Search Results (72)

Background and objectives: In older and frail patients, in-hospital cardiac arrest (IHCA) is associated with high mortality. Early warning scores such as the National Early Warning Score 2 (NEWS2) are widely used to detect clinical deterioration, but their predictive accuracy in frail populations remains uncertain. This study aimed to assess whether integrating frailty measures with NEWS2 could better describe elderly IHCA patients. Materials and Methods: We conducted a single-center, retrospective observational study in adult and frail patients (≥18 years) admitted to medical and surgical wards of the University Hospital of Siena who experienced IHCA between January 2022 and January 2024. Data on demographics, such as last NEWS2 before IHCA, Clinical Frailty Scale (CFS), Barthel Index (BI), and Charlson Comorbidity Index (CCI) were retrospectively collected and analyzed. Patients were stratified into three categories, according to NEWS2: Stable (A), Potentially Unstable or Unstable (B), and Critical (C). Results: Seventy patients were analyzed (mean age 76.9 ± 11.0 years; 56% male). The mean pre-IHCA NEWS2 score was 6.0 ± 3.5, with 41% of patients classified as NEWS2-C, 48% classified as NEWS2-B, and 11% classified as NEWS2-A. The NEWS2-A category showed higher BI and lower CFS than NEWS2-B and NEWS2-C (p < 0.01), while CCI and age did not significantly differ. Conclusions: The association of NEWS2 with frailty scores could identify some elderly patients with limited pre-arrest physiological derangements but high frailty who suffered from IHCA. These findings provide descriptive insights that may inform monitoring strategies for “at-risk” elderly patients to help prevent IHCA. Full article

Background: Cognitive aging is a physiological process that involves gradual and mild changes in mental functions. When these changes significantly affect cognitive performance, it is considered cognitive decline. Objective: This analytical cross-sectional pilot study examined the association between periodontal status, systemic conditions, and cognitive performance in middle-aged and older adults. Methods: Forty adults aged 35–59 years (n = 20) and ≥60 years (n = 20) from northeastern Mexico were evaluated. Oral assessments included the Modified Gingival Index and detection of Porphyromonas gingivalis and Fusobacterium nucleatum using qPCR. Cognitive function was evaluated with the Mini-Mental State Examination (MMSE), and frailty with the Clinical Frailty Scale (CFS) and Oral Frailty Checklist (OF-5). Systemic medical history and oral hygiene habits were determined using a questionnaire. Results: MMSE scores were lower in older adults compared with middle-aged adults, and the magnitude of the difference was small. The presence of P. gingivalis or F. nucleatum was similar between groups. Frailty indicators were more prevalent in older adults. Logistic regression identified age and frailty-related variables as the strongest predictors of lower cognitive performance, whereas microbiological findings were not significant predictors. Conclusions: Age and frailty indicators, rather than bacterial presence alone, were associated with reduced cognitive performance in this pilot sample. Although no microbiological differences were observed, the findings highlight the need for larger analytical studies incorporating quantitative bacterial load and additional confounders to better understand the oral–systemic–cognitive interactions. Full article

Physical activity often remains low after hospitalisation for acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Although post-hospitalisation rehabilitation has shown to support recovery, its impact on daily activity levels in the early post-exacerbation phase is unclear. This study describes the changes in physical activity (PA) and clinical outcomes during an 8-week rehabilitation following hospitalisation for AECOPD. This prospective observational cohort study included patients recently discharged after AECOPD from Aalborg University Hospital, Denmark. Participants received municipality-delivered post-hospitalisation rehabilitation consisting of tailored physiotherapy and occupational therapy of individually determined frequency. PA was assessed using thigh-worn triaxial accelerometers measuring 24 h/day over 8 weeks. Clinical outcomes included lung function (FEV1% predicted), dyspnoea scores, health-related quality of life (EuroQol 5-dimension, 5-level (EQ-5D-5L); EuroQol visual analogue scale (EQ-VAS)), frailty (Clinical Frailty Scale (CFS)), functional status (Short Physical Performance Battery (SPPB)), and symptom burden (COPD Assessment Test (CAT); St. George’s Respiratory Questionnaire (SGRQ)). Changes from baseline to 8 weeks were analysed using linear mixed-effects models and bootstrap resampling. Forty-three participants with a mean age 73.4 years, 67.4% female, and moderate frailty (CFS 5.4 ± 1.3) were included. Physical activity remained largely unchanged. Gait speed and total SPPB declined, whereas self-perceived health improved (EQ-VAS Δ +7.8, p = 0.008). Lung function, dyspnoea, and health related quality of life scores showed no significant change. In this frail, recently admitted COPD population, physical activity did not increase during the rehabilitation period, and some functional parameters declined. The improvement in self-perceived health suggests a divergence between subjective and objective outcomes. These findings highlight the need for long-term, tailored, and flexible approaches to support recovery after AECOPD. Full article

