Prognostic value of the electronic Multimorbidity Frailty Index for mortality, change in basic activities of daily living, length of hospital stay and discharge home in older hospitalized patients.

AIM: This exploratory study aimed to evaluate the ability of the electronic Multimorbidity Frailty Index, consisting of 35 chronic conditions, including chronic diseases, geriatric syndromes and functional limitations from electronic medical record data, to predict clinical outcomes in hospitalized older adults.

METHODS

Our study included 1491 patients aged ≥60 years who were admitted to an acute care hospital. Multimorbidity status was categorized based on the number of chronic conditions included in the electronic Multimorbidity Frailty Index: 0-2 as no or mild, 3-4 as moderate, 5-9 as high and ≥10 as very high multimorbidity. We evaluated the association between multimorbidity categories and clinical outcomes: in-hospital mortality, improvement in basic activities of daily living, extended hospital stay and discharge destination. The hazard ratio (HR) or odds ratio (OR) was calculated using multivariable Cox or logistic regression analyses after adjustment for age, sex and basic activities of daily living score at admission as a reference for no or mild multimorbidity.

RESULTS

Very high multimorbidity was significantly associated with increased in-hospital mortality (HR 3.10, 95% CI 1.28-7.51), less basic activities of daily living improvement (HR 0.51, 95% CI 0.37-0.71), less home discharge for patients admitted from home (HR 0.61, 95% CI 0.44-0.85) and longer hospital stays (OR 2.11, 95% CI 1.34-3.33). High multimorbidity was also associated with extended hospital stay and less discharge to home.

CONCLUSION

The electronic Multimorbidity Frailty Index reflects the cumulative burden of chronic diseases, geriatric syndromes and limitations, and is associated with important clinical outcomes among hospitalized older adults. It might help identify patients at risk of poor prognosis, supporting appropriate medical treatment and care planning in clinical settings. Geriatr Gerontol Int 2025; 25: 1185-1193.