Advertisement

Older women are frailer, but less often die than men: a prospective study of older hospitalized people

      Highlights

      • Hospitalized older women were frailer than hospitalized older men, but experienced a lower in-hospital and one-year death rate.
      • The women were admitted more frequently to a nursing home in the year after hospital discharge.
      • The women experienced a lower rate of rehospitalization than the men.
      • Hospitalized older women were frailer than hospitalized older men.
      • Women experienced a lower in-hospital and one-year death rate.

      Abstract

      Objectives

      The association between frailty, mortality and sex is complex, but a limited literature is available on this topic, particularly for older hospitalized patients. Therefore, the objective of our study was to prospectively evaluate sex differences in frailty, assessed by the Multidimensional Prognostic Index (MPI) and mortality, institutionalization, and re-hospitalization in an international cohort of older people admitted to hospital.

      Study design

      We used data from nine public hospitals in Europe and Australia, to evaluate sex differences in mortality, frailty and the risk of institutionalization and re-hospitalization, during one year of follow-up.

      Main outcome measures

      People aged 65 years or more admitted to hospital for an acute medical condition or for a relapse of a chronic disease were included. A standardized comprehensive geriatric assessment, which evaluated functional, nutritional, and cognitive status, risk of pressure sores, comorbidities, medications and co-habitation status, was used to calculate the MPI to measure frailty in all hospitalized older people. Data regarding mortality, institutionalization and re-hospitalization were also recorded for one year.

      Results

      Altogether, 1140 hospitalized patients (mean age = 84.2 years; 694 women = 60.9%) were included. The one-year mortality rate was 33.2%. In multivariate analysis, adjusted for age, MPI score, centre and diagnosis at baseline, although women had higher MPI scores than men, the latter had higher in-hospital (odds ratio, OR = 2.26; 95% confidence intervals, CI = 1.27–4.01) and one-year post-discharge mortality (OR = 2.04; 95%CI = 1.50–2.79). Furthermore, men were less frequently institutionalized in a care home than female patients (OR = 0.55; 95%CI: 0.34–0.91), but they were also more frequently re-hospitalized (OR = 1.42; 95%CI: 1.06–1.91) during the year after hospital discharge.