Backgrounds/Objectives: The aging of the population is reflected in the increasing number of elderly patients admitted to intensive care units (ICUs), where assessing prognosis and the potential benefit of intensive care is challenging. The aim of this study was to clinically characterize ICU patients aged ≥80 years in the National Medical Institute of the Ministry of Internal Affairs and Administration in Warsaw, Poland. Methods: We retrospectively analyzed ICU patients admitted between 2018 and 2022, considering comorbidities, prognostic scores, the treatment methods and outcomes. Results: We included 476 patients (median age 84 [range 80–103 years], female 54.4%, median ICU stay 8 days) with a high incidence of various comorbidities. The overall risk of death was very high (76.4%) but was independent of sex and, surprisingly, of age. Advanced frailty was common, as indicated by the Clinical Frailty Scale (CFS) score (median 7, n = 189), which was identified as a significant risk factor for death independent of age, sex, and APACHE score (odds ratio for the 1-point CFS increase: 1.08, 95% CI 1.01–1.15, n = 103), but not of SAPS and SOFA scores. Organ support techniques were frequently used (invasive mechanical ventilation in 90.9%, pharmacological cardiovascular support in 83.2%, and renal replacement therapy in 14.1% of patients), with high associated mortality rates (80%, 79%, and 88%, respectively). Conclusions: Our results confirm the value of the prognostic scales used on admission to the ICU, but also highlight the need for individualized assessment of the expected benefit of ICU treatment in elderly patients, considering specific comorbidities, previous treatment and frailty. Full article

Background: Frailty is a key determinant of outcomes in critically ill elderly patients, but data from Portugal remain limited. To our knowledge, this is the first study to examine the prevalence and prognostic impact of frailty among elderly ICU patients in a Portuguese hospital setting. Objective: To determine the prevalence of frailty among elderly patients admitted to an intensive care unit (ICU) in southern Portugal and to examine its crude associations with illness severity, organ support, and mortality outcomes. Methods: We conducted a retrospective cohort study including 125 patients aged ≥ 65 years admitted to the polyvalent ICU of Hospital de Faro over the last six months of 2024. Data included demographics, comorbidities, Charlson Comorbidity Index (CCI), severity scores (SOFA, SAPS II, APACHE II), and frailty status assessed by the Clinical Frailty Scale (CFS). Outcomes were the need for organ support, ICU and hospital mortality, and length of stay. Results: Frailty (CFS ≥ 5) was identified in 30.4% of patients. Frail patients were older, had higher comorbidity burden (CCI), and presented with significantly higher severity scores at admission. They also required more invasive support, including vasopressors and invasive mechanical ventilation, while acute kidney injury (AKI) requiring renal replacement therapy (RRT) was similar between groups. ICU mortality was significantly higher among frail patients (50.0% vs. 31.0%), as was hospital mortality (76.3% vs. 33.3%). Length of ICU stay did not differ, although frail patients tended to have longer hospitalizations overall. Conclusions: Frailty was highly prevalent and strongly associated with increased severity, greater need for organ support, and higher mortality. Routine frailty assessment at ICU admission may enhance prognostic accuracy and support patient-centered decision-making. Full article

Background/Objectives: Major cardiac surgery is associated with a high rate of postoperative complications, particularly in older and frail patients. Prehabilitation—defined as a preoperative intervention based on structured exercise—aims to enhance patients’ physiological and functional reserve before surgery. To evaluate the effectiveness of prehabilitation programs on functional capacity and postoperative complications in cardiac surgery and to propose a clinical exercise-based intervention model tailored to these patients. Methods: A systematic search was conducted in PubMed, Cochrane, PEDro, and LILACS (2005–2025). Randomized controlled trials investigating preoperative exercise interventions in adults undergoing cardiac surgery were included. Outcomes assessed included functional measures (6-Minute Walk Test [6MWT], Timed Up and Go test [TUG], maximal oxygen uptake [VO₂max], maximal inspiratory pressure [MIP]), frailty (Clinical Frailty Scale [CFS], Essential Frailty Toolset [EFT]), postoperative complications and quality of life. Results: Nine studies comprising a total of 873 patients were included. Prehabilitation significantly improved functional capacity (∆6MWT: +52.4 m; p < 0.001), reduced respiratory complications (pneumonia, atelectasis) and shortened hospital stay (−15.2 h; p < 0.001). The greatest benefits were observed in multimodal programs lasting ≥4 weeks. Conclusions: Exercise-based prehabilitation is an effective and safe strategy in patients awaiting cardiac surgery. Its systematic implementation should be considered as part of the perioperative pathway, reinforcing the role of exercise as a therapeutic tool in this clinical context. Full article

