Impact of frailty on 30-day and 1-year mortality in hospitalised elderly patients with community-acquired pneumonia: a prospective observational study

Abstract

ObjectivesThis study evaluates the impact of frailty, which is a state of increased vulnerability to stressors, on 30-day and 1-year mortality among elderly patients with community-acquired pneumonia (CAP). The main hypothesis is that frailty is an independent predictor of prognosis in elderly CAP patients.DesignProspective, observational, follow-up cohort study.SettingA 2000-bed tertiary care hospital in Beijing, China.ParticipantsConsecutive CAP patients aged ≥65 years admitted to the geriatric department of our hospital between September 2017 and February 2019.Main outcome measuresThe primary outcomes were all-cause mortality at 30 days and 1 year after hospital admission. The impact of frailty (defined by frailty phenotype) on 30-day and 1-year mortality of elderly patients with CAP was assessed by Cox regression analysis.ResultsThe cohort included 256 patients. The median (IQR) age was 86 (81–90) years, and 180 (70.3%) participants were men. A total of 171/256 (66.8%) patients were frail. The prevalence of frailty was significantly associated with older age, female gender, lower body mass index, comorbidities, limitations in activities of daily living (ADLs) and poor nutritional status. Frail participants were significantly more likely to have severe CAP (SCAP) than non-frail counterparts (28.65% vs 9.41%, p<0.001). The 1-year mortality risk was approximately threefold higher in frail patients (adjusted HR, 2.70; 95% CI, 1.69 to 4.39) than non-frail patients. Subgroup analysis of patients with SCAP showed that the 1-year mortality risk was approximately threefold higher in the frail group (adjusted HR, 2.87; 95% CI, 1.58 to 4.96) than in the non-frail group. The association between frailty and 30-day mortality was not significant.ConclusionsThese findings suggest that frailty is strongly associated with SCAP and higher 1-year mortality in elderly patients with CAP, and frailty should be detected early to improve the management of these patients.

Frailty is Associated with Susceptibility to and Severity of Pneumonia in Functionally-independent Community-dwelling Older Adults: A JAGES Multilevel Cross-sectional Study

“…The pneumonia cases were likely CAP because HAP and VAP were excluded by asking corresponding questions to the participants (see "Outcome variables" in Methods). Our results also suggest that frailty may be an important indicator in the prevention of pneumonia among community-dwelling older adults, not only be an indicator of the mortality in older adults hospitalized for pneumonia as recently reported 11 .…”

“…Several reports have recently shown that frailty was related to mortality in older adults hospitalized due to respiratory infectious diseases [9][10][11] . However, it is unknown whether frailty is associated with susceptibility to and severity of pneumonia in community-dwelling older adults.…”

“…Lees and colleagues reported that the frailty of hospitalized older adults with in uenza and acute respiratory illness was associated with lower odds of recovery 10 . Luo and colleagues recently reported that frailty was associated with the severity of CAP and mortality among hospitalized older adults 11 . However, it was unknown whether frailty was related to the susceptibility to and severity of pneumonia among community-dwelling older adults.…”

How Do Geriatric Scores Predict 1-Year Mortality in Elderly Patients with Suspected Pneumonia?

“…Amongst several scales estimating patients’ dependence and functionality [ 24 , 25 , 26 ], we used the FIM, which in a recent study among critically ill elderly patients admitted to an intermediate care unit proved a correlation between low ratings on the scale and higher 1-year mortality rates [ 27 ]. Another research showed that frailty, defined as unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity, was strongly associated with the severity of pneumonia and higher 1-year mortality in older patients, suggesting that frailty should be detected early to improve their management [ 28 ]. In our findings, lower FIM ratings were individually associated with a poorer long-term prognosis but failed in finding significant 1-year mortality correlations in multivariate models.…”

One-Year Mortality Prediction in Elderly Patients With Suspected Pneumonia: The Usefulness of a Holistic Approach

“…Amongst several scales estimating patients' dependence and functionality [23][24][25] , we decided to use the FIM, which in a recent study among critically ill elderly patients admitted to an intermediate care unit proved a correlation between low ratings on the scale and higher 1-year mortality rates 26 . Another research showed that frailty, de ned as unintentional weight loss, self-reported exhaustion, weakness slow walking speed, and low physical activity, was strongly associated with the severity of pneumonia and a higher 1-year mortality in older patients, suggesting that frailty should be detected early to improve their management 27 . In our ndings, lower FIM ratings were individually associated with a poorer longterm prognosis but failed in nding signi cant 1-year mortality correlations in multivariate models.…”