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. 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: 18months) was collected through the regional electronic health data system with an 18-month follow-up period. 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. 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.

Adult patients referred for physical function evaluation by physio- or occupational therapists were evaluated with the Cumulated Ambulation Score (CAS) for basic mobility, 30sec-Sit-To-Stand-test (30s-STS) for muscle strength and function in lower extremities, and handgrip strength (HGS) as a proxy for general muscle strength. Results were categorized as normal (mean+/-1SD) or reduced (<-1SD) according to Danish sex- and age-decade reference values. The day of the first CAS assessment was used as an index for 1-year mortality in Cox regression analysis adjusted for age, sex, and multimorbidity (M3-index >1 point). A total of 5062 unselected patients with a mean±SD age of 74.5±13.9 years (54% women), were evaluated with CAS in an acute (n = 337), surgical (n = 1671) or medical (n = 3054) ward. Of these, the 30s-STS was assessed in 85% (n = 4309) and HGS in 51% (n = 2580) patients, respectively. One-year mortality was 19.3%. The adjusted hazard ratio for 1-year mortality in patients with reduced CAS-mobility (57%), reduced 30s-STS (93%), and reduced HGS (44%) was 1.98 (95%CI, 1.71-2.29), 3.57 (2.21-5.78), and 2.06 (1.66-2.56), respectively, versus those with a normal physical function in respective tests. Correspondingly, hazard ratios for patients ≥85 years of age (n = 1185) were 2.02, 3.34 and 1.98. In older medical and surgical hospitalised patients with reduced physical function (CAS, 30s-STS or HGS) 1-year mortality was markedly increased. This simple test battery is rapid and low-cost and can easily be implemented in other hospitals, acute care facilities, and across sectors.