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
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Article info
Publication history
Published online: August 03, 2019
Accepted:
July 30,
2019
Received in revised form:
June 17,
2019
Received:
March 20,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
