Association of the Tilburg Frailty Indicator with mortality, readmission, and healthcare contacts in adult patients with multimorbidity.

Abstract

Purpose: Frailty is closely related to multimorbidity and unfavorable outcomes. The Tilburg Frailty Indicator (TFI) is a self-reported assessment comprising 15 questions across three domains. We assessed whether the TFI predicts 180-day mortality, 30-day readmission and healthcare contacts among adults with multimorbidity across a broad age range.

Methods: Single-center prospective cohort study including adults with multimorbidity. Follow-up was 180 days. Cox regression analyses estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for death and readmission. Poisson regression estimated incidence rate ratios (IRR) of any health care contact. Exposure was TFI as both a dichotomous and a 0-15 points integer variable. Analyses were adjusted for age and sex.

Results: We included 471 participants, median age 70 years (IQR 60-76 years) with an average of 6.0 chronic diseases. In adjusted analyses, frailty (TFI score > 5) was associated with HR 4.6 (CI 2.2, 9.7) for death and HR 2.6 (CI 1.7, 4.1) for readmission. Frailty was associated with an IRR of 1.5 (CI 1.3, 1.7) of any health care contact. A one-point increase in TFI score conferred increments in relative estimates across all outcomes.

Conclusions: Our findings extend prior TFI research from older community-dwelling cohorts to multimorbid adults across clinical settings; TFI was both dichotomously and point-by point associated with adverse outcomes. TFI is a self-reported tool that offers a practical and efficient alternative to traditional frailty scoring systems, requiring neither clinical metrics nor expert evaluation, reducing time and resource demands. TFI may be a relevant multidomain risk assessment tool for care pathways in multimorbidity.