Frailty is a decline in the functioning of several body systems, accompanied by an increase in vulnerability to stressors. The condition is related to high risk of falls, hospitalizations, all-cause mortality, and disability, which poses challenges to public health. There is no consensus regarding frailty. Indeed, several validated instruments based on different conceptual approaches have been developed. Professionals face a challenge when attempting to make a clinical assessment that discriminates between low and high-risk groups. There is a scarcity of frailty assessment data for hospitalized older adults. Understanding aspects related to frailty in a hospital setting is essential to providing comprehensive care to these individuals.

Investigate the association between frailty criteria at hospital admission and intra-hospital death in older patients.

This is a longitudinal observational study of 170 older adults hospitalized in a public hospital of the Federal District, Brazil. Frailty and mortality were the independent and dependent variables, respectively. The former was assessed using the frailty phenotype, considering unintentional weight loss, exhaustion, muscle weakness, slow gait and low physical activity level, and participants were categorized as non-frail, pre-frail or frail. Intra-hospital mortality was collected in the healthcare electronic medical chart system (TrackCare). The older patients were categorized into two groups: those that were discharged and those that died. Data analysis was descriptive and using the chi-squared, Mann-Whitney U and simple and multiple logistic regression tests. Demographic (age and sex) and clinical data (number of medications and body mass index- BMI) were collected to adjust the analyses.

7.1% of the older adults hospitalized during the study period were non-frail, 34.1% pre-frail and 58.8% frail, and 7.1% died during their hospital stay. The group that died exhibited more frailty criteria (U=510.500; p=0.006) and more frequent muscle weakness (X²(1)=7.412; p=0.006) and slow gait (X²(1)=5.636; p=0.030). These individuals showed no differences in age, sex, education level, BMI and medications when compared to their discharged counterparts (p>0.05). In simple regression analyses, one more frailty criterion increased the likelihood of intra-hospital death by 110% (OR=2.100 [95% CI 1.201 – 3.673]). Adjusted multiple analyses did not change the simple regression results.

Older adults with more frailty criteria exhibited a greater likelihood of intra-hospital death. The findings reveal the risk of intra-hospital death in hospitalized frail older patients and therefore, the need for multiprofessional monitoring of these individuals from the moment they are admitted.

Understanding frailty in a hospital setting may contribute to the development of healthcare, screening, health indicator and prevention strategies aimed at improving care and prognosis for these individuals.