Journal of the American Medical Directors Association · 2026
Frailty Modifies the Association Between Multimorbidity and Hospital-Associated Disability in Hospitalized Older Adults.
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Umegaki Hiroyuki, Nakashima Hirotaka, Yamada Yosuke, Watanabe Kazuhisa, Fujisawa Chisato, Komiya Hitoshi, Tajima Tomihiko, Satake Shosuke, Takeya Yasushi, Yakabe Mitsutaka
Аннотация
OBJECTIVES: To examine whether the prognostic relevance of multimorbidity burden for hospital-associated disability (HAD) varies with baseline frailty in hospitalized older adults.
DESIGN: Retrospective multicenter cohort study.
SETTING AND PARTICIPANTS: We analyzed data from 1599 older adults aged ≥65 years admitted to acute care hospitals in Japan between October 2019 and March 2025. After exclusions, 1299 individuals formed the final analytic cohort.
METHODS: Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI). Frailty was categorized using the Clinical Frailty Scale into nonfrail (≤3), mildly frail (4), and frail (≥5). HAD was defined as a decline of at least 5 points in the Barthel Index during hospitalization. Multivariable logistic regression models, including an interaction term between CCI and frailty, were used, adjusted for age, sex, and cognitive function.
RESULTS: Higher CCI was associated with higher odds of HAD in the nonfrail group [odds ratio (OR), 1.44; 95% CI, 1.20-1.73], but this association was attenuated in the mildly frail group (OR, 1.11; 95% CI, 0.91-1.35) and was not observed in the frail group (OR, 0.98; 95% CI, 0.90-1.06). The interaction between CCI and frailty was statistically significant (P for interaction <.001).
CONCLUSIONS AND IMPLICATIONS: The prognostic relevance of multimorbidity diminishes with increasing frailty, suggesting a loss of risk discrimination at higher levels of physiological vulnerability. These findings highlight the importance of integrating frailty into risk stratification frameworks and support a shift toward resilience-based approaches in the management of hospitalized older adults.
DESIGN: Retrospective multicenter cohort study.
SETTING AND PARTICIPANTS: We analyzed data from 1599 older adults aged ≥65 years admitted to acute care hospitals in Japan between October 2019 and March 2025. After exclusions, 1299 individuals formed the final analytic cohort.
METHODS: Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI). Frailty was categorized using the Clinical Frailty Scale into nonfrail (≤3), mildly frail (4), and frail (≥5). HAD was defined as a decline of at least 5 points in the Barthel Index during hospitalization. Multivariable logistic regression models, including an interaction term between CCI and frailty, were used, adjusted for age, sex, and cognitive function.
RESULTS: Higher CCI was associated with higher odds of HAD in the nonfrail group [odds ratio (OR), 1.44; 95% CI, 1.20-1.73], but this association was attenuated in the mildly frail group (OR, 1.11; 95% CI, 0.91-1.35) and was not observed in the frail group (OR, 0.98; 95% CI, 0.90-1.06). The interaction between CCI and frailty was statistically significant (P for interaction <.001).
CONCLUSIONS AND IMPLICATIONS: The prognostic relevance of multimorbidity diminishes with increasing frailty, suggesting a loss of risk discrimination at higher levels of physiological vulnerability. These findings highlight the importance of integrating frailty into risk stratification frameworks and support a shift toward resilience-based approaches in the management of hospitalized older adults.