The impact of frailty on prolonged hospitalization and mortality in elderly inpatients in Vietnam: a comparison between the frailty phenotype and the Reported Edmonton Frail Scale

Figures & data

Table 1 Characteristics of study participants

Variables	N=461
Age, years	76.15±8.89
Female	262 (56.8%)
Levels of education
Not finished high school	286 (62.0%)
Finished high school	88 (19.1%)
Finished university	44 (9.5%)
Higher education	43 (9.3%)
BMI
Underweight	114 (24.7%)
Normal	222 (48.2%)
Overweight	104 (22.6%)
Obese	21 (4.6%)
Comorbidities
Hypertension	288 (62.5%)
Chronic kidney disease (GFR <60 mL/min)	240 (52.1%)
Osteoarthritis	115 (24.9%)
Anemia	115 (24.9%)
Diabetes	110 (23.9%)
Previous stroke	85 (18.4%)
COPD	57 (12.4%)
Peripheral vascular disease/aortic atherosclerosis	32 (6.9%)
Heart failure	29 (6.3%)
Ischemic heart disease	29 (6.3%)
Cancer	16 (3.5%)
Reasons for admission
Stroke	108 (23.4%)
Dizziness	52 (11.3%)
Infection	50 (10.8%)
Musculoskeletal pain	42 (9.1%)
Shortness of breath	34 (7.4%)
General unwell	33 (7.2%)
GI disorders	18 (3.9%)
Hyper/hypoglycemia	13 (2.8%)
Chest pain/discomfort	11 (2.4%)
Urinary incontinence	8 (1.7%)
Falls	5 (1.1%)
Bleeding	5 (1.1%)
Headache	5 (1.1%)
Miscellaneous	86 (18.7%)

Notes: Continuous data are presented as mean ± SD. Categorical data are shown as n (%).

Abbreviations: BMI, body mass index; GFR, glomerular filtration rate; GI, gastrointestinal.

Table 2 The overlap between Fried’s criteria and REFS

	Non-frail (REFS) n=314	Frail (REFS) n=147
Non-frail (Fried’s criteria) n=298	262	36
Frail (Fried’s criteria) n=163	52	111

Abbreviation: REFS, Reported Edmonton Frail Scale.

Table 3 Associations between frailty and prolonged hospitalization

Frailty status	Proportion of prolonged hospitalization	Univariate logistic regression		Multivariate logistic regression
		Unadjusted OR (95% CI)	P-value	Adjusteda OR (95% CI)	P-value
Defined by Fried’s criteria
Non-frail (n=298)	61 (21.7%)	1 (Reference)	0.09	1 (Reference)	0.09
Frail (n=163)	45 (29.0%)	1.48 (0.94–2.31)		1.49 (0.94–2.35)
Defined by REFS
Non-frail (n=314)	69 (22.8%)	1 (Reference)	0.26	1 (Reference)	0.14
Frail (n=147)	37 (27.8%)	1.31 (0.82–2.08)		1.43 (0.89–2.29)

Note:

a Adjusted to stroke on admission and hypertension (which had a P-value <0.05 on univariate analysis).

Abbreviation: REFS, Reported Edmonton Frail Scale.

Figure 1 The Kaplan–Meier survival curves in frail and non-frail participants: (A) defined by Fried’s frailty criteria; (B) defined by REFS. Thin line: non-frail, thick line: frail.

Abbreviation: REFS, Reported Edmonton Frail Scale.

Table 4 Cox proportional hazards regression of factors related to all-cause mortality at 6 months in participants with available follow-up data (n=251)

	Frailty defined by Fried’s frailty phenotype		Frailty defined by REFS
	Adjusted HRs for mortality (95% CI)	P-value	Adjusted HRs for mortality (95% CI)	P-value
Frailty	2.65 (1.02–6.89)	0.04	4.19 (1.59–10.99)	0.004
Chronic pulmonary diseases	4.33 (1.55–12.09)	0.005	4.67 (1.66–13.17)	0.004
Admission due to falls	11.64 (1.40–96.76)	0.02	12.17 (1.46–101.21)	0.02
Cancer	18.92 (5.75–62.24)	<0.001	15.48 (4.61–51.87)	<0.001

Notes: Only the variables that had a P-value <0.20 in univariate regression were chosen for multivariate analysis. The final model contains only variables with P-value <0.05.

Abbreviation: REFS, Reported Edmonton Frail Scale.

Table S1 Univariate logistic regression of potential predictor factors for prolonged hospitalization and mortality at the sixth month

Variables	Prolonged hospitalization		Mortality at sixth month
	Unadjusted OR (95% CI)	P-value	Unadjusted HR (95% CI)	P-value
Frailty (Fried’s criteria)	1.48 (0.94–2.31)	0.09	2.72 (1.07–6.89)	0.04
Frailty (REFS)	1.31 (0.82–2.08)	0.26	4.39 (1.73–11.12)	0.002
Age	1.01 (0.99–1.04)	0.27	1.04 (0.98–1.10)	0.18
Female gender	0.70 (0.45–1.09)	0.11	1.26 (0.49–3.26)	0.63
Comorbidities
Hypertension	1.67 (1.04–2.69)	0.04	1.20 (0.43–3.37)	0.73
Chronic kidney disease (GFR <60 mL/min)	0.88 (0.52–1.50)	0.64	0.92 (0.32–2.60)	0.87
Previous stroke	1.45 (0.85–2.46)	0.17	0.50 (0.12–2.18)	0.36
Osteoarthritis	1.38 (0.85–2.26)	0.20	0.77 (0.26–2.35)	0.65
Anemia	1.15 (0.65–2.03)	0.63	2.05 (0.81–5.17)	0.13
Diabetes	0.85 (0.50–1.44)	0.55	0.59 (0.17–2.02)	0.40
COPD	0.75 (0.37–1.51)	0.42	3.20 (1.20–8.52)	0.02
Peripheral vascular disease/aortic atherosclerosis	1.10 (0.45–2.67)	0.84	0.53 (0.07–3.99)	0.54
Heart failure	0.66 (0.25–1.78)	0.41	1.45 (0.33–6.29)	0.62
Ischemic heart disease	0.69 (0.26–1.87)	0.47	0.89 (0.12–6.72)	0.91
Cancer	1.04 (0.33–3.29)	0.95	15.49 (5.05–47.47)	<0.001
Reasons for admission
Stroke	2.20 (1.37–3.54)	0.001	0.14 (0.02–1.07)	0.06
Falls	2.10 (0.35–12.72)	0.42	4.61 (0.61–34.61)	0.14
Dizziness	0.45 (0.20–1.03)	0.06	N/A
Infection	0.85 (0.41–1.78)	0.67	N/A
Musculoskeletal pain	0.43 (0.16–1.13)	0.09	N/A
Shortness of breath	1.04 (0.45–2.39)	0.93	N/A
General unwell	1.30 (0.58–2.92)	0.53	N/A
GI disorders	0.40 (0.09–1.80)	0.23	N/A
Hyper/hypoglycemia	0.56 (0.12–2.56)	0.45	N/A
Chest pain/discomfort	1.17 (0.31–4.50)	0.82	N/A
Urinary incontinence	1.25 (0.24–6.54)	0.79	N/A
Bleeding	0.78 (0.09–7.02)	0.82	N/A
Headache	3.15 (0.44–22.67)	0.25	N/A

Abbreviations: GFR, glomerular filtration rate; GI, gastrointestinal; N/A, not applicable; REFS, Reported Edmonton Frail Scale.