Analysis on the Related Factors and Predictive Value of Frailty in Elderly Inpatients
Objective: To identify factors associated with frailty among elderly hospitalized patients and to evaluate the predictive performance of relevant indicators. Method: In this retrospective study, we reviewed 211 elderly inpatients from 2022 to 2024 at the Department of Geriatric Medicine, Nanjing Drum Tower Hospital. Data were obtained from electronic medical records and routine admission nursing assessments. Binary logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent predictors and assess the predictive value for frailty. Results: The prevalence of frailty was 39.34%. Logistic regression analysis demonstrated that fall risk and activity of daily living (ADL) were independent predictors associated with frailty (P < 0.05). The areas under the ROC curves (AUC) for fall risk and ADL were 0.854 and 0.895, respectively. Conclusions: Among the clinical assessment indicators used to predict frailty in elderly hospitalized patients, both fall risk and ADL are independent predictors, among which ADL shows the highest discriminative performance.
[1] Battaggia, A., Scalisi, A., Novelletto, B. F., Fusello, M., Michieli, R., & Cancian, M. (2019). Prevalence of frailty in older people in Veneto (Italy). Journal of Drug Assessment, 8(1), 1-12. https://doi. org/10.1080/2155 6660.2018.1563549
[2] Caprini, J. A. (2005). Thrombosis risk assessment as a guide to quality patient care. Disease-a-Month, 51(2-3), 70-78. https://doi.org/10.1016/j.disamonth.2005.02.003
[3] Chen, C. C. H., Yang, Y. T., Lai, I. R., Lin, B. R., Yang, C. Y., Huang, J., ... & Inouye, S. K. (2019). Three nurseadministered protocols reduce nutritional decline and frailty in older gastrointestinal surgery patients: a cluster randomized trial. Journal of the American Medical Directors Association, 20(5), 524-529. https://doi.org/10.1016/j.jamda.2018.09.016
[4] Chen, Y., Liu, Q., & Qian, Y. (2022). Application of frailty assessment instruments in different elderly populations: A review. Journal of Nursing Science, 37(24), 89-94. Retrieved from http://www.hlxzz.com.cn/hlxzz/home
[5] Cronin, M., Dengler, N., Krauss, E. S., Segal, A., Wei, N., Daly, M., ... & Caprini, J. A. (2019). Completion of the updated Caprini risk assessment model (2013 version). Clinical and Applied Thrombosis/Hemostasis, 25, 1076029619838052. https://doi.org/10.1177/1076029619838052
[6] Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L., Rodríguez-Mañas, L., Fried, L. P., ... & Vellas, B. (2019). Physical frailty: ICFSR international clinical practice guidelines for identification and management. The Journal of Nutrition, Health & Aging, 23(9), 771-787. https://doi.org/10.1007/s12603-019-1273-z
[7] Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., ... & McBurnie, M. A. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146-M157. https://doi.org/10.1093/gerona/56.3.m146
[8] Geriatrics Medicine Branch of Chinese Medical Association. (2017). Chinese experts consensus on assessment and intervention for elderly patients with frailty. Chinese Journal of Geriatrics, 36(3), 251-256. https://doi.org/10.3760/cma.j.issn.0254-9026.2017.03.007
[9] Gottesman, D., & McIsaac, D. I. (2022). Frailty and emergency surgery: Identification and evidence based care for vulnerable older adults. Anaesthesia, 77(12), 1430-1438. https://doi.org/10.1111/anae.15860
[10] Guo, Y., Miao, X., Hu, J., Chen, L., Chen, Y., Zhao, K., ... & Xu, Q. (2024). Summary of best evidence for prevention and management of frailty. Age and Ageing, 53(2), afae011. https://doi.org/10.1093/ageing/afae011
[11] Han, J., Wang, J., Xie, B., & Wang, Y. (2021). Comparison of consistency and validity of fried frailty phenotype, FRAIL scale and Edmonton Frailty scale for frailty screening among community-dwelling older adults. Chinese General Practice, 24(21), 2669. https://doi.org/10.12114/j.issn.1007-9572.2021.00.451
[12] Hao, Q., Zhou, L., Dong, B., Yang, M., Dong, B., & Weil, Y. (2019). The role of frailty in predicting mortality and readmission in older adults in acute care wards:A prospective study. Scientific Reports, 9(1), 1207. https://doi.org/10.1038/s41598-018-38072-7
[13] He, B., Ma, Y., Wang, C., Jiang, M., Geng, C., Chang, X., ... & Han, L. (2019). Prevalence and risk factors for frailty among community-dwelling older people in China: A systematic review and meta-analysis. The Journal of Nutrition, Health and Aging, 23(5), 442-450. https://doi.org/10.1007/s12603-019-1179-9
[14] Hothi, H., Paolone, A. R., Pezeshki, M., Griffith, L. E., Kennedy, C. C., Leong, D. P., ... & Lee, J. (2025). The implementation of frailty assessment tools in the acute care setting: A scoping review. Journal of the American Geriatrics Society, 73(8), 2571-2578. https://doi.org/10.1111/jgs.19438
[15] Hou, D. Z., Zhang, Y., Wu, J. L., & Li, Y. (2012). Study on reliability and validity of Chinese version of Barthel Index. Clinical Focus, 27(3), 219. https://doi.org/10.3760/cma.j.issn.0254-1424.2012.05.013
