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

Figures & data

Figure 1 Flow chart of the study cohort.

Table 1 Demographic and Clinical Characteristics of All Participants

	Total Wards n=1000	Cardiology Ward n=542	Non-Surgical Wards n=229	Surgical Wards n=229	P values
Demographics
Age, years	75.2 ± 6.7	75.2 ± 6.5	76.3 ± 7.1	74.2 ± 6.8‡	0.005
Male	515 (51.5)	279 (51.5)	113 (49.3)	123 (53.7)	0.646
Education					0.106
Primary school or lower	157 (15.7)	75 (13.8)	50 (21.8)	32 (14.0)
High school	496 (49.6)	273 (50.4)	100 (43.7)	123 (53.7)
University or higher	347 (34.7)	194 (35.8)	79 (34.5)	74 (32.3)
Residence					0.431
City	964 (96.4)	526 (97.0)	218 (95.2)	220 (96.1)
Rural	36 (3.6)	16 (3.0)	11 (4.8)	9 (3.9)
Income, RMB/Month					0.095
<4000	297 (29.7)	148 (27.3)	78 (34.1)	71 (31.0)
4000–8000	546 (54.6)	303 (55.9)	110 (48.0)	133 (58.1)
≥8000	157 (15.7)	91 (16.8)	41 (17.9)	25 (10.9)
Living alone	86 (8.6)	41 (7.6)	24 (10.5)	21 (9.2)	0.394
Smoking					0.867
Current	90 (9.0)	49 (9.0)	20 (8.7)	21 (9.2)
Past	223 (22.3)	124 (22.9)	54 (23.6)	45 (19.7)
Never	687 (68.7)	369 (68.1)	155 (67.7)	163 (71.2)
Drinking					0.481
Current	233 (23.3)	121	51	61
Past	103 (10.3)	53 (9.8)	29 (12.7)	21 (9.2)
Never	664 (66.4)	368 (67.9)	149 (65.1)	147 (64.2)
Physical Examination
HR, beat/min	69.6 ± 11.4	67.6 ± 10.8	73.2 ± 12.0*	70.8 ± 10.9†	<0.001
SBP, mmHg	135 ± 18.1	134 ± 16.9	136 ± 20.9	138 ± 17.6†	0.003
DBP, mmHg	75.5 ± 10.2	74.7 ± 9.74	76.2 ± 11.4	76.9 ± 9.86†	0.013
Height, cm	163 ± 8.23	164 ± 8.18	163 ± 8.44	164 ± 8.16	0.717
Weight, kg	67.0 ± 11.5	67.7 ± 11.2	65.4 ± 11.9*	67.0 ± 11.5	0.034
BMI, kg/m^2	25.0 ± 3.54	25.2 ± 3.37	24.5 ± 3.75*	25.0 ± 3.67	0.030
Laboratory
HGB, g/L	128 ± 16.4	129 ± 15.7	127 ± 17.1	127 ± 17.1	0.217
WBC, 10^9/L	6.03 ± 1.99	5.84 ± 1.57	6.23 ± 2.13*	6.29 ± 2.60†	0.004
ALB, g/L	39.1 ± 3.21	39.8 ± 3.00	38.1 ± 3.30*	38.5 ± 3.24†	<0.001
D-dimer, ng/mL DDU	139 [85.0, 256]	122 [77.0, 214]	180 [105, 350] *	147[89.8, 293] †	<0.001
≥ 5 comorbidities	112 (11.2)	68 (12.5)	31 (13.5)	13 (5.7) †‡	0.010
≥ 5 medications	506 (50.6)	320 (59.0)	113 (49.3) *	73 (31.9) †‡	<0.001
Hospital length, days	8.00[5.00, 12.0]	6.00[4.00, 8.00]	12.0[9.00, 15.0] *	10.0[6.00, 15.0] †‡	<0.001

Notes: Values are showed as mean ± standard deviation or median [interquartile range: 25th to 75th percentiles] or n (%). *P<0.05, cardiology ward vs non-surgical wards; †P<0.05, cardiology ward vs surgical wards; ‡P<0.05, non-surgical wards vs surgical wards.

Abbreviations: RMB, Renminbi; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; HGB, hemoglobin; WBC, white blood cell; ALB, albumin.

Figure 2 Frailty prevalence in different wards by different measurements.

Abbreviations: CFS, clinical frailty scale; FI, frailty index.

Table 2 Sensitivity and Specificity of Different Frailty Tools in Identifying Frailty According to the Combined Index (the Presumed Gold Standard for Identifying Frailty) in Different Wards

	Screening Tools		Assessment Tools
	CFS≥5	FRAIL≥3	Fried≥3	Edmonton≥8	FI≥0.25
All Patients (n=1000)
Sensitivity	94.1%	63.0%	71.9%	77.8%	94.8%
Specificity	85.2%	97.0%	88.6%	94.2%	87.0%
Cardiology Ward (n=542)
Sensitivity	92.9%	58.0%	80.4%	80.4%	96.4%
Specificity	87.2%	96.3%	87.9%	93.7%	88.8%
Non-Surgical Wards (n=229)
Sensitivity	91.8%	63.9%	85.6%	83.5%	95.9%
Specificity	86.4%	99.2%	81.8%	91.7%	81.1%
Surgical Wards (n=229)
Sensitivity	98.5%	65.7%	86.6%	59.7%	89.6%
Specificity	81.5%	97.5%	90.1%	98.1%	89.5%

Abbreviations: CFS, clinical frailty scale; FI, frailty index.

Table 3 Risk Factors Associated with Frailty of All Patients by Univariable and Multivariable Logistic Regression

Variables	Univariable Analysis				Multivariable Analysis
	OR	95% CI		P values	OR	95% CI		P values
Lower	Upper	Lower	Upper
Age	1.128	1.102	1.154	<0.001	1.089	1.061	1.119	<0.001
Gender (male=1, female=2)	1.467	1.111	1.937	0.007	1.370	0.953	1.970	0.089
Education	0.797	0.703	0.903	<0.001	0.782	0.672	0.910	0.001
Income	0.952	0.768	1.181	0.657	–	–	–	–
Living alone	0.780	0.486	1.253	0.315	–	–	–	–
HR (beat/min)	1.029	1.017	1.041	<0.001	1.025	1.010	1.040	<0.001
SBP (mmHg)	0.996	0.988	1.004	0.315	–	–	–	–
DBP (mmHg)	0.986	0.973	1.000	0.043	1.003	0.986	1.020	0.756
BMI (kg/m2)	0.955	0.918	0.994	0.024	0.972	0.927	1.019	0.236
HBG (g/L)	0.973	0.964	0.981	<0.001	0.993	0.981	1.006	0.303
WBC (10^9/L)	1.100	1.027	1.178	0.007	1.073	0.981	1.162	0.087
ALB (g/L)	0.851	0.812	0.891	<0.001	0.911	0.860	0.966	0.002
Log D-dimer	5.893	3.953	8.784	<0.001	2.940	1.835	4.711	<0.001
≥ 5 comorbidities	3.546	2.373	5.299	<0.001	2.164	1.338	3.502	0.002
≥ 5 medications	2.654	1.984	3.550	<0.001	2.819	1.963	4.047	<0.001

Notes: Other abbreviations are the same as in Table 1. All covariates with a P value of less than 0.05 on univariable analysis were entered into the multivariable model.

Abbreviations: CI, Confidence Interval; OR, Odds Ratio.