Older women are frailer, but less often die than men: a prospective study of older hospitalized people

Abstract

The association between frailty, mortality and sex is complex, but a limited literature is available on this topic, particularly for older hospitalized patients. Therefore, the objective of our study was to prospectively evaluate sex differences in frailty, assessed by the Multidimensional Prognostic Index (MPI) and mortality, institutionalization, and re-hospitalization in an international cohort of older people admitted to hospital. Study design: We used data from nine public hospitals in Europe and Australia, to evaluate sex differences in mortality, frailty and the risk of institutionalization and re-hospitalization, during one year of follow-up. Main outcome measures: People aged 65 years or more admitted to hospital for an acute medical condition or for a relapse of a chronic disease were included. A standardized comprehensive geriatric assessment, which evaluated functional, nutritional, and cognitive status, risk of pressure sores, comorbidities, medications and cohabitation status, was used to calculate the MPI to measure frailty in all hospitalized older people. Data regarding mortality, institutionalization and re-hospitalization were also recorded for one year. Results: Altogether, 1140 hospitalized patients (mean age = 84.2 years; 694 women = 60.9%) were included. The one-year mortality rate was 33.2%. In multivariate analysis, adjusted for age, MPI score, centre and diagnosis at baseline, although women had higher MPI scores than men, the latter had higher in-hospital (odds ratio, OR = 2.26; 95% confidence intervals, CI = 1.27-4.01) and one-year post-discharge mortality (OR = 2.04; 95%CI = 1.50-2.79). Furthermore, men were less frequently institutionalized in a care home than female patients (OR = 0.55; 95%CI: 0.34-0.91), but they were also more frequently re-hospitalized (OR = 1.42; 95%CI: 1.06-1.91) during the year after hospital discharge. Conclusion: Older hospitalized men were less frail, but experienced higher in-hospital and one-year mortality than women. Women were admitted more frequently to nursing homes and experienced a lower risk of rehospitalization. These findings suggest important differences between the sexes and extends the 'male-female health-survival paradox' to acutely ill patient groups.

Social inequalities in heat-attributable mortality in the city of Turin, northwest of Italy: a time series analysis from 1982 to 2018

“…All-causes mortality was assessed by sex, and it was found that women were systematically more at risk than men under heat stress conditions. These results are in line with many studies, which identify higher mortality rates for women compared to men [4,22,57,58], specifically in the European context [21,23,25,26]. This discrepancy may arise from differences in response to thermal stress due to physiological characteristics in body temperature regulation [59,60] as well as preexisting socio-demographic characteristics in the inhabited society [11,26], such as the lower social condition that characterises elderly women, which often live alone due to longer life expectancy compared to men.…”

“…Therefore, the relationship between the age and the sex variable here is consistent. These results extended previous hypothesis based on the evidence that heat stress increases the susceptibility of the elderly to hot temperatures with advancing age [27,30,41,58].…”

“…The RRs at the 99th percentile increased with age and RRs were consistently higher in women than men. In fact, women live longer and die older, while men die younger [58,61]. Therefore, the relationship between the age and the sex variable here is consistent.…”

“…In the youngest groups (“0–64” and “65–74” years), the number of women was slightly lower (15221) than the number of men (25157), while at the oldest groups (“75–84” and “85+”) the number was higher in women (40825) than in men (28752). In fact, women live longer and die older than men [ 57 , 58 ], therefore gender and age are here interlinked. The RR at the 99th percentile grows with age in both sexes, with a RR in the age group “85+” equal to 2.04 (95% CI: 1.76–2.38) in men and 2.13 (95% CI:1.94–2.33) in women.…”

Validation and Adaptation of the Multidimensional Prognostic Index in an Older Australian Cohort

“…We adjusted for these variables as neither age nor sex is included in the original MPI. Furthermore, a recent study reported a higher prevalence of women in the severe risk category [48].…”