Prognostic value of the electronic Multimorbidity Frailty Index for mortality, change in basic activities of daily living, length of hospital stay and discharge home in older hospitalized patients

Kenji Toyoshima^{1

2}, Atsushi Araki^{1

2}, Yoshiaki Tamura^{1

2}, Joji Ishikawa^{2

3}, Rika Iwakiri⁴, Takashi Takei⁵, Kanae Kubo⁶, Satoshi Ono⁷, Shigesaburo Miyakoshi⁸, Ryoji Tanei⁹, Yutaka Kasuya¹⁰, Mitsuhiro Kawata¹¹, Shigehiko Takanashi¹², Kenta Ohara¹², Tsuyoshi Miyazaki¹³, Nobuo Kanazawa¹⁴, Tetsuya Nakazato¹⁴, Hiroshi Yamamoto¹⁵, Atsushi Iwata¹⁶, Kazumasa Harada³, Masaki Anraku¹⁷, Hiroyuki Sasai¹⁸, Shuichi Obuchi¹⁹, Yoshinori Fujiwara^{2

20}, Masahiro Akishita²⁰, Kenji Toba²⁰

Affiliations

¹ Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
² Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
³ Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁴ Department of Geriatric Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁵ Department of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁶ Department of Medicine and Rheumatology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁷ Department of Gastroenterology and Gastrointestinal Endoscopy, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁸ Department of Hematology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁹ Department of Dermatology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁰ Department of Urology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹¹ Department of Cardiovascular surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹² Department of Neurosurgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹³ Department of Orthopedic, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁴ Department of General and Gastrointestinal Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁵ Department of Respiratory Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁶ Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁷ Department of Thoracic Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁸ Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁹ Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
²⁰ Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.

PMID: 40673429
DOI: 10.1111/ggi.70126

Prognostic value of the electronic Multimorbidity Frailty Index for mortality, change in basic activities of daily living, length of hospital stay and discharge home in older hospitalized patients

Kenji Toyoshima et al. Geriatr Gerontol Int. 2025 Sep.

. 2025 Sep;25(9):1185-1193.

doi: 10.1111/ggi.70126. Epub 2025 Jul 17.

Authors

Affiliations

¹ Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
² Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
³ Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁴ Department of Geriatric Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁵ Department of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁶ Department of Medicine and Rheumatology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁷ Department of Gastroenterology and Gastrointestinal Endoscopy, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁸ Department of Hematology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
⁹ Department of Dermatology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁰ Department of Urology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹¹ Department of Cardiovascular surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹² Department of Neurosurgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹³ Department of Orthopedic, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁴ Department of General and Gastrointestinal Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁵ Department of Respiratory Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁶ Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁷ Department of Thoracic Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁸ Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
¹⁹ Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
²⁰ Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.

PMID: 40673429
DOI: 10.1111/ggi.70126

Abstract

Aim: This exploratory study aimed to evaluate the ability of the electronic Multimorbidity Frailty Index, consisting of 35 chronic conditions, including chronic diseases, geriatric syndromes and functional limitations from electronic medical record data, to predict clinical outcomes in hospitalized older adults.

Methods: Our study included 1491 patients aged ≥60 years who were admitted to an acute care hospital. Multimorbidity status was categorized based on the number of chronic conditions included in the electronic Multimorbidity Frailty Index: 0-2 as no or mild, 3-4 as moderate, 5-9 as high and ≥10 as very high multimorbidity. We evaluated the association between multimorbidity categories and clinical outcomes: in-hospital mortality, improvement in basic activities of daily living, extended hospital stay and discharge destination. The hazard ratio (HR) or odds ratio (OR) was calculated using multivariable Cox or logistic regression analyses after adjustment for age, sex and basic activities of daily living score at admission as a reference for no or mild multimorbidity.

Results: Very high multimorbidity was significantly associated with increased in-hospital mortality (HR 3.10, 95% CI 1.28-7.51), less basic activities of daily living improvement (HR 0.51, 95% CI 0.37-0.71), less home discharge for patients admitted from home (HR 0.61, 95% CI 0.44-0.85) and longer hospital stays (OR 2.11, 95% CI 1.34-3.33). High multimorbidity was also associated with extended hospital stay and less discharge to home.

Conclusion: The electronic Multimorbidity Frailty Index reflects the cumulative burden of chronic diseases, geriatric syndromes and limitations, and is associated with important clinical outcomes among hospitalized older adults. It might help identify patients at risk of poor prognosis, supporting appropriate medical treatment and care planning in clinical settings. Geriatr Gerontol Int 2025; 25: 1185-1193.

Keywords: electronic medical records; frailty; hospitalization outcomes; multimorbidity; older adults.

PubMed Disclaimer

References

1. Skou ST, Mair FS, Fortin M et al. Multimorbidity. Nat Rev Dis Primers 2022; 8: 48. https://doi.org/10.1038/s41572-022-00376-4.
1. Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta‐analysis. EClinicalmedicine 2023; 57: 101860. https://doi.org/10.1016/j.eclinm.2023.101860.
1. Saito Y, Igarashi A, Nakayama T, Fukuma S. Prevalence of multimorbidity and its associations with hospitalisation or death in Japan 2014–2019: a retrospective cohort study using nationwide medical claims data in the middle‐aged generation. BMJ Open 2023; 13: e063216. https://doi.org/10.1136/bmjopen-2022-063216.
1. Dorr DA, Markwardt S, Bobo M et al. The extent and burden of high multimorbidity on older adults in the US: a descriptive analysis of Medicare beneficiaries. BMC Geriatr 2024; 24: 777. https://doi.org/10.1186/s12877-024-05329-y.
1. Müller M, Huembelin M, Baechli C et al. Association of in‐hospital multimorbidity with healthcare outcomes in swiss medical inpatients. Swiss Med Wkly 2021; 151: w20405. https://doi.org/10.4414/smw.2021.20405.

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- Wiley

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Prognostic value of the electronic Multimorbidity Frailty Index for mortality, change in basic activities of daily living, length of hospital stay and discharge home in older hospitalized patients

Affiliations

Prognostic value of the electronic Multimorbidity Frailty Index for mortality, change in basic activities of daily living, length of hospital stay and discharge home in older hospitalized patients

Authors

Affiliations

Abstract

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources