reproducibility of Results, Geriatric Assessment, Frail Elderly, Hospital Mortality, Risk Assessment
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