Geriatric risk stratification for discharge outcomes: The role of frailty, function, comorbidity, nutrition, inflammation, and clinical care quality

Background: Geriatric inpatients face frailty, functional decline, high comorbidity, malnutrition, and inflammation. Prior data showed high prevalence of frailty (72.9%), functional impairment (67.0%), high comorbidity (68.6%), hypoalbuminemia (50.7%), and elevated NLR (56.4%), linked to prolonged hospitalization (76.4%) and adverse discharge outcomes (mortality 8.6%, facility discharge 20.6%). However, relationships with daily clinical care quality remain uncharacterized.
Objective: (1) Develop a multidimensional geriatric risk score (CFS, GFRS, AACCI, GNRI, albumin, NLR, SII, HALP) to predict discharge disposition; (2) Validate its performance; (3) Assess associations with clinical care quality; (4) Determine if care quality mediates risk-outcome relationships.
Methods: Retrospective cohort study at Royal Medical Services hospitals (February 2021–November 2025). Geriatric patients (≥65 years) with complete risk parameters and care quality data were included. Derivation (70%, n=593) and validation (30%, n=254) sets were randomly split. Multivariate logistic regression was used for model development.
Results: Among 847 geriatric patients (mean age 74.6±6.8 years, 54.2% male), discharge disposition: home 70.8% (n=600), facility 20.6% (n=175), death 8.6% (n=72). The final risk score (0–14 points) incorporated: CFS ≥5 (3 points), GFRS ≤30 (2), AACCI ≥7 (2), GNRI <92 (2), albumin <2.85 g/dL (2), NLR ≥5.75 (1), SII ≥2.0×10⁶ (1), HALP <115 (1). In validation, AUC was 0.84 (95% CI: 0.80–0.88), Hosmer-Lemeshow p=0.32. At cutoff ≥6, sensitivity 82.4%, specificity 76.8%. Care quality indicators (early ambulation, timely nutrition, antibiotic de-escalation, cannula care, catheter management, pressure injury prevention) were independently associated with better outcomes and partially mediated risk-outcome relationships (proportion mediated 18–34%).
Conclusion: A multidimensional geriatric risk score demonstrates good discrimination and calibration for predicting discharge disposition. Clinical care quality significantly influences outcomes and partially mediates risk. Modifiable care targets should be prioritized in high-risk geriatric patients.