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Original Article • Rev. Latino-Am. Enfermagem 33 • 2025 • https://doi.org/10.1590/1518-8345.7747.4716 linkcopy

Frailty and nursing care demand in hospitalized older adults: a cross-sectional study^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to analyze the relation between nursing care demand and frailty condition and markers in hospitalized older adults.

Method: analytical cross-sectional study with a sample of 400 older adults. Data collection used a sociodemographic questionnaire, frailty phenotype tests, and a nursing care complexity assessment scale. Fisher’s exact test, Kruskal-Wallis test and Dunn’s test were applied, considering statistical significance for p≤0.05.

Results: there was a predominance of pre-frail (48.7%), followed by frail (35.8%) and non-frail individuals(15.5%). Most frail older adults required high-dependency nursing care (44.8%). The minimum nursing care demand was 80.6% for non-frail, 60.5% for pre-frail, and 14% for frail older adults. Frail older adults required higher nursing care level than the non-frail in the areas: mental state, oxygenation, motility, ambulation, elimination, and therapy (p<0.001). There was association between minimal to intensive nursing care demand and reduced hand grip strength (p<0.001), reduced gait speed (p<0.001), fatigue/exhaustion (p<0.001), reduced physical activity level (p<0.001), and unintentional weight loss (p<0.019).

Conclusion: higher nursing care demand was associated with worse frailty condition and markers. Frailty assessment is indispensable to trace specific needs and support nursing care planning.

Descriptors:
Nursing Care; Hospitalization; Frailty; Nurses Improving Care for Health System Elders; Frail Elderly; Cross-Sectional Studies

Highlights:

(1) Nursing care levels vary between frailty conditions. (2) Frail older adults require higher nursing care level than the non-frail. (3) Nursing care demand is proportional to frailty condition and markers. (4) Frailty condition assessment at hospital admission is fundamental. (5) Ambulation, body care and eliminations require higher nursing care level among the frail.

Characteristic	*n=400**	(95% CI ^† )
Sex
Female	223	55.8% (50.7%–60.7%)
Male	177	44.3% (39.3%–49.3%)
Age
60 to 69 years	118	29.5% (25.1%–34.3%)
70 to 79 years	136	34% (29.4%–38.9%)
80 years or more	146	36.5% (31.8%–41.5%)
Skin color
Yellow	3	0.8% (0.19%–2.36%)
White	283	70.8% (66.0%–75.1%)
Mixed-race	90	22.6% (18.4%–28.31%)
Black	24	6% (3.96%–8.92%)
Education
Illiterate	72	18% (14.4%–22.2%)
Literate	38	9.5% (6.89%–12.9%)
Incomplete middle school	206	51.5% (46.5%–56.5%)
Complete middle school	22	5.5% (3.56%–8.33%)
Incomplete high school	12	3% (1.63%–5.33%)
Complete high school	28	7% (4.78%–10.1%)
Incomplete higher education	4	1% (0.32%–2.72%)
Complete higher education	18	4.5% (2.77%–7.15%)
Household income (MW ^‡ )
No income	22	5.5% (3.56%–8.33%)
0-1	135	33.8% (29.2%–38.6%)
1.1-3	159	39.8% (35%–44.7%)
3.1-5	55	13.8% (10.6%–17.6%)
5.1-10	5	1.3% (0.46%–3.6%)
>10	1	0.3% (0.01%–1.61%)
Not informed	23	5.8% (3.76%–8.63%)

Categorization	*n=400**	Frailty Classification			p -value ^†
Categorization	*n=400**	Non-frail n=62	Pre-frail n=195	Frail n=143	p -value ^†
Minimum nursing care	188 47% (42%−52%)	80.6% (68.3%−89.2%)	60.5% (53.3%−67.4%)	14% (8.96%−21%)	<0.001
Intermediate nursing care	89 22.3% (18.3%−26.7%)	16.1% (8.41%−28.1%)	27.7% (21.7%−34.6%)	17.5% (11.8%−24.9%)
High-dependency nursing care	87 21.6% (17.9%−26.2%)	3.2% (0.56%−12.2%)	10.8% (6.94%−16.2%)	44.8% (36.5%−53.3%)
Semi-intensive nursing care	29 7.3% (4.99%−10.4%)	0% (0%−7.27%)	1% (0.18%−4.05%)	18.8% (13%−26.5%)
Intensive nursing care	7 1.8% (0.77%−3.73%)	0% (0%−7.27%)	0% (0%−2.41%)	4.9% (2.16%−10.2%)