Background/Objectives: Acute coronary syndrome (ACS) remains a leading cause of short-term mortality, particularly in elderly patients with multimorbidity and frailty. Conventional models such as the GRACE score provide robust prognostication but do not incorporate comorbidity or frailty burden. This study investigated the prognostic value of combining the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and Clinical Frailty Score (CFS) with GRACE in predicting one-month mortality in older ACS patients. Methods: A single-center, retrospective cohort study was conducted including 90 patients aged ≥65 years admitted with ACS. Demographic, clinical, echocardiographic, and laboratory data were collected. CIRS-G, CFS, and GRACE scores were calculated at admission. The primary endpoint was one-month all-cause mortality. Statistical analyses included group comparisons, correlation tests, logistic regression, and ROC curve analysis. Results: The mean age was 74.8 ± 6.6 years, and 73.3% were male. At one month, mortality was 8.9% (n = 8). Non-survivors had significantly higher CIRS-G (median 18.5 vs. 14.0, p = 0.006), CFS (6.0 vs. 4.0, p = 0.008), and GRACE scores (183 vs. 122, p < 0.001), and lower ejection fraction (32.5 vs. 50.0, p < 0.001) compared with survivors. Logistic regression identified GRACE as the only independent predictor of mortality (OR = 1.081 per 10-point increase, p = 0.044). ROC analysis showed GRACE had the highest discriminative performance (AUC = 0.919), while CIRS-G (AUC = 0.796) and CFS (AUC = 0.777) also demonstrated significant predictive value. The combined CIRS-G + CFS model provided comparable discrimination (AUC = 0.785; sensitivity 75%, specificity 87%). Conclusions: GRACE remains the strongest independent predictor of one-month mortality in elderly ACS patients; however, comorbidity and frailty scores also contribute meaningful prognostic information. Integrating these geriatric assessments with traditional risk models may improve individualized risk stratification and management. Full article

Background: Frailty is a multidimensional syndrome characterized by reduced physiological reserve and resilience and has become a crucial predictor of outcomes in liver surgery. Unlike chronological age, frailty reflects broader vulnerabilities that significantly influence postoperative recovery. Aim: To review and synthesize current evidence on the relationship between frailty and postoperative outcomes following liver resection, with an emphasis on short-term complications, mortality, and long-term survival. Methods: A comprehensive literature review was performed, drawing on recent meta-analyses, large-scale cohort studies, and prospective observational data. Frailty was evaluated using a range of assessment tools, including the Modified Frailty Index (mFI), Clinical Frailty Scale (CFS), Kihon Checklist (KCL), and claims-based measures such as the Johns Hopkins Frailty Indicator. Results: Across studies, frailty has been consistently linked to a higher incidence of postoperative complications, such as post-hepatectomy liver failure (PHLF), infections, extended hospital stays, and increased mortality. In patients undergoing liver resection for cancer, frailty is also associated with poorer long-term survival. Importantly, frailty serves as an independent risk factor, even after adjusting for age, comorbid conditions, and tumor characteristics. Preoperative identification of frailty enhances risk stratification, informs surgical planning, potentially favoring parenchymal-sparing or minimally invasive approaches, and highlights patients who may benefit from prehabilitation. Conclusions: Frailty is a strong and independent predictor of poor outcomes after liver resection. Incorporating frailty assessment into routine preoperative evaluation can improve surgical decision-making, facilitate informed patient counseling, and optimize perioperative care strategies. Full article

