Geriatric Syndromes and Mortality Among Hospitalized Older Adults
Thiago J. Avelino-Silva, Maria Fernanda B. Roma, Adriana F. Dutra, Alexandra Malheiro, Ana Cristina C. Speranza, Arlety M. C. Casale, Beatriz N. A. Lopes, Clineu M. Almada-Filho, Danilsa V. de Sousa, Eduardo Marques da Silva, Fabiola Sepulveda, Flavia Barreto Garcez, Gabriel T. Constantino, Gabriela S. Keller, Ianna L. S. Braga, Jonas Gordilho Souza, Juliana J. M. Teixeira, Karoline Rodrigues da Silva Martins, Laiane Moraes Dias, Lara M. Q. Araujo, Luana A. C. Macedo, Lucas G. de Andrade, Lucas K. P. Prado, Luis Carlos Venegas‐Sanabria, Marco P. D. Freitas, Marcos D. C. Saraiva, Maria Aparecida C. Bicalho, Maria Carolyna F. B. Arbex, Maria E. Pires, Maria M. V. Guedes, Marina M. G. Borges, Milton L. Gorzoni, Mirella R. Bezerra, Natalia I. B. Garção, Natascha G. F. Palmeira, Nereida K. C. Lima, Oberdã G. Moreira-Filho, Paulo José F. Villas Boas, Perola Q. de Almeida, Renata M. Dip, Renato G. Bandeira de Mello, Samir A. Aruachan, Theodora Karnakis, Vitor L. Pintarelli, Welma W. C. C. Amorim, Yngrid Dieguez Ferreira, Kenneth E. Covinsky, Eduardo Ferriolli, Sei J. Lee, Alexander K. Smith, Claudia K. Suemoto, Marlon J. R. Aliberti, CHANGE Study Group, Ivan M. de Oliveira, Diana Francisco, Eunice Andrade, Nazareth Neto, Nidia Van Dunem, Beatriz N. Cunha, Ewerton Miyadahira, Gustavo M. Mil Homens, Lisa L. Mello, Mariana M. Teruya, Mario S. S. Cabral, Matheus P. Viola, Renato T. Galvão, Beatriz N. Nassif, Dannielle M. Guimarães, Ezemir D. Fernandes, Flavia A. de Amorim, Flávia Campora, Flavia T. T. Nakamura, Jose S. Cardoso, Julia M. Menezes, Luis E. M. Martins, Mayara V. Batista, Raiza T. Lira, Silvio C. Amorim, Vitor A. Fontenelles, Gabriela M. Costa, Julio C. Moriguti, Edgar N. de Moraes, Tatiana C. E. Pinheiro, Alicia R. M. Accioly, Hugo O. D. M. Gomes, Mariana A. de Luna, Mayara S. Honorato, Milena B. A. Silva, Rebeca M. S. Coelho, Rosana S. Batista, André Fattori, Estela F. Vilela, Jessica Valonini, Rodolfo A. O. Nogueira, Emilio H. Moriguchi, Francine F. Klein, Aline T. S. Santos, Giovanni G. N. Santos, João G. A. de Lima, Juliana C. de Souza
Abstract
Importance: Geriatric syndromes are common in hospitalized older adults and complicate acute care; however, their overall prevalence and cumulative burden remain poorly understood, especially in resource-limited settings. Objectives: To measure the prevalence of geriatric syndromes upon hospital admission and examine the independent association between the number of geriatric syndromes and 90-day mortality. Design, Setting, and Participants: This cohort study used data from the Creating a Hospital Assessment Network in Geriatrics (CHANGE) study, a multicenter, prospective cohort of 43 hospitals, including 38 in Brazil, 1 in Angola, 1 in Chile, 2 in Colombia, and 1 in Portugal. Consecutive patients aged 65 years or older admitted under geriatric teams between June 1, 2022, and December 31, 2023, were enrolled within 48 hours; patients with terminally illness were excluded. Data were analyzed from February 1 to November 23, 2025. Exposure: A standardized comprehensive geriatric assessment captured 14 geriatric syndromes: loneliness, dementia, depressive symptoms, sensory impairment, disability, immobility, incontinence, falls, frailty, malnutrition, pressure ulcers, polypharmacy, potentially inappropriate medications, and delirium. The exposure of interest was the within-patient count of syndromes. Main Outcomes and Measures: The primary outcome was 90-day all-cause mortality, ascertained by masked telephone follow-up with verification in medical records or public registries. Prespecified mixed-effects Cox proportional hazards regression were performed. Results: The study included 2556 participants (mean [SD] age, 79 [9] years, 1437 female [56.2%]). The median number of geriatric syndromes was 5 (IQR, 3-8). The highest prevalence rates for syndromes were 70.8% (95% CI, 69.1%-72.6%) for disability, 61.7% (95% CI, 59.8%-63.6%) for polypharmacy, 58.2% (95% CI, 56.3%-60.1%) for frailty, and 54.7% (95% CI, 52.8%-56.7%) for sensory impairment. Across categories, the mortality rate rose from 8.4% (95% CI, 6.2%-11.4%) for 0 to 2 syndromes to 12.7% (95% CI, 10.1%-15.7%) for 3 to 4 syndromes, 25.4% (95% CI, 22.2%-29.1%) for 5 to 6 syndromes, 30.4% (95% CI, 26.7%-34.5%) for 7 to 8 syndromes, 39.5% (95% CI, 34.4%-44.8%) for 9 to 10 syndromes, and 47.0% (95% CI, 36.4%-57.9%) for 11 or more syndromes. After adjusting for confounders, each additional geriatric syndrome was associated with an increased risk of mortality (hazard ratio, 1.22 [95% CI, 1.15-1.30), which became increasingly pronounced in older age groups. Conclusions and Relevance: This cohort study found that hospitalized older adults had a median of 5 geriatric syndromes, which were independently and incrementally associated with 90-day mortality. Multidomain assessments should be integrated into standard hospital care to identify and address vulnerabilities that commonly affect older adults with acute illness.