Frailty Syndrome and Its Associated Factors Among Elderly Patients

The 30-Item Frailty Index (FI):

Frailty will be assessed using a 30-item Frailty Index (FI) constructed in accordance with the deficit accumulation model originally proposed by Rockwood and Mitnitski. This model conceptualizes frailty as the cumulative burden of age-related health deficits across multiple physiological domains. Each deficit is coded as 0 (absent) or 1 (present); where a deficit is gradable in severity, an intermediate score of 0.5 is assigned. The FI is calculated by the following formula:

FI="Number of deficits present" /30

Participants are subsequently classified into three frailty categories according to their FI score:

FI Score Frailty Category < 0.10 Robust 0.10 - 0.24 Pre-frail

≥ 0.25 Frail

The 30 deficits are distributed across six sections as follows:

Section A: Chronic Diseases (10 items) The presence of each chronic disease is confirmed through a combination of patient interview, review of medical records, and available investigation results. The ten items are: hypertension (diagnosed and/or on antihypertensive therapy); diabetes mellitus (diagnosed and/or on antidiabetic treatment); ischemic heart disease (confirmed by electrocardiography, echocardiography, or documented medical history); heart failure (diagnosed clinically and/or by echocardiographic assessment of ejection fraction); atrial fibrillation (confirmed on 12-lead ECG or Holter monitoring); prior stroke or transient ischemic attack (documented cerebrovascular event in the medical record); chronic obstructive pulmonary disease or chronic lung disease (diagnosed by spirometry or clinical assessment); chronic kidney disease (estimated glomerular filtration rate below 60 mL/min/1.73m² for more than three months); chronic liver disease (confirmed by clinical, laboratory, or imaging findings); and active or prior malignancy (confirmed by histopathological report or documented in the clinical record).

Section B: General Symptoms (5 items):

These items are assessed through a structured patient interview. They include: unintentional weight loss, defined as a loss of more than 4.5 kg or more than 5% of body weight over the preceding year; persistent fatigue, defined as self-reported fatigue present most of the time for a duration of three or more months; chronic pain, defined as pain persisting beyond three months and requiring regular analgesia or limiting daily activity; dyspnea on exertion, graded using the Modified Medical Research Council (mMRC) Dyspnea Scale with a score of 2 or above considered positive; and poor appetite, defined as self-reported reduction in food intake over the preceding month.

Section C: Basic Activities of Daily Living - ADL (5 items):

Functional status with respect to basic self-care activities will be assessed using the Katz Activities of Daily Living (ADL) Scale. Dependency in any of the following activities will be coded as 1 (dependent) versus 0 (independent): bathing, dressing, toileting, transferring from bed to chair, and feeding. Pre-admission functional status will be recorded based on patient or caregiver recall to reflect the patient's baseline prior to the acute illness.

Section D: Instrumental Activities of Daily Living - IADL (4 items):

Higher-order functional independence will be assessed using the Lawton Instrumental Activities of Daily Living (IADL) Scale. The four items assessed are: ability to use a telephone, ability to shop, ability to prepare meals, and ability to manage medications. Each item is coded as 0 (independent) or 1 (dependent).

Section E: Cognition and Mood (3 items):

Cognitive status will be evaluated using the Mini-Mental State Examination (MMSE); a score below 24 will be coded as cognitive impairment (1). Depressive symptoms will be screened using the 15-item Geriatric Depression Scale (GDS-15); a score of 6 or above will be coded as depression (1). Subjective memory complaint, defined as self-reported difficulty with memory not fully captured by formal cognitive testing, will be recorded separately and coded as 0 (absent) or 1 (present).

Section F: Physical and Laboratory Indicators (3 items):

Three objectively measured indicators will be included. Anemia is defined according to World Health Organization (WHO) criteria as a hemoglobin level below 13 g/dL in men and below 12 g/dL in women, determined from the admission complete blood count. Hypoalbuminemia is defined as a serum albumin level below 3.5 g/dL, measured using the colorimetric bromocresol green (BCG) method on the admission blood sample. Abnormal body mass index (BMI) is defined as BMI below 18.5 kg/m² (underweight) or 30 kg/m² and above (obese); body weight will be measured using a calibrated digital scale with the patient in light clothing and without footwear, and height will be measured using a wall-mounted stadiometer.

• a. Inclusion criteria:
• Age ≥ 60 years
• Patient attending Assiut university hospital during the study period, regardless primary diagnosis.
• Ability to provide informed consent and agreed to participate in the study.
• Ability to communicate and answer the study questionnaire.
• b. Exclusion criteria:
• Age < 60 years
• Patients admitted for elective surgical procedures or transferred from surgical wards
• Patients with a terminal illness or those receiving palliative/end-of-life care only
• Patients with incomplete medical records or inability to complete the assessment due to severe aphasia or critical hemodynamic instability
• Patients with severe cognitive impairment or psychiatric disorders affecting communication.
• Patients who refused to participate