Frailty outweighs psychiatric variables in predicting clinical outcomes among older adults receiving consultation-liaison psychiatry: a multicentre prospective cohort study (OLD-3 Study)

Older adults evaluated by consultation-liaison psychiatry services (CLPS) often present with complex psychiatric and medical comorbidity, frequent psychotropic exposure and a high prevalence of frailty. However, the relative contribution of these factors to clinical outcomes remains unclear.

Methods

We conducted a multicentre prospective cohort study including 465 consecutive patients aged ≥65 years evaluated by CLPS in 10 general hospitals in Spain between January and July 2024. Psychiatric history, post-consultation psychiatric diagnoses, psychotropic use, age group (65–74 vs ≥75 years) and frailty assessed using the Clinical Frailty Scale were recorded. Outcomes included falls, institutionalisation, access to mental health follow-up and mortality at 1 and 3 months after discharge.

Results

The mean (SD) age was 77.4 (7.8) years and 55.9% were women. Psychiatric history was present in 68.8% of patients and 55.8% received a new psychiatric diagnosis, most commonly delirium. Psychotropic use was frequent (71.6%), particularly antidepressants (49.0%) and benzodiazepines (42.6%). Psychotropic polypharmacy was associated with falls. Frailty was prevalent (60.2%) and independently associated with early mortality, whereas age was the main predictor of mortality between 1 and 3 months. Older age was also associated with a lower likelihood of specialised mental health follow-up.

Conclusions

Among older adults evaluated by CLPS, frailty and medical comorbidity appear to outweigh psychiatric variables in predicting outcomes. Integrating comprehensive geriatric assessment and medication review into CLPS may improve care for this population.