Mortality risks after two years in frail and pre-frail older adults admitted to hospital

Background: Frailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whe...

Descripción completa

Detalles Bibliográficos
Autores: Cano-Escalera, Guillermo, Graña, Manuel, Irazusta, Jon, Labayen Goñi, Idoia, González Pinto, Ana, Besga, Ariadna
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universidad Pública de Navarra
Repositorio:Academica-e. Repositorio Institucional de la Universidad Pública de Navarra
OAI Identifier:oai:academica-e.unavarra.es:2454/45627
Acceso en línea:https://hdl.handle.net/2454/45627
Access Level:acceso abierto
Palabra clave:Frail
Frailty
Fried frailty scale
Mortality
Pre-frail
Survival
id ES_bbb0cdf960a29fe172f918fdabd89f4b
oai_identifier_str oai:academica-e.unavarra.es:2454/45627
network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Mortality risks after two years in frail and pre-frail older adults admitted to hospital
title Mortality risks after two years in frail and pre-frail older adults admitted to hospital
spellingShingle Mortality risks after two years in frail and pre-frail older adults admitted to hospital
Cano-Escalera, Guillermo
Frail
Frailty
Fried frailty scale
Mortality
Pre-frail
Survival
title_short Mortality risks after two years in frail and pre-frail older adults admitted to hospital
title_full Mortality risks after two years in frail and pre-frail older adults admitted to hospital
title_fullStr Mortality risks after two years in frail and pre-frail older adults admitted to hospital
title_full_unstemmed Mortality risks after two years in frail and pre-frail older adults admitted to hospital
title_sort Mortality risks after two years in frail and pre-frail older adults admitted to hospital
dc.creator.none.fl_str_mv Cano-Escalera, Guillermo
Graña, Manuel
Irazusta, Jon
Labayen Goñi, Idoia
González Pinto, Ana
Besga, Ariadna
author Cano-Escalera, Guillermo
author_facet Cano-Escalera, Guillermo
Graña, Manuel
Irazusta, Jon
Labayen Goñi, Idoia
González Pinto, Ana
Besga, Ariadna
author_role author
author2 Graña, Manuel
Irazusta, Jon
Labayen Goñi, Idoia
González Pinto, Ana
Besga, Ariadna
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv Institute on Innovation and Sustainable Development in Food Chain - ISFOOD
dc.subject.none.fl_str_mv Frail
Frailty
Fried frailty scale
Mortality
Pre-frail
Survival
topic Frail
Frailty
Fried frailty scale
Mortality
Pre-frail
Survival
description Background: Frailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality. Materials: Two cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR. Methods: Kaplan–Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0–05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years. Results: Frailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29–0.66)), age (1.05 (1.01–1.09)), weight (0.98 (0.96–1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41–0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33–0.74)), SPPB sit and stand (0.62 (0.45–0.85)), heart failure (0.67 (0.46–0.98)), use of antiplatelets (1.80 (1.19–2.71)), and quetiapine (0.31 (0.12–0.81)). Specific high-risk factors in the pre-frail cohort are Barthel’s score (120 (7.7–1700)), Pfeiffer test (8.4; (2.3–31)), Mini Nutritional Assessment (MNA) (1200 (18–88,000)), constipation (0.025 (0.0027–0.24)), falls (18,000 (150–2,200,000)), deep venous thrombosis (8400 (19–3,700,000)), cerebrovascular disease (0.01 (0.00064–0.16)), diabetes (360 (3.4–39,000)), thyroid disease (0.00099 (0.000012–0.085)), and the use of PPIs (0.062 (0.0072–0.54)), Zolpidem (0.000014 (0.0000000021–0.092)), antidiabetics (0.00015 (0.00000042–0.051)), diuretics (0.0003 (0.000004–0.022)), and opiates (0.000069 (0.00000035–0.013)). Conclusions: Frailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2454/45627
url https://hdl.handle.net/2454/45627
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv info:eu-repo/grantAgreement/AEI/Plan Estatal de Investigación Científica y Técnica y de Innovación 2017-2020/PID2020-116346GB-I00
dc.rights.none.fl_str_mv https://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/zip
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv reponame:Academica-e. Repositorio Institucional de la Universidad Pública de Navarra
instname:Universidad Pública de Navarra
instname_str Universidad Pública de Navarra
reponame_str Academica-e. Repositorio Institucional de la Universidad Pública de Navarra
collection Academica-e. Repositorio Institucional de la Universidad Pública de Navarra
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869418048287408128
spelling Mortality risks after two years in frail and pre-frail older adults admitted to hospitalCano-Escalera, GuillermoGraña, ManuelIrazusta, JonLabayen Goñi, IdoiaGonzález Pinto, AnaBesga, AriadnaFrailFrailtyFried frailty scaleMortalityPre-frailSurvivalBackground: Frailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality. Materials: Two cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR. Methods: Kaplan–Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0–05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years. Results: Frailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29–0.66)), age (1.05 (1.01–1.09)), weight (0.98 (0.96–1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41–0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33–0.74)), SPPB sit and stand (0.62 (0.45–0.85)), heart failure (0.67 (0.46–0.98)), use of antiplatelets (1.80 (1.19–2.71)), and quetiapine (0.31 (0.12–0.81)). Specific high-risk factors in the pre-frail cohort are Barthel’s score (120 (7.7–1700)), Pfeiffer test (8.4; (2.3–31)), Mini Nutritional Assessment (MNA) (1200 (18–88,000)), constipation (0.025 (0.0027–0.24)), falls (18,000 (150–2,200,000)), deep venous thrombosis (8400 (19–3,700,000)), cerebrovascular disease (0.01 (0.00064–0.16)), diabetes (360 (3.4–39,000)), thyroid disease (0.00099 (0.000012–0.085)), and the use of PPIs (0.062 (0.0072–0.54)), Zolpidem (0.000014 (0.0000000021–0.092)), antidiabetics (0.00015 (0.00000042–0.051)), diuretics (0.0003 (0.000004–0.022)), and opiates (0.000069 (0.00000035–0.013)). Conclusions: Frailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.The work in this paper has been partially supported by FEDER funds for the MICIN project PID2020-116346GB-I00, and 2016111138 of the health funding program of the Basque Government. The author M.G. has received research funds from the Basque Government as the head of the Grupo de Inteligencia Computacional, Universidad del Pais Vasco, UPV/EHU since 2007 until 2025. The current code for the grant is IT1689-22. Additionally, the authors are participating in Elkartek projects KK-2022/00051 and KK-2021/00070.MDPIInstitute on Innovation and Sustainable Development in Food Chain - ISFOOD2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/ziphttps://hdl.handle.net/2454/45627reponame:Academica-e. Repositorio Institucional de la Universidad Pública de Navarrainstname:Universidad Pública de NavarraInglésinfo:eu-repo/grantAgreement/AEI/Plan Estatal de Investigación Científica y Técnica y de Innovación 2017-2020/PID2020-116346GB-I00© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:academica-e.unavarra.es:2454/456272026-06-17T12:41:47Z
score 15,300719

Similares en LA Referencia