title: Psychosocial factors modify the association of frailty with adverse outcomes: a prospective study of hospitalised older people.
abstract: BACKGROUND
  Frailty increases the risk of adverse outcomes in older people. The impact of psychosocial factors on frailty and adverse clinical outcomes associated with frailty has not yet been examined in the hospital setting. The aims of this study were to: i) investigate the association between psychosocial factors and frailty, and ii) to establish whether psychosocial factors impact on the association between frailty and adverse outcomes.
  
  
  METHODS
  Data was collected from a Geriatric Evaluation and Management Unit (GEMU) in Australia. Frailty was identified using Fried's frailty criteria. Psychosocial factors included wellbeing, sense of control (mastery), social activities, home/neighbourhood satisfaction, social relationships, anxiety and depression. Outcome measures were: mortality at 12 months, long length of GEMU stay (LOS), 1-month emergency rehospitalisation, and a higher level of care needed on discharge. Covariates adjusted for were age, gender and comorbidity.
  
  
  RESULTS
  The mean (SD) age of participants (n = 172) at admission was 85.2 (6.4) years, with 129 (75%) female patients. 96 (56%) patients were classified as frail, with 64 (37%) pre-frail and 12 (7%) robust. Frail patients had an increased likelihood of 12-month mortality (HR, 95% CI = 3.16, 1.36-7.33), discharge to a higher level of care (OR, 95% CI = 2.40, 1.21-4.78), long LOS (OR, 95% CI = 2.04, 1.07-3.88) and 1-month emergency rehospitalisation (OR, 95% CI = 2.53, 1.10-5.82). Psychosocial factors associated with frailty included poor wellbeing, anxiety, depression, and a low sense of control. Several psychosocial factors increased the likelihood of adverse outcomes associated with frailty, including anxiety and low ratings for: wellbeing, sense of control, social activities and home/neighbourhood satisfaction.
  
  
  CONCLUSIONS
  Our results indicate that frail older adults with low psychosocial resources had an elevated risk of mortality, discharge to higher level care, long LOS and rehospitalisation. Consideration of psychosocial factors in comprehensive geriatric assessments will assist in patient care planning.
authors.affiliation: Discipline of Public Health, School of Population Health, The University of Adelaide, 178 North Terrace-Terrace Towers, Adelaide, Australia. elsa.dent@adelaide.edu.au.
authors.forename: Elsa
authors.initials: E
authors.lastname: Dent
authors.forename: Emiel O
authors.initials: EO
authors.lastname: Hoogendijk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012944:Social Support; D016896:Treatment Outcome