Frailty, multimorbidity and adverse hospitalization outcomes: a cross-sectional study of geriatric patients in a low-resource setting

Abstract

Background: As the global population ages, frailty has emerged as a critical predictor of adverse hospitalization outcomes. In low-resource settings like Bangladesh, socioeconomic barriers frequently lead to Discharge Against Medical Advice (DAMA), yet the specific role of frailty in driving these premature discharges remains poorly understood. Methods: A cross-sectional study was conducted at Sir Salimullah Medical College Mitford Hospital, Dhaka, involving 250 inpatients aged ≥ 50 years. Frailty was assessed using the 9-point Clinical Frailty Scale (CFS), categorized into three tiers: Low Risk/Vulnerable (CFS 2-4), Moderately Frail (CFS 5-6), and Severely/Terminally Frail (CFS 7-9). Multimorbidity and hospitalization outcomes (mortality, length of stay, and DAMA) were analyzed using Pearson's Chi-square and binary logistic regression. Results: High levels of frailty were observed, with 60% of the cohort classified as moderately to severely frail. Multimorbidity was prevalent, led by diabetes (53.6%), hypertension (50.0%), and anemia (49.6%). The DAMA rate was alarmingly high at 61.6%. Logistic regression identified moderate frailty as a primary predictor of DAMA (AOR = 2.66, 95% CI: 1.26-5.64, p = 0.011), while severe frailty did not reach statistical significance (p = 0.313). Patients identified home health monitoring (81.2%) and financial support (57.2%) as the most critical needs to reduce future hospitalizations. Conclusions: Moderate frailty serves as a critical tipping point where clinical needs and caregiver burden intersect, significantly increasing the risk of DAMA. Addressing geriatric outcomes in Bangladesh requires integrating clinical frailty assessments with socioeconomic support and home-based care strategies to mitigate premature hospital discharge.