Prognostic value of the electronic Multimorbidity Frailty Index for mortality, change in basic activities of daily living, length of hospital stay and discharge home in older hospitalized patients
Corresponding Author
Kenji Toyoshima
Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Correspondence
Kenji Toyoshima MD, PhD, Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan. Email: [email protected]
Search for more papers by this authorAtsushi Araki
Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorYoshiaki Tamura
Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorJoji Ishikawa
Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorRika Iwakiri
Department of Geriatric Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorTakashi Takei
Department of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorKanae Kubo
Department of Medicine and Rheumatology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorSatoshi Ono
Department of Gastroenterology and Gastrointestinal Endoscopy, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorShigesaburo Miyakoshi
Department of Hematology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorRyoji Tanei
Department of Dermatology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorYutaka Kasuya
Department of Urology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorMitsuhiro Kawata
Department of Cardiovascular surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorShigehiko Takanashi
Department of Neurosurgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorKenta Ohara
Department of Neurosurgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorTsuyoshi Miyazaki
Department of Orthopedic, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorNobuo Kanazawa
Department of General and Gastrointestinal Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorTetsuya Nakazato
Department of General and Gastrointestinal Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorHiroshi Yamamoto
Department of Respiratory Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorAtsushi Iwata
Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorKazumasa Harada
Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorMasaki Anraku
Department of Thoracic Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorHiroyuki Sasai
Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorShuichi Obuchi
Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorYoshinori Fujiwara
Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorMasahiro Akishita
Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorKenji Toba
Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Kenji Toyoshima
Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Correspondence
Kenji Toyoshima MD, PhD, Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan. Email: [email protected]
Search for more papers by this authorAtsushi Araki
Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorYoshiaki Tamura
Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorJoji Ishikawa
Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorRika Iwakiri
Department of Geriatric Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorTakashi Takei
Department of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorKanae Kubo
Department of Medicine and Rheumatology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorSatoshi Ono
Department of Gastroenterology and Gastrointestinal Endoscopy, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorShigesaburo Miyakoshi
Department of Hematology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorRyoji Tanei
Department of Dermatology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorYutaka Kasuya
Department of Urology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorMitsuhiro Kawata
Department of Cardiovascular surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorShigehiko Takanashi
Department of Neurosurgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorKenta Ohara
Department of Neurosurgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorTsuyoshi Miyazaki
Department of Orthopedic, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorNobuo Kanazawa
Department of General and Gastrointestinal Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorTetsuya Nakazato
Department of General and Gastrointestinal Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorHiroshi Yamamoto
Department of Respiratory Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorAtsushi Iwata
Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorKazumasa Harada
Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorMasaki Anraku
Department of Thoracic Surgery, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorHiroyuki Sasai
Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorShuichi Obuchi
Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorYoshinori Fujiwara
Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorMasahiro Akishita
Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorKenji Toba
Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
Search for more papers by this authorAbstract
Aim
This exploratory study aimed to evaluate the ability of the electronic Multimorbidity Frailty Index, consisting of 35 chronic conditions, including chronic diseases, geriatric syndromes and functional limitations from electronic medical record data, to predict clinical outcomes in hospitalized older adults.
Methods
Our study included 1491 patients aged ≥60 years who were admitted to an acute care hospital. Multimorbidity status was categorized based on the number of chronic conditions included in the electronic Multimorbidity Frailty Index: 0–2 as no or mild, 3–4 as moderate, 5–9 as high and ≥10 as very high multimorbidity. We evaluated the association between multimorbidity categories and clinical outcomes: in-hospital mortality, improvement in basic activities of daily living, extended hospital stay and discharge destination. The hazard ratio (HR) or odds ratio (OR) was calculated using multivariable Cox or logistic regression analyses after adjustment for age, sex and basic activities of daily living score at admission as a reference for no or mild multimorbidity.
Results
Very high multimorbidity was significantly associated with increased in-hospital mortality (HR 3.10, 95% CI 1.28–7.51), less basic activities of daily living improvement (HR 0.51, 95% CI 0.37–0.71), less home discharge for patients admitted from home (HR 0.61, 95% CI 0.44–0.85) and longer hospital stays (OR 2.11, 95% CI 1.34–3.33). High multimorbidity was also associated with extended hospital stay and less discharge to home.
Conclusion
The electronic Multimorbidity Frailty Index reflects the cumulative burden of chronic diseases, geriatric syndromes and limitations, and is associated with important clinical outcomes among hospitalized older adults. It might help identify patients at risk of poor prognosis, supporting appropriate medical treatment and care planning in clinical settings. Geriatr Gerontol Int 2025; ••: ••–••.
Open Research
Data availability statement
The data supporting the findings of this study are available upon reasonable request from the corresponding author.
Supporting Information
| Filename | Description |
|---|---|
| ggi70126-sup-0001-Supplementary_Table_1.docxWord 2007 document , 19.1 KB | Table S1. Electronic Multimorbidity Frailty index (original:45 items) and eMFI-35. |
| ggi70126-sup-0002-Supplementary_Table_2.docxWord 2007 document , 17.8 KB | Table S2. Classification of Hospitalization Diagnoses Based on ICD-10. |
| ggi70126-sup-0003-Supplementary_Table_3.docxWord 2007 document , 21.6 KB | Table S3a. Cox regression analysis for the association between the eMFI-35 categories with different cut-off and in-hospital death. Table S3b. Cox regression analysis for the association between number of chronic diseases and in-hospital death. Table S3c. Cox regression analysis for the association between the eMFI-45 and in-hospital death. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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