Frailty, not old age, best predictor of death

A new study involving researchers from the University of Aberdeen has found that regardless of age, the more frail a patient is, the less likely they are to survive.

The study, published in the journal Age and Ageing by Oxford University Press, indicates that frail patients in any age group are more likely to die than those who are not frail.

Data from more than 2,200 patients in the UK found that each incremental step of worsening frailty was associated with an 80% increase in mortality 90 days after initial admission to hospital. In addition, the frailest patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days.

Previously, studies on frailty have evaluated patients in terms of frail or not (with an intermediate category of pre-frail in between). This is the first study to look at this relationship in more detail. 

Surgeons are faced with challenging decision-making processes and it is not standard practice to reject a frail patient for emergency surgery based on their condition. This is the first study to assess frailty in adults of all ages admitted as a surgical emergency, finding that frailty exists in all age groups and is not exclusive to the older adult population. The researchers here demonstrated that there is an approximately linear relationship between increasing frailty and increased odds of mortality 90 days after initial admission; increasing frailty is associated with incrementally worsening outcomes.

Professor Myint, Chair in Old Age Medicine at the University of Aberdeen and one of the authors, explained:  “This is an important finding for clinical practice. This knowledge will help clinicians in identifying surgical patients with poor prognosis so that they can make appropriate management decisions and also help them to communicate with the patients and families regarding the prognosis”

This study aimed to evaluate the prevalence of frailty its associated risk of death, readmission rate, and length of hospital stay in all adults, regardless of age, admitted as a surgical emergency. Researchers here assessed on a frailty scale with values from one to seven, with one indicating patients who were “robust, active, energetic, well-motivated and fit” and seven indicating patients who were severely frail; they were “completely dependent on others for activities of daily living, or terminally ill.”

Lead author Dr Jonathan Hewitt, Clinical Senior Lecturer at Cardiff University added: “We found that patients fared worse as they become more frail.

 “This was true even in people who were classed as only slightly frail and got increasingly worse the frailer you were.”

The paper “Frailty Predicts Mortality in All Emergency Surgical Admissions regardless of Age. An observational study” is available at: