Geriatric Syndromes and Mortality Among Hospitalized Older Adults.
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Avelino-Silva Thiago J, Roma Maria Fernanda B, Dutra Adriana F, Malheiro Alexandra, Speranza Ana Cristina C, Casale Arlety M C, Lopes Beatriz N A, Almada-Filho Clineu M, de Sousa Danilsa V, Marques da Silva Eduardo, Sepulveda Fabiola, Garcez Flavia Barreto, Constantino Gabriel T, Keller Gabriela S, Braga Ianna L S, Gordilho Souza Jonas, Teixeira Juliana J M, Rodrigues da Silva Martins Karoline, Moraes Dias Laiane, Araujo Lara M Q, Macedo Luana A C, de Andrade Lucas G, Prado Lucas K P, Venegas-Sanabria Luis Carlos, Freitas Marco P D, Saraiva Marcos D C, Bicalho Maria Aparecida C, Arbex Maria Carolyna F B, Pires Maria E, Guedes Maria M V, Borges Marina M G, Gorzoni Milton L, Bezerra Mirella R, Garção Natalia I B, Palmeira Natascha G F, Lima Nereida K C, Moreira-Filho Oberdã G, Villas Boas Paulo José F, de Almeida Perola Q, Dip Renata M, Bandeira de Mello Renato G, Aruachan Samir A, Karnakis Theodora, Pintarelli Vitor L, Amorim Welma W C C, Dieguez Ferreira Yngrid, Covinsky Kenneth E, Ferriolli Eduardo, Lee Sei J, Smith Alexander K, Suemoto Claudia K, Aliberti Marlon J R, CHANGE Study Group
Аннотация
OBJECTIVES: To measure the prevalence of geriatric syndromes upon hospital admission and examine the independent association between the number of geriatric syndromes and 90-day mortality.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Creating a Hospital Assessment Network in Geriatrics (CHANGE) study, a multicenter, prospective cohort of 43 hospitals, including 38 in Brazil, 1 in Angola, 1 in Chile, 2 in Colombia, and 1 in Portugal. Consecutive patients aged 65 years or older admitted under geriatric teams between June 1, 2022, and December 31, 2023, were enrolled within 48 hours; patients with terminally illness were excluded. Data were analyzed from February 1 to November 23, 2025.
EXPOSURE: A standardized comprehensive geriatric assessment captured 14 geriatric syndromes: loneliness, dementia, depressive symptoms, sensory impairment, disability, immobility, incontinence, falls, frailty, malnutrition, pressure ulcers, polypharmacy, potentially inappropriate medications, and delirium. The exposure of interest was the within-patient count of syndromes.
MAIN OUTCOMES AND MEASURES: The primary outcome was 90-day all-cause mortality, ascertained by masked telephone follow-up with verification in medical records or public registries. Prespecified mixed-effects Cox proportional hazards regression were performed.
RESULTS: The study included 2556 participants (mean [SD] age, 79 [9] years, 1437 female [56.2%]). The median number of geriatric syndromes was 5 (IQR, 3-8). The highest prevalence rates for syndromes were 70.8% (95% CI, 69.1%-72.6%) for disability, 61.7% (95% CI, 59.8%-63.6%) for polypharmacy, 58.2% (95% CI, 56.3%-60.1%) for frailty, and 54.7% (95% CI, 52.8%-56.7%) for sensory impairment. Across categories, the mortality rate rose from 8.4% (95% CI, 6.2%-11.4%) for 0 to 2 syndromes to 12.7% (95% CI, 10.1%-15.7%) for 3 to 4 syndromes, 25.4% (95% CI, 22.2%-29.1%) for 5 to 6 syndromes, 30.4% (95% CI, 26.7%-34.5%) for 7 to 8 syndromes, 39.5% (95% CI, 34.4%-44.8%) for 9 to 10 syndromes, and 47.0% (95% CI, 36.4%-57.9%) for 11 or more syndromes. After adjusting for confounders, each additional geriatric syndrome was associated with an increased risk of mortality (hazard ratio, 1.22 [95% CI, 1.15-1.30), which became increasingly pronounced in older age groups.
CONCLUSIONS AND RELEVANCE: This cohort study found that hospitalized older adults had a median of 5 geriatric syndromes, which were independently and incrementally associated with 90-day mortality. Multidomain assessments should be integrated into standard hospital care to identify and address vulnerabilities that commonly affect older adults with acute illness.