Do the Positives Through Life Decrease Later-life Frailty?: Positive Psychosocial Resources and Health Status in Older Adult, a Prospective Cohort Study

Abstract

Background: Frailty is a known predictor of poorer outcomes for hospitalised older adults, but does not account for all variation in outcomes. Health Assets, which include positive psychosocial factors, have been associated with improved outcomes in the hospital setting. Methods: A prospective cohort study from adults aged 70 and older with an unplanned admission to general medical, orthogeriatric and subacute wards of two hospitals in Australia. 298 participants were recruited with an average age of 84.7. The Health Assets Index (HAI), frailty, functional status and covariates were measured at the time of recruitment. Outcomes were mortality at 30 days and functional decline at the time of discharge. Results: 56.4% of participants had functional decline on discharge from hospital with 30 day mortality of 5.7%. People with a higher number of health assets were less likely to be frail (OR 0.36(95%CI 0.19-0.68)). At 30 days, odds of mortality were highest amongst those with high frailty/high-HAI and low frailty/low-HAI. At low levels of health assets, odds of mortality decreased with increasing frailty but this reversed at high levels of health assets where frailty was associated with increased mortality. Conclusions: Health assets and frailty combine to predict the odds of mortality for older people entering hospital. This highlights the need to consider psychosocial factors in conjunction with health status for older adults.