      Conclusion

      Older hospitalized men were less frail, but experienced higher in-hospital and one-year mortality than women. Women were admitted more frequently to nursing homes and experienced a lower risk of re-hospitalization. These findings suggest important differences between the sexes and extends the ‘male-female health-survival paradox’ to acutely ill patient groups.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Austad S.N.
        • Bartke A.
        Sex differences in longevity and in responses to anti-aging interventions: a mini-review.
        Gerontology. 2016; 62: 40-46
        • Gordon E.
        • Peel N.
        • Samanta M.
        • Theou O.
        • Howlett S.
        • Hubbard R.
        Sex differences in frailty: a systematic review and meta-analysis.
        Exp. Gerontol. 2017; 89: 30-40
        • Collard R.M.
        • Boter H.
        • Schoevers R.A.
        • Oude Voshaar R.C.
        Prevalence of frailty in community-dwelling older persons: a systematic review.
        J. Am. Geriatr. Soc. 2012; 60: 1487-1492
        • Shamliyan T.
        • Talley K.M.
        • Ramakrishnan R.
        • Kane R.L.
        Association of frailty with survival: a systematic literature review.
        Ageing Res. Rev. 2013; 12: 719-736
        • Oksuzyan A.
        • Gumà J.
        • Doblhammer G.
        Sex Differences in Health and Survival, a Demographic Perspective on Gender, Family and Health in Europe.
        Springer, Cham2018: 65-100
        • Mitnitski A.
        • Song X.
        • Skoog I.
        • Broe G.
        • Cox J.L.
        • Grunfeld E.
        • Rockwood K.
        Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality.
        J. Am. Geriatr. Soc. 2005; 53: 2184-2189
        • Berges I.-M.
        • Graham J.E.
        • Ostir G.V.
        • Markides K.S.
        • Ottenbacher K.J.
        Sex differences in mortality among older frail Mexican Americans.
        J. Womens Health. 2009; 18: 1647-1651
        • Saum K.-U.
        • Dieffenbach A.K.
        • Müller H.
        • Holleczek B.
        • Hauer K.
        • Brenner H.
        Frailty prevalence and 10-year survival in community-dwelling older adults: results from the ESTHER cohort study.
        Eur. J. Epidemiol. 2014; 29: 171-179
        • Puts M.T.E.
        • Lips P.
        • Deeg D.J.H.
        Sex differences in the risk of frailty for mortality independent of disability and chronic diseases.
        J. Am. Geriatr. Soc. 2005; 53: 40-47
        • Kulminski A.M.
        • Culminskaya I.V.
        • Ukraintseva S.V.
        • Arbeev K.G.
        • Land K.C.
        • Yashin A.I.
        Sex-specific health deterioration and mortality: the morbidity–mortality paradox over age and time.
        Exp. Gerontol. 2008; 43: 1052-1057
        • Kulmala J.
        • Nykänen I.
        • Hartikainen S.
        Frailty as a predictor of all-cause mortality in older men and women.
        Geriatr. Gerontol. Int. 2014; 14: 899-905
        • Tropea J.
        • LoGiudice D.
        • Liew D.
        • Gorelik A.
        • Brand C.
        Poorer outcomes and greater healthcare costs for hospitalised older people with dementia and delirium: a retrospective cohort study.
        Int. J. Geriatr. Psychiatry. 2017; 32: 539-547
        • Chong E.
        • Ho E.
        • Baldevarona-Llego J.
        • Chan M.
        • Wu L.
        • Tay L.
        • Ding Y.Y.
        • Lim W.S.
        Frailty in hospitalized older adults: comparing different frailty measures in predicting short-and long-term patient outcomes.
        J. Am. Med. Dir. Assoc. 2018; 19 (450-457. e3)
        • Hao Q.
        • Zhou L.
        • Dong B.
        • Yang M.
        • Dong B.
        • Weil Y.
        The role of frailty in predicting mortality and readmission in older adults in acute care wards: a prospective study.
        Sci. Rep. 2019; 9: 1207
        • Parker R.B.
        • Larkin T.
        • Cockburn J.
        Gender bias in medical images affects students’ implicit but not explicit gender attitudes.
        AERA Open. 2018; 42332858418798832
        • Pilotto A.
        • Ferrucci L.
        • Franceschi M.
        • D’Ambrosio L.P.
        • Scarcelli C.
        • Cascavilla L.
        • Paris F.
        • Placentino G.
        • Seripa D.
        • Dallapiccola B.
        • Leandro G.
        Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients.
        Rejuvenation Res. 2008; 11: 151-161
        • Pilotto A.
        • Rengo F.
        • Marchionni N.
        • Sancarlo D.
        • Fontana A.
        • Panza F.
        • Ferrucci L.
        Comparing the prognostic accuracy for all-cause mortality of frailty instruments: a multicentre 1-year follow-up in hospitalized older patients.
        PLoS One. 2012; 7e29090
        • Katz S.
        • Downs T.D.
        • Cash H.R.
        • Grotz R.C.
        Progress in development of the index of ADL.
        Gerontologist. 1970; 10: 20-30
        • Lawton M.P.
        • Brody E.M.
