The overlap of frailty and malnutrition in older hospitalised patients: An observational study

Background and Objectives: Frailty and malnutrition are geriatric syndromes with common risk-factors. Limited studies have investigated these two conditions simultaneously in hospitalised patients. This study investigated the overlap of frailty and malnutrition in older hospitalised patients. Methods and Study Design: This prospective study enrolled 263 patients ≥65 years in a tertiary-teaching hospital in Australia. Frailty status was assessed by use of the Edmonton-Frail-Scale (EFS) and malnutrition risk was determined by use of the Malnutrition Universal Screening Tool (MUST). Patients were divided into four categories for comparison: normal, at malnutrition-risk only, frail-only and both frail and at malnutrition risk. Multivariable regression models compared clinical outcomes: length of hospital stay (LOS), in-hospital mortality, health-related quality of life (HRQoL) and 30-day readmissions after adjustment for age, sex, Charlson comorbidity index (CCI) and living-status. Results: The mean (SD) age was 84.1 (6.6) years and 51.2% were females. The prevalence of patients who were at malnutrition-risk only was 14.8%, frailty only 27.8% and 33.5% were both frail and at malnutrition-risk. Frail-only patients were more likely to be older, from a nursing home and with a higher CCI than malnourished only patients. Frail patients had a worse HRQoL (coefficient –0.08, 95% -0.0132–-0.031, p=0.002) and were more likely to have a longer LOS (coefficient 5.91, 95% CI 0.77–11.14, p=0.024) than patients at-risk of malnutrition. Other clinical outcomes were similar between the two groups. Conclusions: There is a substantial overlap of frailty and malnutrition in older hospitalised patients and frailty is associated with worse clinical outcomes than malnutrition