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. 2019 Oct:128:81-86.
doi: 10.1016/j.maturitas.2019.07.025. Epub 2019 Aug 3.

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

Nicola Veronese  1 , Giacomo Siri  2 , Alberto Cella  2 , Julia Daragjati  3 , Alfonso J Cruz-Jentoft  4 , Maria Cristina Polidori  5 , Francesco Mattace-Raso  6 , Marc Paccalin  7 , Eva Topinkova  8 , Antonio Greco  9 , Arduino A Mangoni  10 , Stefania Maggi  11 , Luigi Ferrucci  12 , Alberto Pilotto  13 ; MPI AGE Investigators
Affiliations

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

Nicola Veronese et al. Maturitas. 2019 Oct.

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: Cohort study; Hospital; Multidimensional Prognostic Index; Prognosis; Sex.

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Conflict of interest statement

Declaration of Competing Interest

The authors declare that they have no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Differences in mortality between male and female sex in hospitalized older people.
See this image and copyright information in PMC

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