Abstract

Background: This study aims to identify risk factors and develop a predictive model for frailty progression in older adults with geriatric conditions. It assesses the impact of cardiac function-related frailty decompensation on adverse events, compares outcomes between compensated and decompensated (LVEF ≤ 52.5%) subgroups, and elucidates the clinical and prognostic significance of decompensation. The findings aim to provide a scientific basis for early identification and intervention in frail elderly individuals.

Methods: From January 2022 to June 2024, a total of 538 elderly patients diagnosed with geriatric syndromes were consecutively enrolled from The Affiliated Chuzhou Hospital of Anhui Medical University. Participants were classified into frail and non-frail groups based on the Fried phenotype criteria. The frailty group was further stratified into compensated (LVEF > 52.5%) and decompensated (LVEF ≤ 52.5%) subgroups using the LVEF threshold derived from ROC curve analysis. The median follow-up duration was 24 months (interquartile range: 18–30 months). Multivariate Cox regression was employed to identify independent predictors of frailty progression, and the predictive performance of the model was evaluated using ROC analysis. The association between frailty decompensation and adverse clinical outcomes, as well as hospitalization frequency, was assessed using the χ² test and Spearman correlation analysis.

Results: Of the 538 patients, 237 (44.05%) were identified as frail. Independent risk factors for frailty progression included advanced age, lower Mini Nutritional Assessment Short Form (MNA-SF) scores, reduced left ventricular ejection fraction (LVEF), low serum albumin levels, New York Heart Association (NYHA) functional class III–IV, and comorbid anxiety or depression. ROC analysis identified an optimal LVEF threshold of 52.5% for predicting frailty decompensation (AUC = 0.852, sensitivity = 0.805, specificity = 0.835). Compared with the compensated subgroup, the decompensated subgroup exhibited significantly higher rates of urinary incontinence (30.34% vs. 16.89%, P = 0.015), all-cause mortality (43.82% vs. 23.65%, P = 0.008), stroke (48.31% vs. 33.11%, P = 0.020), and cardiovascular events (64.04% vs. 44.59%, P = 0.004). Hospitalization frequency was positively correlated with frailty decompensation (Spearman’s rho = 0.620, P < 0.001).

Conclusion: Frailty is highly prevalent among elderly patients with geriatric syndromes. Advanced age, malnutrition, psychological comorbidities, and impaired cardiac function are significant contributors to frailty progression. An LVEF threshold of ≤52.5% effectively predicts frailty decompensation and is strongly associated with increased risks of major adverse events and hospitalization frequency. Early identification and targeted intervention for frailty decompensation may significantly improve clinical outcomes in this vulnerable population.