Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Gerontology. 2022;68(1):8-16. doi: 10.1159/000514948. Epub 2021 Apr 29.
Frailty has gained increasing attention as it is by far the most prevalent geriatric condition amongst older patients which heavily impacts chronic health status. However, the relationship between frailty and adverse health outcomes in China is far from clear. This study explored the relation between frailty and a panel of adverse health outcomes.
We performed a multicentre cohort study of older inpatients at 6 large hospitals in China, with two-stage cluster sampling, from October 2018 to April 2019. Frailty was measured according to the FRAIL scale and categorized into robust, pre-frail, and frail. A multivariable logistic regression model and multilevel multivariable negative binomial regression model were used to analyse the relationship between frailty and adverse outcomes. Outcomes were length of hospitalization, as well as falls, readmission, and mortality at 30 and 90 days after enrolment. All regression models were adjusted for age, sex, BMI, surgery, and hospital ward.
We included 9,996 inpatients (median age 72 years and 57.8% male). The overall mortality at 30 and 90 days was 1.23 and 1.88%, respectively. At 30 days, frailty was an independent predictor of falls (odds ratio [OR] 3.19; 95% CI 1.59-6.38), readmission (OR 1.45; 95% CI 1.25-1.67), and mortality (OR 3.54; 95% confidence interval [CI] 2.10-5.96), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. At 90 days, frailty had a strong predictive effect on falls (OR 2.10; 95% CI 1.09-4.01), readmission (OR 1.38; 95% CI 1.21-1.57), and mortality (OR 6.50; 95% CI 4.00-7.97), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. There seemed to be a dose-response association between frailty categories and fall or mortality, except for readmission.
Frailty is closely related to falls, readmission, and mortality at 30 or 90 days. Early identification and intervention for frailty amongst older inpatients should be conducted to prevent adverse outcomes.
衰弱作为最常见的老年患者的老年病，严重影响慢性健康状况，因此受到越来越多的关注。然而，衰弱与中国老年患者不良健康结局之间的关系尚不清楚。本研究探讨了衰弱与一系列不良健康结局之间的关系。
我们在中国 6 家大型医院进行了一项多中心队列研究，采用两阶段整群抽样，时间为 2018 年 10 月至 2019 年 4 月。根据 FRAIL 量表测量衰弱程度，并分为强壮、衰弱前期和衰弱。采用多变量逻辑回归模型和多水平多变量负二项回归模型分析衰弱与不良结局之间的关系。结局为住院时间以及入院后 30 天和 90 天的跌倒、再入院和死亡。所有回归模型均调整了年龄、性别、BMI、手术和医院病房。
我们纳入了 9996 名住院患者（中位年龄为 72 岁，57.8%为男性）。30 天和 90 天的总死亡率分别为 1.23%和 1.88%。30 天时，衰弱是跌倒（比值比[OR]3.19；95%置信区间[CI]1.59-6.38）、再入院（OR 1.45；95% CI 1.25-1.67）和死亡（OR 3.54；95%CI 2.10-5.96）的独立预测因子，调整了年龄、性别、BMI、手术和医院病房聚类效应。90 天时，衰弱对跌倒（OR 2.10；95% CI 1.09-4.01）、再入院（OR 1.38；95% CI 1.21-1.57）和死亡（OR 6.50；95% CI 4.00-7.97）具有很强的预测作用，调整了年龄、性别、BMI、手术和医院病房聚类效应。除了再入院，衰弱程度与跌倒或死亡率之间似乎存在剂量反应关系。
衰弱与 30 天或 90 天的跌倒、再入院和死亡密切相关。应在老年住院患者中早期识别和干预衰弱，以预防不良结局。
