1. Older women are frailer, but less often die then men: a prospective study of older hospitalized people
- Author
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Alfonso J. Cruz-Jentoft, Nicola Veronese, Stefania Maggi, Antonio Greco, Maria Cristina Polidori, Marc Paccalin, Luigi Ferrucci, Eva Topinkova, Alberto Cella, Julia Daragjati, Alberto Pilotto, Francesco U.S. Mattace-Raso, Giacomo Siri, Arduino A. Mangoni, Internal Medicine, Veronese, N., Siri, G., Cella, A., Daragjati, J., Cruz-Jentoft, A.J., Polidori, M.C., Mattace-Raso, F., Paccalin, M., Topinkova, E., Greco, A., Mangoni, A.A., Maggi, S., Ferrucci, L., and Pilotto, A.
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Male ,Gerontology ,Multivariate analysis ,Prognosi ,Lower risk ,Article ,General Biochemistry, Genetics and Molecular Biology ,Hospital ,03 medical and health sciences ,0302 clinical medicine ,Multidimensional Prognostic Index ,Humans ,Medicine ,Longitudinal Studies ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Geriatric Assessment ,Aged ,Aged, 80 and over ,Sex Characteristics ,030219 obstetrics & reproductive medicine ,Frailty ,business.industry ,Mortality rate ,Australia ,Obstetrics and Gynecology ,Odds ratio ,Prognosis ,Hospitals ,Patient Discharge ,Confidence interval ,Europe ,Hospitalization ,Survival Rate ,Cohort ,Sex ,Female ,Cohort study ,business - 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.
- Published
- 2019
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