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Key summary points Aim <p>To develop a simple admission risk stratification rule to identify older inpatients at risk of hospital-associated disability (HAD).</p> Findings <p>A four-item rule (age ≥ 80, CFS ≥ 5, MMSE ≤ 23, emergency admission) stratified HAD risk effectively (AUC 0.80). Low scores identified patients with very low risk, whereas high scores identified those at markedly increased risk.</p> Message <p>This bedside rule supports targeted use of comprehensive geriatric assessment and tailored management while avoiding unnecessary intervention in low-risk patients.</p> Abstract <p>Hospital-associated disability (HAD) is a frequent complication in hospitalized older adults and is associated with unfavorable outcomes. Because preventive interventions require substantial resources, efficient identification of high-risk patients at admission is required. We developed a simple admission-based clinical decision rule for early risk stratification using routinely available admission information.</p> Methods <p>In a multicenter retrospective cohort study, adults aged ≥ 65&#xa0;years admitted to acute care hospitals between October 2019 and March 2025 were included. HAD was defined as a ≥ 5-point decline in the Barthel Index from admission to discharge. Candidate predictors included age, admission type, Clinical Frailty Scale (CFS), and Mini-Mental State Examination (MMSE). A multivariable logistic regression model derived a simplified point-based score; discrimination was assessed by AUC, calibration by bootstrap-corrected calibration, and clinical utility by decision curve analysis with 2,000 bootstrap resamples.</p> Results <p>Among 1,292 patients (mean age 82.9 ± 6.7&#xa0;years, 58.2% women), 26.2% developed HAD. The final score (0–8 points) included emergency admission, frailty (CFS ≥ 5), cognitive impairment (MMSE ≤ 23), and age ≥ 80&#xa0;years. Discrimination was good (AUC 0.796; 95% CI 0.771–0.820) with adequate calibration. HAD incidence increased from &lt; 5% in the lowest-risk group to ~ 50% in the highest-risk group, and decision curve analysis showed net clinical benefit across relevant thresholds.</p> Conclusions <p>This bedside rule supports targeted use of comprehensive geriatric assessment and tailored management while avoiding unnecessary intervention in low-risk patients.</p>

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A simple admission-based risk score for hospital-associated disability in older adults

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月9日

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  • Hiroyuki Umegaki,
  • Hirotaka Nakashima,
  • Yosuke Yamada,
  • Kazuhisa Watanabe,
  • Chisato Fujisawa,
  • Hitoshi Komiya,
  • Tomihiko Tajima,
  • Shosuke Satake,
  • Yasushi Takeya,
  • Mitsutaka Yakabe

摘要

Key summary points Aim

To develop a simple admission risk stratification rule to identify older inpatients at risk of hospital-associated disability (HAD).

Findings

A four-item rule (age ≥ 80, CFS ≥ 5, MMSE ≤ 23, emergency admission) stratified HAD risk effectively (AUC 0.80). Low scores identified patients with very low risk, whereas high scores identified those at markedly increased risk.

Message

This bedside rule supports targeted use of comprehensive geriatric assessment and tailored management while avoiding unnecessary intervention in low-risk patients.

Abstract

Hospital-associated disability (HAD) is a frequent complication in hospitalized older adults and is associated with unfavorable outcomes. Because preventive interventions require substantial resources, efficient identification of high-risk patients at admission is required. We developed a simple admission-based clinical decision rule for early risk stratification using routinely available admission information.

Methods

In a multicenter retrospective cohort study, adults aged ≥ 65 years admitted to acute care hospitals between October 2019 and March 2025 were included. HAD was defined as a ≥ 5-point decline in the Barthel Index from admission to discharge. Candidate predictors included age, admission type, Clinical Frailty Scale (CFS), and Mini-Mental State Examination (MMSE). A multivariable logistic regression model derived a simplified point-based score; discrimination was assessed by AUC, calibration by bootstrap-corrected calibration, and clinical utility by decision curve analysis with 2,000 bootstrap resamples.

Results

Among 1,292 patients (mean age 82.9 ± 6.7 years, 58.2% women), 26.2% developed HAD. The final score (0–8 points) included emergency admission, frailty (CFS ≥ 5), cognitive impairment (MMSE ≤ 23), and age ≥ 80 years. Discrimination was good (AUC 0.796; 95% CI 0.771–0.820) with adequate calibration. HAD incidence increased from < 5% in the lowest-risk group to ~ 50% in the highest-risk group, and decision curve analysis showed net clinical benefit across relevant thresholds.

Conclusions

This bedside rule supports targeted use of comprehensive geriatric assessment and tailored management while avoiding unnecessary intervention in low-risk patients.