Identification of Frailty and Its Risk Factors in Elderly Hospitalized Patients from Different Wards: A Cross-Sectional Study in China

Abstract

Objectives

To survey the difference of frailty prevalence in elderly inpatients amongdifferent wards; to compare the diagnostic performance of five frailty measurements (Clinical Frailty Scale [CFS], FRAIL, Fried, Edmonton, Frailty Index [FI]) in identifying frailty; and to explore the risk factors of frailty in elderly inpatients.

Participants and methods

This was a cross-sectional study including 1000 inpatients (mean age 75.2±6.7 years, 51.5% male; 542, 229, and 229 patients from cardiology, non-surgical, and surgical wards, respectively) in a tertiary hospital from September 2018 to February 2019. We applied the combined index to integrate the five frailty measurements mentioned above as the gold standard of frailty diagnosis. Multivariate logistic regression models were used to determine the independent risk factors of frailty.

Results

Frailty prevalence was 32.3% (Fried), 36.2% (CFS), 19.2% (FRAIL), 25.2% (Edmonton), 35.1% (FI) in all patients. The frailty was more common in non-surgical wards, regardless of the frailty assessment tools used (non-surgical wards: 27.5% to 51.5%; cardiology ward: 14.9% to 29.3%; surgical wards: 18.8% to 41.9%). CFS≥5 showed a sensitivity of 94.1% and a specificity of 85.2% for all patients. FI≥0.25 showed a sensitivity of 94.8% and a specificity of 87.0% for all patients. Age [odds ratio (OR) = 1.089, P<0.001], education level (OR = 0.782, P=0.001), heart rate (OR = 1.025, P<0.001), albumin (OR = 0.911, P=0.002), log D-dimer (OR = 2.940, P<0.001), ≥5 comorbidities (OR = 2.164, P=0.002), and ≥5 medications (OR = 2.819, P<0.001) were independently associated with frailty in all participants.

Conclusion

Frailty is common among elderly inpatients, especially in non-surgical wards. CFS is a preferred screening tool and FI may be an optimal assessment tool. Old age, low educational level, fast heart rate, low albumin, high D-dimer, ≥5 comorbidities, and polypharmacy are independent risk factors of frailty in elderly hospitalized patients.

Keywords:

• frailty
• elderly hospitalized patients
• wards
• risk factor
• China

Acknowledgments

We appreciate sincerely all eight investigators (Ms. Du Pingjing, Ms. Gao Junyan, Ms. Jiao Fengling, Ms. Li Meilan, Ms. Sun Qingyun, Ms. Shen Yueli, Ms. Xu Li, and Ms. Yi Lin) for their dedicated and responsible assessment of every patient; Professor Yang Liu (Nursing College, Wannan Medical College, Wuhu, China) for providing us with the validated Chinese version of the Edmonton Frail Scale; Mr. Jiang Yingkai and Mr. Li Yichao (PhD candidates, Center for Statistical Science, Tsinghua University, Beijing, China) for their friendly support to our statistical analyses; and all participants and patients in every ward for their cooperation.

Abbreviations

FI, Frailty index; EFS, Edmonton frail scale; CFS, Clinical frailty scale; BADL, Basic activities of daily living; IADL, Instrumental activities of daily living; CGA, Comprehensive geriatric assessment; GDS, Geriatric depression scale; HADS-A, Hospital anxiety and depression scale-anxiety; MMSE, Mini-mental state examination; AIS, Athens insomnia scale; BMI, Body mass index; OR, Odds Ratio; CI, Confidence interval.

Ethics Approval and Informed Consent

The study conformed to the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Hospital (No. 2018BJYYEC-121-02). All participants gave their written informed consent. This study was monitored by Peking University Clinical Research Institute who were entrusted by Beijing Municipal Science & Technology Commission.

Data Sharing Statement

Data will be available upon request from the corresponding authors.

Author Information

Dr. Wang Hua (MSc) is a professor in the Department of Cardiology, Beijing Hospital, National Center of Gerontology. Dr. Yang Jiefu (MSc) is a professor and the director in Department of Cardiology, Beijing Hospital, National Center of Gerontology. Dr. Liang Yaodan (MD) is a postdoctoral scholar in the Department of Cardiology, Beijing Hospital, National Center of Gerontology, No. 1, Dahua Road, Dongcheng District, Beijing, 100730, China.

Disclosure

Dr Hua Wang report grants from Beijing Municipal Science & Technology Commission, grants from CAMS Innovation Fund for Medical Sciences, grants from Chinese Academy of Medical Sciences, during the conduct of the study. The authors report no other conflicts of interest in this work.