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

bjectives:The association between frailty, mortality and sex is complex, but a limited literature is available onthis topic, particularly for older hospitalized patients. Therefore, the objective of our study was to prospectivelyevaluate sex differences in frailty, assessed by the Multidimensional Prognostic Index (MPI) and mortality, in-stitutionalization, 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 inmortality, 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 fora relapse of a chronic disease were included. A standardized comprehensive geriatric assessment, which eval-uated 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 re-garding 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 diag-nosis 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 pa-tients (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 mortalitythan women. Women were admitted more frequently to nursing homes and experienced a lower risk of re-hospitalization. Thesefindings suggest important differences between the sexes and extends the'male-femalehealth-survival paradox'to acutely ill patient group