Impact of pressure ulcers and frailty on long-term mortality: a prospective cohort study of hospitalized older adults

Purpose: This study investigates the impact of pressure ulcers (PU) on long-term survival in hospitalized older adults, to understand how frailty and PU interact to influence mortality and to explore their independent prognostic accuracy. Methods: Between February 21, 2022, and July 1, 2022, 324 patients (198 female, 126 male; mean age: 86), admitted to the Geriatric Unit and Transitional Care of San Bartolomeo Hospital, Sarzana, Italy, were enrolled. A comprehensive geriatric assessment (CGA) was performed by geriatricians, including the assessment of frailty using the Clinical Frailty Scale (CFS), and PU assessment, carried out by a trained nurse. Long-term mortality (median duration: 18 months) was collected through the regional electronic health data system with an 18-month follow-up period. Results: Older adults with PU had advanced frailty, higher nutritional risk, increased disability, and higher polypharmacy. Multivariate analysis showed that both frailty (CFS: HR 1.535, 95% CI 1.314-1.793, p < 0.001) and PU (HR 1.500, 95% CI 1.059-2.126, p = 0.020) were significant predictors of long-term mortality. Namely, each increment in CFS score was associated with a 53% increased risk in PU carriers. No significant interaction between CFS and PU on survival outcomes was found. Conclusion: The study underscored the independent prognostic significance of both PU and frailty in predicting long-term mortality in hospitalized older adults. A multidimensional approach considering both frailty and PU is crucial for accurate prognostication and improving care strategies for older patients.