Nursing care area	Fried Classification			p -value ^†	Significant differences ^‡
Nursing care area	Non-frail n*=62	Pre-frail n*=195	Frail n*=143	p -value ^†	Significant differences ^‡
Mental state	1 (1−1.1)	1.1 (1.1−1.2)	1.8 (1.7−2)	<0.001	Frail – Non-Frail, Frail – Pre-Frail
Oxygenation	1.1 (1−1.2)	1.2 (1.2−1.3)	1.6 (1.5−1.8)	<0.001	Frail – Non-Frail, Frail – Pre-Frail
Vital signs	2	2	2	0.298
Motility	1.2 (1.1−1.3)	1.4 (1.3−1.5)	2.4 (2.2−2.6)	<0.001	Frail – Non-Frail, Frail – Pre-Frail
Ambulation	1.1 (1−1.3)	1.6 (1.5−1.8)	3 (2.8−3.2)	<0.001	Frail – Non-Frail, Frail – Pre-Frail, Non-Frail – Pre-Frail
Eating	1 (1−1)	1.1 (1−1.1)	1.6 (1.5−1.8)	<0.001	Frail – Non-Frail, Frail – Pre-Frail
Body care	1.3 (1.1−1.4)	1.8 (1.6−2)	3.2 (3−3.4)	<0.001	Frail – Non-Frail, Frail – Pre-Frail, Non-Frail – Pre-Frail
Elimination	1.4 (1.2−1.6)	1.8 (1.6−1.9)	2.8 (2.7−3)	<0.001	Frail – Non-Frail, Frail – Pre-Frail, Non-Frail – Pre-Frail
Therapy	2 (2−2)	2 (2−2)	2.1 (2−2.2)	<0.001	Frail – Non-Frail, Frail – Pre-Frail
Tissue impairment	1.3 (1.1−1.4)	1.2 (1.1−1.3)	1.3 (1.2−1.5)	0.031	Frail – Pre-Frail
Dressing	1.1 (1−1.2)	1.1 (1−1.1)	1.2 (1.1−1.3)	0.004	Frail – Pre-Frail
Time for dressing	1.1 (1−1.2)	1 (1−1.1)	1.2 (1.1−1.3)	<0.001	Frail – Pre-Frail
Total score	15.6 (15.0−16.3)	17.3 (16.8−17.8)	24.4 (23.5−25.4)	<0.001	Frail – Non-Frail, Frail – Pre-Frail, Non-Frail – Pre-Frail

Marker	*n=400**	Nursing care level					p-value ^†
Marker	*n=400**	Minimum n*=188	Intermediary n*=89	High-dependency n*=87	Semi-intensive n*=29	Intensive n*=7	p-value ^†
Reduced hand grip strength	23%	7.4% (4.29%–12.4%)	14.6% (8.31%–24%)	40.2% (30%–51.3%)	79.3% (59.7%–91.3%)	100% (56.1%–100%)	<0.001
Reduced gait speed	41%	3.2% (1.3%–7.14%)	41.6% (31.4%–52.5%)	96.6% (89.5%–99.1%)	100% (85.4%–100%)	100% (56.1%–100%)	<0.001
Decreased physical activity level	44%	25.5% (19.6%–32.5%)	41.6% (31.4%–52.5%)	71.3% (60.4%–80.2%)	82.8% (63.5%–93.5%)	85.7% (42%–99.2%)	<0.001
Unintentional weight loss	55%	37.8% (30.9%–45.1%)	40.4% (30.3%–51.4%)	49.4% (38.6%–60.3%)	58.6% (39.1%–75.9%)	85.7% (42%–99.2%)	0.019
Self-reported fatigue/exhaustion	43%	43.1% (36%–50.5%)	55.1% (44. 2%–65.5%)	65.5% (54.5%–75.2%)	82.8% (63.5%–93.5%)	100% (56.1%–100%)	<0.001

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