Background/Objectives: Mobility screening is standard practice in hospitalized geriatric patients, but clinical assessments alone may not fully capture functional capacity and related risks. This study aimed to describe the physical performance (gait analysis, postural stability and regulation) and clinical–functional status (e.g., Tinetti [TIN], Barthel Index [BI]) in geriatric inpatients, and to explore associations between measures from different domains. Methods: Fifty-five geriatric inpatients (mean age: 84.3 ± 5.47 years, range: 71–97; 49% female) underwent spatiotemporal gait analysis (inertial sensor system/RehaGait) and posturography (Interactive Balance System). Clinical assessments included TIN, BI, Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), Clinical Frailty Scale (CFS), and Numeric Rating Scale (NRS). Gait and postural data were compared with age-, sex-, and height-adjusted reference values. Results: Clinical data indicated a low fall risk (TIN: 24), moderate functional independence (BI: 54), and moderate frailty (CFS: 5). Deviations from reference values were more frequent in gait parameters (18/50%) than in postural parameters (6/17%), with postural stability consistently reduced. The largest differences for the geriatric patients compared with the reference gait data were found for stride length, walking speed, double and single support, roll-off angle, and landing angle. TIN showed the strongest correlation with walking speed (r = 0.47, 95% CI: 0.22–0.67), a relationship unaffected by gender (partial r = 0.52). Conclusions: Gait assessment revealed greater performance deficits than postural measures in this cohort. Full article

Background: Older adults who are hospitalized in internal medicine wards often present with a challenging interplay of multimorbidity and geriatric syndromes. The timely identification of clinical and geriatric predictors of in-hospital mortality is crucial for guiding individualized care pathways and ensure appropriate resource allocation. In this study, we investigate the prognostic impact of frailty, delirium—including its motor subtypes—and global comorbidity burden on in-hospital mortality in patients aged 70 years and older. Methods: We conducted a retrospective observational study including 556 consecutive patients aged ≥ 70 years who were admitted to the Internal Medicine Unit of the University Hospital of Parma from January 2019 to July 2019. Demographic, clinical, and geriatric data were collected within 48 h of admission, including Clinical Frailty Scale (CFS), Cumulative Illness Rating Scale (CIRS), and delirium diagnosis with the 4AT tool. Multivariate Cox and logistic regression analyses were performed, including sex-stratified models. Results: The median age was 85 years (IQR 80–89), 58% were female, and in-hospital mortality was 11% (n = 61). Non-survivors had higher rates of severe frailty (CFS ≥ 7: 39% vs. 16%, p < 0.001), prevalent delirium (20% vs. 4%, p < 0.001), hypokinetic delirium (20% vs. 5%, p < 0.001), liver disease (23% vs. 11%, p = 0.008), cancer (44% vs. 24%, p < 0.001), and dementia (43% vs. 29%, p = 0.026) and a higher CIRS severity index (≥3:55% vs. 31%, p < 0.001). In Cox regression, independent predictors of death were prevalent delirium (HR 4.66, 95% CI 2.42–8.96), CFS ≥ 7 (HR 2.26, 95% CI 1.32–3.87), CIRS-LIVER ≥ 2 (HR 2.05, 95% CI 1.18–3.56), and cancer (HR 1.83, 95% CI 1.07–3.14). Sex-stratified models showed that in males, prevalent delirium (HR 10.23) and cancer (HR 2.49) predicted mortality, whereas in females, hypokinetic delirium (HR 3.67) and CIRS-LIVER ≥ 2 (HR 2.75) were the strongest predictors. Logistic regression confirmed these associations and additionally identified anemia and CFS ≥ 7 in males and CIRS severity index ≥ 3 in females as significant risk factors. Conclusions: In elderly patients who are admitted to internal medicine wards, prevalent and hypokinetic delirium, severe frailty, and high comorbidity burden, particularly liver disease and cancer, are strong independent predictors of in-hospital mortality, with distinct sex-specific patterns. Early multidimensional geriatric assessment may improve risk stratification and guide targeted interventions. Full article

