Geriatric Syndromes and Mortality Among Hospitalized Older Adults

Importance: Geriatric syndromes are common in hospitalized older adults and complicate acute care; however, their overall prevalence and cumulative burden remain poorly understood, especially in resource-limited settings. Objectives: To measure the prevalence of geriatric syndromes upon hospital admission and examine the independent association between the number of geriatric syndromes and 90-day mortality. Design, Setting, and Participants: This cohort study used data from the Creating a Hospital Assessment Network in Geriatrics (CHANGE) study, a multicenter, prospective cohort of 43 hospitals, including 38 in Brazil, 1 in Angola, 1 in Chile, 2 in Colombia, and 1 in Portugal. Consecutive patients aged 65 years or older admitted under geriatric teams between June 1, 2022, and December 31, 2023, were enrolled within 48 hours; patients with terminally illness were excluded. Data were analyzed from February 1 to November 23, 2025. Exposure: A standardized comprehensive geriatric assessment captured 14 geriatric syndromes: loneliness, dementia, depressive symptoms, sensory impairment, disability, immobility, incontinence, falls, frailty, malnutrition, pressure ulcers, polypharmacy, potentially inappropriate medications, and delirium. The exposure of interest was the within-patient count of syndromes. Main Outcomes and Measures: The primary outcome was 90-day all-cause mortality, ascertained by masked telephone follow-up with verification in medical records or public registries. Prespecified mixed-effects Cox proportional hazards regression were performed. Results: The study included 2556 participants (mean [SD] age, 79 [9] years, 1437 female [56.2%]). The median number of geriatric syndromes was 5 (IQR, 3-8). The highest prevalence rates for syndromes were 70.8% (95% CI, 69.1%-72.6%) for disability, 61.7% (95% CI, 59.8%-63.6%) for polypharmacy, 58.2% (95% CI, 56.3%-60.1%) for frailty, and 54.7% (95% CI, 52.8%-56.7%) for sensory impairment. Across categories, the mortality rate rose from 8.4% (95% CI, 6.2%-11.4%) for 0 to 2 syndromes to 12.7% (95% CI, 10.1%-15.7%) for 3 to 4 syndromes, 25.4% (95% CI, 22.2%-29.1%) for 5 to 6 syndromes, 30.4% (95% CI, 26.7%-34.5%) for 7 to 8 syndromes, 39.5% (95% CI, 34.4%-44.8%) for 9 to 10 syndromes, and 47.0% (95% CI, 36.4%-57.9%) for 11 or more syndromes. After adjusting for confounders, each additional geriatric syndrome was associated with an increased risk of mortality (hazard ratio, 1.22 [95% CI, 1.15-1.30), which became increasingly pronounced in older age groups. Conclusions and Relevance: This cohort study found that hospitalized older adults had a median of 5 geriatric syndromes, which were independently and incrementally associated with 90-day mortality. Multidomain assessments should be integrated into standard hospital care to identify and address vulnerabilities that commonly affect older adults with acute illness.