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Comparative Study
. 2017 Oct 25;17(1):248.
doi: 10.1186/s12877-017-0645-7.

Comparing Clinician Descriptions of Frailty and Geriatric Syndromes Using Electronic Health Records: A Retrospective Cohort Study

Free PMC article
Comparative Study

Comparing Clinician Descriptions of Frailty and Geriatric Syndromes Using Electronic Health Records: A Retrospective Cohort Study

Laura J Anzaldi et al. BMC Geriatr. .
Free PMC article


Background: Geriatric syndromes, including frailty, are common in older adults and associated with adverse outcomes. We compared patients described in clinical notes as "frail" to other older adults with respect to geriatric syndrome burden and healthcare utilization.

Methods: We conducted a retrospective cohort study on 18,341 Medicare Advantage enrollees aged 65+ (members of a large nonprofit medical group in Massachusetts), analyzing up to three years of administrative claims and structured and unstructured electronic health record (EHR) data. We determined the presence of ten geriatric syndromes (falls, malnutrition, dementia, severe urinary control issues, absence of fecal control, visual impairment, walking difficulty, pressure ulcers, lack of social support, and weight loss) from claims and EHR data, and the presence of frailty descriptions in clinical notes with a pattern-matching natural language processing (NLP) algorithm.

Results: Of the 18,341 patients, we found that 2202 (12%) were described as "frail" in clinical notes. "Frail" patients were older (82.3 ± 6.8 vs 75.9 ± 5.9, p < .001) and had higher rates of healthcare utilization, including number of inpatient hospitalizations and emergency department visits, than the rest of the population (p < .001). "Frail" patients had on average 4.85 ± 1.72 of the ten geriatric syndromes studied, while non-frail patients had 2.35 ± 1.71 (p = .013). Falls, walking difficulty, malnutrition, weight loss, lack of social support and dementia were more highly correlated with frailty descriptions. The most common geriatric syndrome pattern among "frail" patients was a combination of walking difficulty, lack of social support, falls, and weight loss.

Conclusions: Patients identified as "frail" by providers in clinical notes have higher rates of healthcare utilization and more geriatric syndromes than other patients. Certain geriatric syndromes were more highly correlated with descriptions of frailty than others.

Keywords: Electronic health records; Frailty; Geriatric syndromes; Natural language processing; Unstructured data.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the institutional review board of Johns Hopkins University (IRB# 6196). Participant consent was not required as data was de-identified prior to analysis.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Fig. 1
Fig. 1
Number of Geriatric Syndromes among “Frail” and Non-frail Patients. Bar graph depicts the distributions of the “frail” (n = 2202) and non-frail (n = 16,139) populations based on the number of geriatric syndromes determined for each patient
Fig. 2
Fig. 2
Ten Most Common Geriatric Syndrome Patterns and Correlations with Frailty Label. The top half of the figure gives the ten most common individual geriatric syndrome combinations observed in “frail” patients. N gives the number of “frail” patients with each exact syndrome combination, and the % column gives the percentage out of all 2202 “frail” patients. The bottom half of the figure gives the percentage of all “frail” patients with each individual syndrome, as well as the Pearson correlation of each individual syndrome with the frailty label. Abbreviations – AFC: absence of fecal control; DEC: decubitus ulcer; DEM: dementia; FAL: falls; MAL: malnutrition; N: count; SSN: lack of social support; URC: severe urinary control issues; VIS: visual impairment; WEI: weight loss; WLK: walking difficulty

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