The association between the degree of frailty and the risk of hospital related adverse events in older acutely admitted patients

INTRODUCTION: Frailty is an age-related syndrome characterised by increased vulnerability. Hospital-related adverse events (AEs) are complications not directly caused by patient's conditions. While age has been widely studied, less is known about the effect of the degree of frailty on in-hospital AEs among older adults. METHODS: This single-centre observational study used routinely collected data from a university teaching hospital in the UK October 2017 and 2023. Patients aged ≥65 admitted via the Emergency d.Department (ED) with a recorded frailty score at ED using the Clinical Frailty Scale (CFS) were included. AE types were in-hospital falls, pressure ulcers, moisture damage, infections, medication-related events, self-harm, discharge/transfer incidents and hospital injuries. Poisson regression models were used to estimate associations between frailty and AEs, adjusting for age, sex, ethnicity, ED wait time and Inpatient (IP) length of stay. RESULTS: Out of 369 798 admissions, 158 470 were included, and the degree of frailty was significantly associated with increased risk of AE. Compared to non-frail patients, adjusted RRs for those with CFS 7-9: in-hospital falls (RR = 1.46), pressure ulcers (RR = 2.75), moisture damage (RR = 3.56), infections (RR = 2.03), discharge/transfer incidents (RR = 2.42) and hospital injuries (RR = 1.66). While AE risk increased with frailty, some AE showed a slight decline in the severely frail group. CONCLUSION: The degree of frailty was associated with the risk of hospital-related AEs in older adults. Higher degree of frailty was associated with multiple AE types, supporting early frailty identification, targeted preventive strategies and tailored care for risk reduction.