Background/Objectives: Multiple myeloma (MM) predominantly affects older adults, a heterogeneous population. Comprehensive Geriatric Assessment (CGA) and abbreviated tools support individualized treatment planning. This study aimed to evaluate the feasibility of CGA and its impact on clinical outcomes in this subgroup of patients. Methods: Prospective, observational, and single-center study including patients aged ≥65 years assessed at MM diagnosis and one year later in an onco-hematogeriatrics clinic. A CGA was performed, and frailty was evaluated using the following: G8, Geriatric Assessment in Hematology (GAH), Clinical Frailty Scale (CFS), Frail-VIG Index (FI-VIG), modified Fried phenotype, International Myeloma Working Group Frailty Index (IMWG-FI), and Revised Myeloma Comorbidity Index (R-MCI). At one year, patients were reassessed; treatment response (IMWG criteria), adverse events (CTCAE v5.03), and mortality were recorded. Results: Fifty-five patients (mean age 78.0 ± 5.4 years, 58.2% female) diagnosed between December 2019 and May 2024 were included. CGA completion exceeded 90% at both time points. At one year, 9 patients (16.4%) had died, and 16 (29.1%) achieved complete response, with daratumumab-lenalidomide-dexamethasone (DRd) being the most used regimen. Frailty prevalence significantly declined (FRAIL: p = 0.012; CFS: p = 0.016; IMWG-FI: p = 0.020). GAH was significantly associated with ≥grade 3 hematologic toxicity (OR = 5.67, p = 0.004) and mortality (AUC = 0.750, p = 0.027). FI-VIG also predicted mortality (OR = 14.67, p = 0.026). Conclusions: CGA and its abbreviated forms are feasible and clinically valuable tools for identifying vulnerable older adults with MM, enabling treatment individualization and improved risk stratification. Full article

Objectives: Patients with chronic limb-threatening ischemia (CLTI) represent a high-risk cohort for cardiac surgery due to the systemic atherosclerotic burden and frailty. This study aimed to evaluate the short- and mid-term prognoses of CLTI patients undergoing open cardiac surgery and to assess the prognostic utility of four risk scoring systems: Japan SCORE, SPINACH SCORE, Clinical Frailty Scale (CFS), and Geriatric Nutritional Risk Index (GNRI). Methods: We retrospectively analyzed 44 patients with CLTI who underwent open cardiac surgery between 2014 and 2023. Thirty-day and 1-year mortality were assessed. Patients were stratified using ROC-derived cutoffs for each scoring system. Kaplan–Meier survival curves and time-dependent ROC analyses were used to evaluate predictive performance over time. Results: Thirty-day mortality was significantly associated with a higher Japan SCORE; survivors had significantly lower scores than non-survivors (5.5% vs. 25.8%, p < 0.05). One-year mortality was significantly associated with nutritional status, as survivors showed a significantly higher GNRI than non-survivors (92.0 vs. 86.0, p < 0.05). Time-dependent ROC analysis revealed that the GNRI and SPINACH SCORE’s sustained prognostic accuracy beyond 1 year. Calibration plots showed good agreement between predicted and observed probabilities for the SPINACH SCORE and GNRI, while decision curve analysis (DCA) demonstrated that these two models provided greater net clinical benefit across a range of thresholds, particularly in the 5–20% range. Conclusions: Japan SCORE is effective for short-term risk prediction, while SPINACH SCORE and GNRI offer superior prognostic value for mid-term outcomes. These scoring systems may support preoperative risk stratification and decision-making in CLTI patients undergoing cardiac surgery. Full article

Background: Malnutrition contributes to frailty dementia, intensifying adverse health outcomes including mortality risk. Objectives: We aim to investigate the impact of malnutrition risk in those with frailty and functional decline on short-term mortality among older adults with dementia and/or cognitive impairment. Methods: We conducted a retrospective cohort study involving 2677 hospitalized patients aged ≥65 years with a diagnosis of dementia or cognitive impairment discharged between March 2022 and December 2023. Information was obtained from electronic medical records. Frailty was assessed using the Clinical Frailty Scale (CFS) and Hospital Frailty Risk Score (HFRS), functional status using premorbid activity of daily living (ADL) scores, and malnutritional risk using the 3-Minute Nutrition Screening (3-Min NS) tool. Associations with 30- and 90-day mortality were examined using Kaplan–Meier analysis and multivariate logistic regression models. Results: A total of 29.2% were at risk of malnutrition, highest in the old-old (37.1%). Thirty-day mortality was significantly associated with CFS (aOR = 1.498, 95% CI: 1.349–1.664, p < 0.001), HFRS (aOR = 1.020, 95% CI: 1.001–1.040, p = 0.038), and ADL (aOR = 0.819, 95% CI: 0.753–0.890, p < 0.001). Malnutrition risk demonstrated the strongest association across all models (ADL: aOR = 2.573, 95% CI: 1.922–3.443, p < 0.001; CFS: aOR = 2.348, 95% CI: 1.738–3.156, p < 0.001; HFRS: aOR = 2.944, 95% CI: 2.210–3.922, p < 0.001). Associations between 90-day mortality and malnutrition risk remained significant across all models, including those adjusted for CFS and ADL. Notably, interactions between malnutrition and CFS further amplified mortality risk among the old-old (30-day: aOR = 1.435, 95% CI: 1.082–1.902, p = 0.012; 90-day: aOR = 1.263, 95% CI: 1.005–1.588, p = 0.045). Conclusions: Risk of malnutrition independently predicted short-term mortality in older adults with dementia or cognitive impairment, particularly among those with frailty, functional decline, and of advanced age. Full article

