Frailty, multimorbidity and functional status as predictors for health outcomes of acute psychiatric hospitalisation in older adults

Figures & data

Figure 1. Flow diagram of inclusion.

Table 1. Demographics, psychiatric and geriatric characteristics on admission.

Total sample N = 120	N (%)
Age mean (SD)	74.6 (7.8)
Sex: female	74 (61.7)
Marital status
Married	49 (40.8)
Never married or divorced	34 (28.3)
Widowhood	37 (30.8)
Level of Education
Low	62 (51.7)
Middle	24 (20.0)
High	24 (20.0)
Not specified	10 (8.3)
Living situation
Independent (alone or with spouse)	94 (78.3)
Not independent	26 (21.6)
Nursing home	10 (8.3)
Residential home	13 (10.8)
Sheltered Care Mental Care	3 (2.5)
Diagnosis DSM IV
• Depressive disorders	41 (34.2)
• Cognitive disorders	41 (34.2)
• Psychosis and Bipolar disorders	17 (14.2)
• Other diagnoses	21 (17.5)
Clinical Global Impressions
CGI Severity admission	5.17 (0.76)
Frailty Index	0.27 (0.10)
<0.08	5 (4.2)
0.08 ≤ FI <0.25	52 (43.3)
0.25 ≤ FI ≤0.45	56 (46.7)
>0.45	7 (5.8)
Walking speed 6 meter (m/sec) (n = 112)	0.85 (0.33)
>1.0	31 (27.7)
0.8–1.0	21 (18.8)
<0.8	50 (44.6)
Mobility too impaired to perform test	5 (4.5)
Not able for other reasons.	5 (4.5)
Hand Grip Strenght (HGS) (n = 112)
Women (n = 72)	19.6 (7.7)
Men (n = 40)	30.7 (8.7)
Nutritional status (n = 114)
Mini Nutritional Assessment (MNA) (0–30)	18.1 (4.4)
<17	39 (34.2)
17–23.5	66 (57.9)
24–30	9 (7.9)
Fried criteria
Walking speed < cut-off	36 (33.6)
HGS < cut-off	52 (46.4)
MNA <17	39 (34.2)
Comorbidity
Cumulative Index Rating Scale Geriatrics (CIRS-G) (0–56)
CIRS-G Sumscore	13.5 (5.4)
CIRS-G Comorbidity Index	4.6 (2.1)
Functional status (n = 116)
ADL Barthel index (0–20)	15.4 (5.3)
ADL Barthel 1–18 (n)	64 (55.2)
ADL Barthel 19–20 (n)	52 (44.8)
Cognition (n = 114)
MMSE	22.9 (6.5)
Number of medications	7.3 (3.7)

Note: between brackets: % for number of patients, and SD for continuous measures.

Table 2. Psychiatric and geriatric variables on admission and at discharge per diagnosis group.

	Depressive disorder	BPSD	Psychosis/bipolar disorder	Other diagnosis	p
Admission	N = 41 (SD)	N = 41 (SD)	N = 17 (SD)	N = 21 (SD)
Age(yrs)	76.5 (6.8)	76.8 (7.6)	71.8 (8.4)	68.9 (6.4)	0.000*
Clinical Global Impression scores
CGI- SA	5.15 (0.75)	5.32 (0.82)	5.00 (0.83)	5.06 (0.56)	0.418
Frailty characteristics:
Frailty Index	0.26 (0.12)	0.30 (0.09)	0.27 (0.12)	0.22 (0.11)	0.074
Walking speed 6 meter (m/sec)	0.88 (0.32)	0.81 (0.32)	0.74 (0.32)	0.94 (0.39)	0.289
Hand Grip Strenght (n = 112)
Women (n = 72) kgf	19.2 (6.9)	18.6 (9.2)	18.8 (7.1)	22.1 (7.40	0.672
Men (n = 40) kgf	31.8 (6.4)	28.7 (7.1)	23.2 (9.8)	40.6 (6.2)	0.034
Functional status (n = 116)
ADL Barthel index (0–20)	16.7 (4.6)	13.6 (5.9)	14.3 (5.1)	17.4 (4.4)	0.013
Comorbidity
CIRS-G total score	13.7 (5.3)	13.3 (5.0)	14.9 (5.4)	12.4 (6.3)	0.556
CIRS-G CI	4.5 (2.1)	4.6 (2.1)	5.1 (2.0)	4.1 (2.5)	0.632
Cognitive status (n = 114)
MMSE	25.4 (4.3)	17.4 (7.1)	23.4 (4.3)	26.9 (3.5)	0.000*
Nutritional status
MNA (0–30)	16.6 (4.7)	19.3 (4.2)	19.2 (3.6)	18.1 (4.3)	0.036
Discharge
Clinical Global Impressions scores
CGI- SD	3.40 (1.00)	4.44 (1.02)	3.69 (1.12)	3.76 (0.89)	0.000*
CGI-I	2.41 (0.87)	3.22 (1.20)	2.67 (0.87)	2.75 (0.14)	0.006*
Discharge destination (n = 118)	11	24	6	2	0.000**
Higher level of care	9	21	5	2
In hospital mortality	2	3	1	0
Length of stay (days)	98.3 (64.3)	99.0 (77.3)	94.6 (59.4)	66.7 (47.0)	0.265

