Frailty as a predictor of mortality in older adults within 5 years of psychiatric admission

Objectives: Older adults with psychiatric disorders have a substantially lower life expectancy than age matched controls. Knowledge of risk factors may lead to targeting treatment and interventions to reduce this gap in life expectancy. In this study we investigated whether frailty independently predicts mortality in older patients following an acute admission to a geriatric psychiatry hospital. Methods: Clinical cohort study with a 5-year follow up of 120 older patients admitted to a psychiatric hospital between February 2009 and September 2010. On admission we assessed frailty with a Frailty Index (FI). We applied Cox-regression analyses with time to death as the dependent variable, to examine whether the FI was a predictor for mortality, adjusted for age, sex, level of education, multimorbidity (Cumulative Illness Rating Scale for Geriatrics, CIRS-G scores), functional status (Barthel Index), neuropsychiatric symptoms (NPS) and severity of psychiatric symptoms at admission (Clinical Global Impressions Scale of Severity). Results Of the 120 patients, 63 (53%) patients were frail (FI >= 0.25) and 59 (49%) had died within 5 years. The FI predicted mortality with a HR of 1.78 [95%-CI 1.06 – 2.98] per 0.1 point increase, independent of the covariates. Co-morbidity measured by the CIRS-G and functional status measured by the Barthel Index were not significantly associated. Conclusions Frailty was a strong predictor of mortality, independent of age, gender, multimorbidity and functional status. This implies that frailty may be helpful in targeting inpatient psychiatric treatment and aftercare according to patients' life expectancy. This article is protected by copyright. All rights reserved