[16] Huang, C., Ma, Y., Wang, C., Jiang, M., Yuet Foon, L., Lv, L., & Han, L. (2021). Predictive validity of the Braden scale for pressure injury risk assessment in adults: A systematic review and meta analysis. Nursing Open, 8(5), 2194-2207. https://doi.org/10.1002/nop2.792
[17] Jia, W., Zhao, H., Dai, F., Zhang, H., Wang, L., & Chen, R. (2019). The current situation and influential factors of frailty in elderly patients with diabetes. Chinese Journal of Nursing, 54(2), 188-193. https://doi.org/10.3761/j.issn.0254-1769.2019.02.005
[18] Jing, Z. J., Wu, J., Yang, X. H., & Jiang, P. (2024). Research progress on relationship between frailty and brain health. Journal of Clinical Medicine in Practice, 28(13), 131-136,143. https://doi.org/10.7619/jcmp.20240641
[19] Kondrup, J., Rasmussen, H. H., Hamberg, O. L. E., Stanga, Z., & An ad hoc ESPEN Working Group. (2003). Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clinical nutrition, 22(3), 321-336. https://doi.org/10.1016/s0261-5614(02)00214-5
[20] Liang, Y. D., Zhang, Y. N., Li, Y. M., Chen, Y. H., Xu, J. Y., Liu, M., ... & Wang, H. (2019). Identification of frailty and its risk factors in elderly hospitalized patients from different wards: A cross-sectional study in China. Clinical Interventions in Aging, 2249-2259. https://doi.org/10.2147/CIA.S225149
[21] Liu, J., Wu, Y., Long, Z., Zhang, S., & Wu, S. (2025). The association between cognitive frailty and the risk of fall occurrence in older adults: A meta-analysis of cohort studies. Frontiers in Medicine, 12, 1537240. https://doi.org/10.3389/fmed.2025.1537240
[22] Liu, X., Chen, C., & Wang, J. (2019). Analysis of frailty status and influencing factors of the elderly in community. Chinese Nursing Research, 33(3), 390-393. Retrieved from https://www.hlyjzz.com/
[23] Ma, L., & Chan, P. (2020). Frailty research in China: Current status and perspectives. Chinese Journal of Geriatrics, 39(4), 369-372. https://doi.org/10.3760/cma.j.issn.0254-9026.2020.04.001
[24] Ma, R. Y., Fang, H., & Liu, H. (2025). Summary and enlightenment of venous thrombosis assessment models: Based on guidelines and expert consensus on thrombosis prevention in various countries. Chinese Journal of Laboratory Diagnosis, 29(8), 980-987. https://doi.org/10.3969/i.issn.1007-4287.2025.08.017
[25] Ministry of Civil Affairs of the People's Republic of China. (2025). 2024 national aging development bulletin. https://www.mca.gov.cn/n152/n166/c1662004999980006135/content.html
[26] National Bureau of Statistics. (2021, May 12). Interpretation of the bulletin of the seventh national population census. Retrieved from http://www.stats.gov.cn/xxgk/jd/sjjd2020/202105/t20210512_1817342.html
[27] Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D. B., McDowell, I., & Mitnitski, A. (2005). A global clinical measure of fitness and frailty in elderly people. CMAJ, 173(5), 489-495. https://doi.org/10.1503/cmaj.050051.
[28] Rodriguez, J. J. L., Prina, A. M., Acosta, D., Guerra, M., Huang, Y., Jacob, K. S., ... & Prince, M. J. (2018). The prevalence and correlates of frailty in urban and rural populations in Latin America, China, and India: A 10/66 population-based survey. Journal of the American Medical Directors Association, 19(4), 287-295. https://doi.org/10.1016/j.jamda.2017.09.026
[29] Troncoso-Pantoja, C., Concha-Cisternas, Y., LeivaOrdoñez, A. M., Martínez-Sanguinetti, M. A., Petermann-Rocha, F., Díaz-Martínez, X., ... & CelisMorales, C. (2020). Prevalencia de fragilidad en personas mayores de Chile: Resultados de la Encuesta Nacional de Salud 2016-2017. Revista Médica De Chile, 148 (10), 1418-1426. https://doi. org/10.4067/S0034-98872 020001001418
[30] Wade, D. T., & Collin, C. (1988). The Barthel ADL Index: A standard measure of physical disability?. International Disability Studies, 10(2), 64-67. https://doi.org/10.3109/09638288809164105
[31] Wang, H., Li, N., Wang, H., Zhang, H., Zhu, G., & Xia, X. (2023). The current situation and influential factors of frailty in elderly patients with vertigo. Chinese Journal of Nursing, 58(2), 205-210. Retrieved from https://zh.zhhlzzs.com
[32] Wang, R. H. (2004). Application of nursing evaluation sheets of tumbles prevention of clinical inpatients. Chinese Nursing Research, 22, 2047-2049. Retrieved from https://www.hlyjzz.com/
[33] Wang, S., Wang, M., Leung, I. S. H., Ge, S., Xu, X., Chen, S., & Yin, Y. (2023). The association of cognitive frailty and the risk of falls among older adults: A systematic review and meta‐analysis. International Journal of Nursing Practice, 29(4), e13181. https://doi.org/10.1111/ijn.13181
[34] Zhang, X., Zhang, L., & Sui, R. B. (2023). Construction of a frailty prediction model for elderly stroke patients based on Logistic regression and artificial neural network. Military Nursing, 40(2), 10-14. Retrieved from http://jfjhlzz.smmu.edu.cn/