Frailty Status Predicts Outcomes After Hospital Discharge

TOPLINE:

In older hospitalized adults, frailty was associated with discharge to postacute care facilities and a higher risk for readmissions and mortality. 

METHODOLOGY:

• Researchers conducted a retrospective cohort study to examine whether frailty was associated with the various facilities patients were discharged to and their health outcomes.
• The analysis included over 23,000 patients aged 65 years or older (53% women) who were hospitalized for at least 24 hours between 2021 and 2023 at five hospitals within a US-based academic health system.
• An electronic health record-based frailty index capturing 54 age-related health deficits was calculated at the most recent outpatient visit before hospitalization. Patients were classified as non-frail, pre-frail, frail, or severely frail.
• Overall, 22% of patients were identified as non-frail, 46% as pre-frail, 23% as frail, and 8% as severely frail.
• The hospital discharge destinations included home, home with home health services, and skilled nursing facilities (SNFs); health outcomes included rates of hospital readmission and post-discharge mortality.

TAKEAWAY:

• Overall, 61% of patients were discharged home, 24% were discharged to SNF, and 15% were discharged home with home health services.
• Patients with higher degrees of frailty were more likely to be discharged to SNFs or home healthcare than to home alone (adjusted odds ratio [aOR], 1.20; 95% CI, 1.09-1.33 for frail and aOR, 1.17; 95% CI, 1.03-1.34 for severely frail patients).
• Patients with frailty had higher odds of readmission within 90 days of discharge than those without frailty (aOR, 1.91; 95% CI, 1.67-2.20), with odds increasing as the degree of frailty increased; a similar pattern was observed for the risks for mortality within 90 days after discharge.
• Discharge to SNFs was associated with significantly higher mortality, with hazard ratios of 5.46 (95% CI, 4.43-6.73) and 2.06 (95% CI, 1.54-2.77) for those discharged home with home health services than those discharged to home alone.

IN PRACTICE:

“Automated frailty assessment at hospital discharge can identify in real time the most vulnerable individuals — severely frail patients discharged to SNF — for pragmatic trials and population health interventions,” the authors wrote. “Discharge with home health services, particularly for frail patients, may mitigate readmission risk.”

SOURCE:

This study was led by Charles T. Semelka, of the Department of Internal Medicine at the Wake Forest University School of Medicine in Winston-Salem, North Carolina. It was published online on August 6, 2025, in Journal of the American Geriatrics Society.

LIMITATIONS:

Confounding factors, including functional status, caregiver support, illness severity, may have been unaccounted for. The study was conducted in only one healthcare system in the southeastern US. The analyses only included individuals with a frailty score.

DISCLOSURES:

This study received support from the Foundation of Post-Acute and Long-Term Care Medicine and Claude D. Pepper Older Americans Independence Center, Wake Forest School of Medicine. One author reported receiving grants from the funding agencies for activities related to this work and professional effort.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.