Background and Objectives: Adverse clinical outcomes are associated with malnutrition and frailty, which are highly prevalent among hospitalized older patients. This study aimed to evaluate their predictive value for the duration of hospitalization, short-term survival, and rehospitalization of patients admitted to internal medicine wards. Materials and Methods: This prospective cohort study included 134 acutely ill patients aged ≥50 years who were hospitalized in an internal medicine department and evaluated within the first 48 h of admission. Nutritional status was evaluated using the Mini nutritional assessment–short form (MNA-SF), Nutritional Risk Screening 2002 (NRS-2002), and Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty was evaluated using the FRAIL scale and Clinical Frailty Scale (CFS). The primary outcomes were prolonged hospitalization (>10 days), mortality, and rehospitalization at 3 and 6 months post-discharge. Results: According to MNA-SF, 33.6% of patients were malnourished; 44% had nutritional risk per NRS-2002, and 44.8% were malnourished per GLIM. Frailty prevalence was 53.7% (FRAIL) and 59% (CFS). Malnutrition defined by all three scales (MNA-SF, NRS-2002, GLIM) was significantly associated with prolonged hospitalization (p = 0.043, 0.014, and 0.023, respectively), increased rehospitalization at both 3 months (p < 0.001) and 6 months (p < 0.001). Mortality was also significantly higher among malnourished patients. Higher CFS scores and low handgrip strength were additional predictors of adverse outcomes (p < 0.05). In multivariable analysis, GLIM-defined malnutrition and CFS remained independent predictors of rehospitalization and mortality. Conclusions: Frailty and malnutrition are highly prevalent and independently associated with prolonged hospital stay, short-term rehospitalization and mortality. Routine screening at admission may facilitate early identification and guide timely interventions to improve patient outcomes. These findings might guide hospital protocols in aging health systems and support the development of standardized geriatric care pathways. Full article

Background/Objectives: Frailty is a key determinant of outcomes in older adults with heart failure (HF). The free triiodothyronine/free thyroxine (FT₃/FT₄) ratio has emerged as a promising frailty biomarker that reflects metabolic and systemic resilience. This study investigates its association with frailty, nutrition, muscle strength, inflammation, and one-year mortality in very old patients with HF. Methods: In this longitudinal, single-center study, we enrolled 193 older outpatients (mean age, 86.5 ± 6.1 years; 56% women) recently discharged after acute HF. All patients underwent physical examination, blood testing, and comprehensive geriatric assessment, including handgrip strength (HGS). Participants were stratified by FT₃/FT₄ ratio (<1.7 vs. ≥1.7). Associations with the Clinical Frailty Scale (CFS) were examined using multivariable linear regression. Spearman’s correlations assessed relationships with inflammatory and nutritional biomarkers. Cox regression evaluated the association with all-cause mortality. Results: Patients with a low FT₃/FT₄ ratio (31.1%) exhibited greater frailty (CFS: median [IQR], 6 [2] vs. 4 [3]; p = 0.020), poorer nutritional status (Mini Nutritional Assessment: 10 [4] vs. 12 [3]; p = 0.008), and lower HGS (mean ± SD, 16.8 ± 3.7 kg vs. 20.3 ± 4.8 kg; p = 0.002). An inverse association was identified between the FT₃/FT₄ ratio and frailty (adjusted β = −0.09; p = 0.019). Individuals with low FT₃/FT₄ also showed elevated inflammatory markers and had more than double the one-year mortality rate compared to those with higher ratios [HR 2.32 (95% CI, 1.24–4.34; p = 0.007)]. Conclusions: In very old adults recently hospitalized for HF, a lower FT₃/FT₄ ratio was associated with frailty, malnutrition, inflammation, and increased mortality, supporting its potential role as a marker of biological vulnerability. Full article