Associations of Frailty, Defined Using Three Different Instruments, with All-Cause Mortality in a Tertiary Outpatient Clinic in Turkiye

Yildiray Topcu,1 Robbert JJ Gobbens,2– 5 Tjeerd van der Ploeg,2 Fatih Tufan6 1Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, Istanbul, Turkiye; 2Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 3Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 4Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; 5Tranzo, Tilburg University, Tilburg, the Netherlands; 6Istanbul Esenler Avicenna Hospital, Department of Internal Medicine and Geriatrics, Istanbul, TurkiyeCorrespondence: Fatih Tufan, Assoc. Prof. of Geriatrics, Istanbul Esenler Avicenna Hospital, Department of Internal Medicine and Geriatrics, Istanbul, Turkiye, Tel +90 5331683458, Email fatihtufan@gmail.comPurpose: To our knowledge, there have been no comparative studies evaluating the associations of frailty defined using the Tilburg Frailty Indicator (TFI), frailty phenotype by Fried et al, and FRAIL scale with all-cause mortality in Turkiye. In this study, we aimed to evaluate the ability of these instruments in predicting all-cause mortality in outpatients admitted to the outpatient geriatrics clinic of a university hospital.Patients and Methods: This historical prospective study was performed in the geriatrics outpatient clinic of a university hospital in Istanbul, Turkiye. Consecutive older adults (aged ≥ 70 years) who provided written informed consent were enrolled in the study. The survival status of participants was checked electronically using the official death registry system. Univariate analyses and multivariate Cox regression analyses were performed to determine the independent predictors of mortality.Results: A total of 198 participants with a median age of 77 years were enrolled. During the median follow-up period of 2236 days, 54 (27.3%) patients died. In univariate analyses, male sex, history of falls in the previous year, dependency in instrumental activities of daily living, malnutrition, and frailty with respect to the phenotype by Fried et al, FRAIL scale, and TFI were associated with mortality. In multivariate Cox regression analyses, frailty according to each of the three frailty instruments, male sex, older age, history of falls, and malnutrition or malnutrition risk were independently associated with mortality. The Fried scale was the best frailty tool among the three frailty instruments used to predict all-cause mortality.Conclusion: The findings of this study suggest that frailty, determined using each of the three instruments used in the present study, is independently associated with all-cause mortality in patients admitted to the outpatient geriatrics clinic of a university hospital in Turkiye. The Fried scale appears to be the best for predicting all-cause mortality.Keywords: Turkiye, frailty, mortality, malnutrition, falls, dependency