Aging Clinical and Experimental Research

, Volume 31, Issue 1, pp 151–155 | Cite as

Frailty modifications and prognostic impact in older patients admitted in acute care

  • Giorgio BasileEmail author
  • Antonino Catalano
  • Giuseppe Mandraffino
  • Giuseppe Maltese
  • Angela Alibrandi
  • Giuliana Ciancio
  • Daniela Brischetto
  • Nunziata Morabito
  • Antonino Lasco
  • Matteo Cesari
Short Communication



Frailty is a predictor of adverse outcomes in older subjects.


The aims of this study are to (1) measure the frailty status and its changes occurring during the hospital stay, (2) determine the relationships among frailty and adverse outcomes.


Frailty was assessed using a 46-item Frailty Index (FI) in 156 patients admitted to an Acute Geriatric Medicine Unit. The FI was calculated within 24 h from the hospital admission (aFI) and at his/her discharge (dFI). Patients were followed up to 12 months after the hospital discharge.


A statistically significant difference was reported between the aFI (0.31, IQR 0.19–0.44) and the dFI (0.29, IQR 0.19–0.40; p = 0.04). The aFI was directly associated with the risk of in-hospital death (OR = 5.9; 95% CI 2.0–17.5; p = 0.001), 1 year mortality (OR = 5.5, 95% CI 2.4–12.7, p < 0.001) and re-hospitalization (OR = 6.3, 95% CI 2.2–17.9, p = 0.03).


Frailty is a strong predictor of negative endpoints in hospitalized older persons.


Frailty assessment from routinely collected clinical data may provide important insights about the biological status of the individual and promote the personalization of care.


Elderly Frailty Hospitalization Length of stay Mortality 



This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of the University of Messina (prot. number 19/17). The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381:752–762CrossRefGoogle Scholar
  2. 2.
    Morley JE, Vellas B, van Kan GA et al (2013) Frailty consensus: a call to action. J Am Med Dir Assoc 14:392–397CrossRefGoogle Scholar
  3. 3.
    Mitnitski AB, Mogilner AJ, Rockwood K (2001) Accumulation of deficits as a proxy measure of aging. Sci World J 1:323–336CrossRefGoogle Scholar
  4. 4.
    Cesari M, Gambassi G, van Kan GA et al (2014) The frailty phenotype and the frailty index: different instruments for different purposes. Age Ageing 43:10–12CrossRefGoogle Scholar
  5. 5.
    Jones D, Song X, Mitnitski A et al (2005) Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians. Aging Clin Exp Res 17:465–471CrossRefGoogle Scholar
  6. 6.
    Evans SJ, Sayers M, Mitnitski A et al (2014) The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment. Age Ageing 43:127–132CrossRefGoogle Scholar
  7. 7.
    Hastings SN, Purser JL, Johnson KS et al (2008) Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department. J Am Geriatr Soc 56:1651–1657CrossRefGoogle Scholar
  8. 8.
    Eeles EMP, White SV, O’Mahony SM et al (2012) The impact of frailty and delirium on mortality in older inpatients. Age Ageing 41:412–416CrossRefGoogle Scholar
  9. 9.
    Zeng A, Song X, Dong J et al (2015) Mortality in relation to frailty in patients admitted to a specialized geriatric intensive care unit. J Gerontol Ser A Biomed Sci Med 70:1586–1594CrossRefGoogle Scholar
  10. 10.
    Ekerstad N, Swan E, Janzon M et al (2011) Frailty is independently associated with short-term outcomes for elderly patients with non-ST elevation myocardial infarction. Circulation 124:2397–2404CrossRefGoogle Scholar
  11. 11.
    Wellens NIH, Verbeke G, Flamaing J et al (2013) Clinical changes in older adults during hospitalization: responsiveness of the interRAI Acute Care Instrument. J Am Geriatr Soc 61:799–804CrossRefGoogle Scholar
  12. 12.
    Chong E, Ho E, Baldevarona-Llego J et al (2017) Frailty and risk of adverse outcomes in hospitalized older adults: a comparison of different frailty measures. J Am Med Dir Assoc 18:638e7–638e11CrossRefGoogle Scholar
  13. 13.
    Hubbard RE, Peel NM, Samanta M et al (2015) Derivation of a frailty index from the inteRAI acute care instrument. BMC Geriatr 15:27CrossRefGoogle Scholar
  14. 14.
    Searle SD, Mitnitski A, Gahbauer EA et al (2008) Standard procedure for creating a frailty index. BMC Geriatr 8:24CrossRefGoogle Scholar
  15. 15.
    Abete P, Basile C, Bulli G et al (2017) The italian version of the “frailty index” based on deficits in health: a validation study. Aging Clin Exp Res 29:913–926CrossRefGoogle Scholar
  16. 16.
    Rockwood K, Mitnitski A (2006) Limits to deficit accumulation in elderly people. Mech Ageing Dev 127:494–496CrossRefGoogle Scholar
  17. 17.
    Basile G, Catalano A, Mandraffino G et al (2017) Relationship between blood pressure and frailty in older hypertensive outpatients. Aging Clin Exp Res 29:1049–1053CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Giorgio Basile
    • 1
    • 5
    Email author
  • Antonino Catalano
    • 1
    • 5
  • Giuseppe Mandraffino
    • 2
  • Giuseppe Maltese
    • 3
  • Angela Alibrandi
    • 4
  • Giuliana Ciancio
    • 1
  • Daniela Brischetto
    • 1
  • Nunziata Morabito
    • 1
  • Antonino Lasco
    • 1
  • Matteo Cesari
    • 5
    • 6
  1. 1.Unit and School of Geriatrics, Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
  2. 2.Unit of Internal Medicine, Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
  3. 3.Unit for Metabolic Medicine, Cardiovascular DivisionKing’s College LondonLondonUK
  4. 4.Department of EconomicsUniversity of MessinaMessinaItaly
  5. 5.Gérontopôle, Centre Hospitalier Universitaire de ToulouseToulouseFrance
  6. 6.Université de Toulouse III Paul SabatierToulouseFrance

Personalised recommendations