BPSD: Behavioural and Psychological Symptoms in Dementia; Significance at p < 0.005: *One Way ANOVA and **χ².

Table 3. FI, Walking speed, CIRS-G and Barthel as predictors for Clinical Global Impressions of Improvement (CGI-I) in multivariable linear regression models.

	Multivariable linear regression model with FI as independent variable.			Multivariable linear regression model with CIRS-G as independent variable			Multivariable linear regression model with Barthel as independent variable			Multivariable linear regression model with walking speed as independent variable
Covariates	B (SE)	β	p	B (SE)	β	p	B (SE)	β	p	B (SE)	β	p
Intercept	2.55 (1.50)			2.53 (1.50)			2.39 (1.69)			3.79 (1.62)
FI (per 0.1 increase)	0.07 (0.10)	0.07	0.52
CIRS-G (per point)				0.01 (0.02)	0.08	0.47
Barthel (per point)							0.01 (0.23)	0.05	0.69
Walking speed (per 0.1 m/s slower)										−0.06 (0.03)	−0.21	0.09
CGI-SA	0.07 (0.14)	0.05	0.63	0.08 (0.14)	0.06	0.60	0.06 (0.15)	0.04	0.71	−0.08 (0.14)	−0.07	0.55
Diagnosis group vs depression
- BPSD	0.76 (0.26)	0.35	0.004	0.80 (0.26)	0.37	0.003	0.80 (0.26)	0.37	0.003	0.85 (0.25)	0.43	0.001
- psychosis/bipolar disorders	0.35 (0.34)	0.12	0.31	0.34 (0.34)	0.12	0.32	0.42 (0.36)	0.14	0.25	0.47 (0.32)	0.18	0.14
- other diagnoses	0.20 (0.30)	0.08	0.51	0.19 (0.30)	0.08	0.53	0.17 (0.31)	0.07	0.58	0.36 (0.28)	0.16	0.19
Age per 5 years	−0.07 (0.08)	−0.10	0.41	−0.07 (0.08)	−0.10	0.40	−0.04 (0.08)	−0.07	0.60	−0.07 (0.08)	−0.12	0.37
Sex reference female
- male	0.30 (0.22)	0.15	0.18	0.27 (0,23)	0.13	0.23	0.30 (0.23)	0.14	0.19	0.27 (0.22)	0.14	0.23
Education vs low
- middle	0.45 (0.26)	0.19	0.09	0.43 (0.26)	0.18	0.10	0.44 (0.27)	0.18	0.11	0.55 (0.24)	0.26	0.03
- high	−0.10 (0.29)	−0.04	0.74	−0.11 (0.28)	−0.05	0.69	−0.14 (0.29)	−0.06	0.61	0.11 (0.76)	0.05	0.68
Marital status vs married
– unmarried or divorced	0.11 (0.26)	0.05	0.69	0.10 (0.27)	0.05	0.72	0.08 (0.27)	0.01	0.78	−0.02 (0.25)	−0.01	0.94
- widowed	0.31 (0.29)	0.14	0.28	0.30 (0.29)	0.14	0.31	0.28 (0.30)	0.13	0.34	0.29 (0.27)	0.14	0.28
Living situation vs institutional care
- independent	0.03 (0.28)	0.01	0.93	0.02 (0.28)	0.01	0.95	−0.04 (0.29)	−0.01	0.90	0.15 (0.26)	0.07	0.56

Note: B: unstandardized regression coefficient; β: standardized regression coefficient; SE: standard error; FI: Frailty Index; CIRS-G: Cumulative Illness Rating Scale-Geriatrics; BPSD: Behavioral and Psychological Symptoms in Dementia; CGI-SA: Clinical Global Impressions Scale at Admission.

