Geriatric syndromes including polypharmacy and frailty are highly prevalent among hospitalised adults aged 65 years or older and the cumulative number of syndromes at admission is independently associated with a marked rise in 90-day mortality, a large international study has found.
This multicentre prospective cohort study aimed to measure the prevalence of geriatric syndromes at hospital admission and to examine whether the cumulative burden of these syndromes was independently associated with 90-day all-cause mortality.
Led by the Creating a Hospital Assessment Network in Geriatrics (CHANGE) Study Group, with coordination across academic geriatric teams in multiple countries, the study enrolled 2,556 consecutive patients aged 65 years or older who were admitted under geriatric teams between June 2022 and December 2023.
Participants were recruited from 43 hospitals across five countries: Brazil (n=38 hospitals), Angola (n=1), Chile (n=1), Colombia (n=2) and Portugal (n=1). Patients with terminal illness, defined as a Clinical Frailty Scale score of 9, and those hospitalised for less than 48 hours were excluded. The mean age of the cohort was 79 years and 56.2% were women. Most hospitals were publicly funded and located in low- and middle-income settings.
Geriatric syndromes and all-cause mortality
Within 48 hours of admission, trained assessors conducted a standardised comprehensive geriatric assessment covering 14 geriatric syndromes, including disability, frailty, polypharmacy, sensory impairment, delirium, malnutrition, falls, incontinence, immobility, dementia, depressive symptoms, loneliness, pressure ulcers and potentially inappropriate medication use.
The primary outcome was 90-day all-cause mortality, determined through masked telephone follow-up and verification in records or registries.
The median number of geriatric syndromes per patient was five. Disability was the most prevalent syndrome (70.8%), followed by polypharmacy (61.7%), frailty (58.2%) and sensory impairment (54.7%).
Mortality increased stepwise with a higher syndrome count, rising from 8.4% in patients with zero to two syndromes to 47.0% in those with 11 or more. After adjustment for age, comorbidity burden, illness severity and health-system factors, each additional geriatric syndrome was associated with a 22% higher hazard of death within 90 days.
Informing care planning
The authors concluded that multidomain geriatric assessments at hospital admission provided important prognostic information beyond traditional disease-centred measures, which could help to identify at-risk patients, guide interventions and inform care planning.
A lack of generalisability was acknowledged by the authors due to the predominance of Brazilian hospital sites, as well as limitations regarding recruitment from patients already under geriatric care, and the use of an unweighted syndrome count rather than syndrome-specific weighting.
They also noted that the operational list of syndromes was pragmatic rather than exhaustive and highlighted the need for future implementation research to embed streamlined, context-appropriate geriatric assessments into routine hospital workflows, particularly in resource-constrained settings.
Reference
Avelino-Silva TJ et al. Geriatric Syndromes and Mortality Among Hospitalized Older Adults. JAMA Netw Open 2026 Jan 2;9(1):e2555740.
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