Frailty and outcomes in older adults hospitalized for epilepsy

Background: Epilepsy has a bimodal incidence distribution, with a second peak in older age. Older adults with epilepsy represent a clinically vulnerable and relatively understudied population, and frailty may be an important determinant of outcomes in this setting. This study examined the prevalence of frailty among older adults hospitalized with epilepsy and its associations with in-hospital outcomes. Methods: This population-based retrospective study used data from the Nationwide Inpatient Sample (2005–2022). Hospitalized adults aged ≥ 60 years with a primary diagnosis of epilepsy were included. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator. Propensity score matching was performed to balance baseline characteristics. Multivariable regression analyses were used to examine the associations between frailty and in-hospital outcomes, including major complications, prolonged length of stay (LOS), unfavorable discharge, total hospital costs, and in-hospital mortality. Results: Among 176,884 eligible hospitalizations, 57.7% were classified as frail. After matching, 140,094 patients were analyzed. Frailty was associated with higher risks of major complications (aOR 1.17, 95% CI 1.14–1.20), urinary tract infection (aOR 1.26, 95% CI 1.22–1.30), prolonged LOS (aOR 1.34, 95% CI 1.31–1.38), and unfavorable discharge (aOR 1.84, 95% CI 1.80–1.89), as well as increased total hospital costs. These associations were consistent across subgroups defined by age, intractable epilepsy status, and substance abuse. In contrast, frailty was associated with a lower risk of in-hospital mortality (aOR 0.77, 95% CI 0.71–0.84). Conclusions: Frailty was highly prevalent among older adults hospitalized with epilepsy and is associated with worse in-hospital outcomes and greater healthcare resource utilization. The observed lower in-hospital mortality among frail patients likely reflects differences in discharge patterns and care pathways. These findings support the clinical relevance of frailty recognition in older adults hospitalized with epilepsy.