Admission triage for hospital-associated disability in older inpatients: a multicenter clinical decision rule

Hospital-associated disability (HAD) is a frequent complication in hospitalized older adults and is associated with unfavorable outcomes. Because preventive interventions require substantial resources, efficient identification of high-risk patients at admission is required. We developed a simple admission clinical decision rule for triage using routinely available admission information. Methods : In a multicenter retrospective cohort study, adults aged ≥65 years admitted to acute care hospitals between October 2019 and March 2025 were included. HAD was defined as a ≥5-point decline in the Barthel Index from admission to discharge. Candidate predictors included age, admission type, Clinical Frailty Scale (CFS), and Mini-Mental State Examination (MMSE). A multivariable logistic regression model derived a simplified point-based score; discrimination was assessed by AUC, calibration by bootstrap-corrected calibration, and clinical utility by decision curve analysis with 2,000 bootstrap resamples. Results: Among 1,292 patients, 26.2% developed HAD. The final score (0–8 points) included emergency admission, frailty (CFS ≥5), cognitive impairment (MMSE ≤23), and age ≥80 years. Discrimination was good (AUC 0.796; 95% CI 0.771–0.820) with adequate calibration. HAD incidence increased from <5% in the lowest-risk group to ~50% in the highest-risk group, and decision curve analysis showed net clinical benefit across relevant thresholds. Conclusions : This admission triage rule identifies patients who may require early geriatric co-management and supports targeted preventive care and efficient allocation of limited geriatric resources.