Frailty and its multidimensional correlates among hospitalized older adults with pulmonary tuberculosis: a cross-sectional study
TL;DR
Frailty is an important clinical issue among hospitalized older adults with PTB and is associated with inflammatory status, social support, and fall-risk-related functional vulnerability, and the findings suggest that frailty assessment should be integrated into routine care for older adults with PTB.
Abstract
Background and objective Frailty is a clinically important geriatric syndrome that may increase vulnerability to adverse outcomes in older adults with chronic infectious diseases. Older adults with PTB often experience infection-related inflammation, nutritional depletion, functional decline, psychological distress, multimorbidity, and treatment burden, all of which may contribute to frailty. However, evidence regarding frailty and its associated factors in hospitalized older adults with PTB remains limited. This study aimed to assess the current status of frailty and identify multidimensional factors associated with frailty among hospitalized older adults with PTB. Methods This hospital-based cross-sectional study consecutively enrolled older adults with PTB from two tuberculosis wards of a tertiary specialist hospital in Ningxia, China, between January and June 2026. Eligible participants were aged ≥60 years and had bacteriologically confirmed or clinically diagnosed PTB. Frailty was assessed using the FRAIL scale. Fall risk, anxiety and depressive symptoms, social support, and activities of daily living were evaluated using the MFS, HADS, SSRS, and Barthel Index, respectively. Demographic characteristics, disease-related variables, medication use, and laboratory indicators were also collected. Non-normally distributed continuous variables were described as medians and interquartile ranges. Group differences were analyzed using the Mann–Whitney U test or Kruskal–Wallis H test. Spearman correlation analysis and multiple linear regression were used to explore factors associated with FRAIL score. Results A total of 225 questionnaires were distributed, and 219 valid questionnaires were included, yielding an effective response rate of 97.3%. The median FRAIL score was 2.00 (1.00–3.00), suggesting that many participants were in a vulnerable or pre-frail state. The median MFS, HADS-A, HADS-D, SSRS, and WBC values were 40.08 (25.00–50.00), 9.00 (7.00–11.00), 11.00 (9.00–12.00), 38.00 (34.00–42.00), and 5.30 (4.35–6.44) × 109/L, respectively. Univariate analysis showed that FRAIL score differed significantly according to monthly household income per capita, sputum smear or culture result, and number of medication types. Spearman correlation analysis showed that FRAIL score was negatively correlated with MFS and HADS-A scores, but positively correlated with SSRS score and WBC count. In multivariable linear regression, WBC count, SSRS score, and MFS score remained independently associated with FRAIL score. The final model was statistically significant, with an adjusted R2 of 0.070. Conclusion Frailty is an important clinical issue among hospitalized older adults with PTB and is associated with inflammatory status, social support, and fall-risk-related functional vulnerability. These findings suggest that frailty assessment should be integrated into routine care for older adults with PTB. Multidimensional screening that incorporates infection-related indicators, functional status, psychosocial context, and nursing care needs may help identify vulnerable patients and support individualized geriatric management during anti-TB treatment.