        Assessment of older people: self-maintaining and instrumental activities of daily living.
        Gerontologist. 1969; 9: 179-186
        • Pfeiffer E.
        A Short Portable Mental Status Questionnaire (SPMSQ).
        J. Am. Geriatr. Soc. 1975; 23: 1975
        • Sancarlo D.
        • D’Onofrio G.
        • Franceschi M.
        • Scarcelli C.
        • Niro V.
        • Addante F.
        • Copetti M.
        • Ferrucci L.
        • Fontana L.
        • Pilotto A.
        Validation of a Modified-Multidimensional Prognostic Index (m-MPI) including the Mini Nutritional Assessment Short-Form (MNA-SF) for the prediction of one-year mortality in hospitalized elderly patients.
        J. Nutr. Health Aging. 2011; 15: 169-173
        • Bliss M.R.
        • McLaren R.
        • Exton-Smith A.N.
        Mattresses for preventing pressure sores in geriatric patients.
        Mon. Bull. Minist. Health Public Health Lab. Serv. 1966; 25: 238-268
        • Pilotto A.
        • Panza F.
        • Ferrucci L.
        A multidimensional prognostic index in common conditions leading to death in older patients.
        Arch. Intern. Med. 2012; 172 (discussion 594-5): 594
        • Oksuzyan A.
        • Petersen I.
        • Stovring H.
        • Bingley P.
        • Vaupel J.W.
        • Christensen K.
        The male–female health–survival paradox: a survey and register study of the impact of sex-specific selection and information bias.
        Ann. Epidemiol. 2009; 19: 504-511
        • Warnier R.
        • Van Rossum E.
        • Van Velthuijsen E.
        • Mulder W.
        • Schols J.
        • Kempen G.
        Validity, reliability and feasibility of tools to identify frail older patients in inpatient hospital care: a systematic review.
        J. Nutr. Health Aging. 2016; 20: 218-230
        • Volpato S.
        • Bazzano S.
        • Fontana A.
        • Ferrucci L.
        • Pilotto A.
        Multidimensional Prognostic Index predicts mortality and length of stay during hospitalization in the older patients: a multicenter prospective study.
        J. Gerontol. A Biol. Sci. Med. Sci. 2015; 70: 325-331
        • Pilotto A.
        • Veronese N.
        • Daragjati J.
        • Cruz-Jentoft A.J.
        • Polidori M.C.
        • Mattace-Raso F.
        • Paccalin M.
        • Topinkova E.
        • Siri G.
        • Greco A.
        • Mangoni A.A.
        • Maggi S.
        • Ferrucci L.
        Using the multidimensional prognostic index to predict clinical outcomes of hospitalized older persons: a prospective, multicentre, international study.
        J. Gerontol. A Biol. Sci. Med. Sci. 2018;
        • Romero-Ortuno R.
        • Fouweather T.
        • Jagger C.
        Cross-national disparities in sex differences in life expectancy with and without frailty.
        Age Ageing. 2013; 43: 222-228
        • Seripa D.
        • Franceschi M.
        • Matera M.G.
        • Panza F.
        • Kehoe P.G.
        • Gravina C.
        • Orsitto G.
        • Solfrizzi V.
        • Di Minno G.
        • Dallapiccola B.
        Sex differences in the association of apolipoprotein E and angiotensin-converting enzyme gene polymorphisms with healthy aging and longevity: a population-based study from Southern Italy.
        J. Gerontol. A Biol. Sci. Med. Sci. 2006; 61: 918-923
        • Spiers N.
        • Jagger C.
        • Clarke M.
        • Arthur A.
        Are gender differences in the relationship between self-rated health and mortality enduring? Results from three birth cohorts in Melton Mowbray, United Kingdom.
        Gerontologist. 2003; 43: 406-411
        • Hubbard R.E.
        • Rockwood K.
        Frailty in older women.
        Maturitas. 2011; 69: 203-207
        • Volpato S.
        • Custureri R.
        • Puntoni M.
        • Bianchi L.
        • Daragjati J.
        • Garaboldi S.
        • Simonato M.
        • Greco A.
        • Rizzo E.
        • Dal Santo P.
        Effects of oral amino acid supplementation on Multidimensional Prognostic Index in hospitalized older patients: a multicenter randomized, double-blind, placebo-controlled pilot study.
        Clin. Interv. Aging. 2018; 13: 633
        • Agosti P.
        • Tettamanti M.
        • Vella F.
        • Suppressa P.
        • Pasina L.
        • Franchi C.
        • Nobili A.
        • Mannucci P.
        • Sabbà C.
        • Investigators R.
        Living alone as an independent predictor of prolonged length of hospital stay and non-home discharge in older patients.
        Eur. J. Intern. Med. 2018;
        • Scapinello M.P.
        • Posocco A.
        • De Ronch I.
        • Castrogiovanni F.
        • Lollo G.
        • Sergi G.
        • Tomaselli I.
        • Tonon L.
        • Solmi M.
        • Traversa S.
        • Zambianco V.
        • Veronese N.
        Predictors of emergency department referral in patients using out-of-hours primary care services.
        Health Policy (Amsterdam, Netherlands). 2016; 120: 1001-1007