Table 4. FI, Walking speed, CIRS-G and Barthel as predictors for ‘Adverse Discharge Destination ‘in uni- and multivariable logistic regression models.

	Univariable logistic regression models		Multivariable logistic regression model with FI as independent variable.		Multivariable logistic regression model with CIRS-G as independent variable		Multivariable logistic regression model with Barthel as independent variable		Multivariable logistic regression model with walking speed as independent variable
Covariates	Odds ratio (95% CI)	p	Odds ratio (95% CI)	p	Odds ratio (95% CI)	p	Odds ratio (95% CI)	p	Odds ratio (95% CI)	p
FI (per 0.1 increase)	1.57 (1.09 – 2.25)	0.02	1.91 (1.09 – 3.37)	0.03
CIRS-G (per point)	1.08 (1.00 – 1.16)	0.04			1.19 (1.06 – 1.34)	0.004
Barthel (per point)	0.95 (0.88 – 1.02)	0.13					0.97 (0.87 – 1.08)	0.55
Walking speed (per 0.1 m/s slower)	1.15 (1.01 – 1.32)	0.03							1.35 (1.06 - 1.72)	0.02
CGI-SA	1.59 (0.94 – 2.69)	0.08	1.19 (0.60 – 2.38)	0.62	1.22 (0.59 – 2.51)	0.59	1.18 (0.58 – 2.41)	0.65	0.84 (0.35 – 2.05)	0.71
Diagnosis group vs depression
- BPSD	4.36 (1.70 – 11.23)	0.002	10.26 (2.65 – 39.80)	0.001	15.05 (3.66 – 61.95)	0.000	8.84 (2.39 – 32.69)	0.001	17.90 (3.53 – 90.86)	0.000
- psychosis/bipolar disorders	1.49 (0.44 – 4.99)	0.52	2.60 (0.46 – 14.86)	0.28	2.26 (0.38 – 13.42)	0.37	2.45 (0.45 – 13.42)	0.30	3.20 (0.41 – 25.24)	0.27
- other diagnoses	0.29 (0.06 – 1.44)	0.13	0.66 (0.09 – 4.73)	0.68	0.43 (0.05 – 3.97)	0.46	0.67 (0.10 – 4.38)	0.67	0.62 (0.07 – 5.78)	0.68
Age (per 5 years)	1.34 (1.04 – 1.74)	0.03	1.07 (0.71 – 1.61)	0.75	1.04 (0.68 – 1.59)	0.85	1.16 (0.78 – 1.72)	0.46	0.69 (0.90 – 1.53)	0.69
Sex reference female
- male	1.74 (0.81 - 3,75)	0.16	1.67 (0.54 – 5.18)	0.38	1.33 (0.41 – 4.30)	0.63	1.65 (0.53 – 5.09)	0.38	2.14 (0.54 – 8.46)	0.28
Education vs low
- middle	0.24 (0.08 – 0.80)	0.02	0.28 (0.06 – 1.29)	0.10	0.17 (0.03 – 0.94)	0.04	0.27 (0.06 – 1.24)	0.09	0.19 (0.04 – 1.06)	0.06
- high	0.61 (0.28 – 1.64)	0.33	0.67 ( 0.18 – 2.55)	0.56	0.61 (0.16 – 2.40)	0.49	0.49 (0.14 – 1.74)	0.27	0.51 (0.10 – 2.58)	0.42
Marital status vs married
– unmarried or divorced	1.86 (0.72 – 4.81)	0.20	5.81 (1.36 – 24.81)	0.02	4.95 (1.12 – 21.95)	0.04	5.31 (1.28 - 22.06)	0.02	6.02 (1.07 – 33.77)	0.04
- widowhood	3.00 (1.19 – 7.56)	0.02	8.61 (1.85 – 40.32	0.01	6.64 (1.45 – 30.38)	0.02	6.10 (1.44 – 25.93)	0.01	7.96 (1.43 – 44.22)	0.02
Living situation vs institutional care
- independent	1.75 (0.67 – 4.57)	0.26	8.63 (1.00 – 37.18)	0.004	10.10 (2.26 – 45.23)	0.003	6.09 (1.51 – 24.50)	0.01	15.96 (2.75 – 92.47)	0.002

Note: 95%CI: 95% Confidence Interval; FI: Frailty Index; CIRS-G: Cumulative Illness Rating Scale-Geriatrics; BPSD: Behavioral and Psychological Symptoms in Dementia; CGI-SA: Clinical Global Impressions Scale at Admission