What is the clinical evidence from this study?

Study design: Cohort. Population: Older adults aged ≥65 years discharged from acute care hospitals in South Korea (n=1115556). Intervention: Discharge destination (home, tertiary/general hospitals, hospitals, long-term care hospitals, others) vs. Discharged home. Primary outcome: All-cause mortality over 4 years following discharge (aHR 2.922 for long-term care hospital discharge versus home, 95% CI 2.892–2.952).

March 2, 2026Open Access

Influence of comorbidities, geriatric syndromes, and frailty on mortality risk by discharge destination in older adults after acute hospitalization: a nationwide cohort study

Key Result

Discharge to long-term care hospitals nearly tripled mortality risk compared to home discharge (aHR 2.922, 95% CI 2.892–2.952) among older adults discharged from acute care hospitals in South Korea.

Key Points

This research aims to examine how discharge destination, frailty, geriatric syndromes, and comorbidities affect mortality risk in older adults after hospital discharge.
Analyzed nationwide claims data from South Korea for older adults discharged from acute care hospitals in 2017.
Participants (aged ≥65) were followed for 4 years to assess mortality outcomes.
Utilized multivariable Cox proportional hazards models to estimate hazard ratios for mortality based on discharge destination and geriatric status.
Included 1,115,556 participants with an average age of 75.5 years.
Home was the most common discharge destination (76.5%).
Higher mortality risk associated with discharge to tertiary/general hospitals (aHR 1.806), general hospitals (aHR 1.480), and long-term care hospitals (aHR 2.922).
Increased mortality risk linked to higher Charlson comorbidity index (≥3), more geriatric syndromes, and severe frailty.

Study Design

Type

Cohort (n=1,115,556)

Multicenter

Yes

Structured PICO

Does discharge destination, along with frailty, geriatric syndromes, and comorbidities, affect mortality risk in older adults after acute hospitalization?

Population

1,115,556 adults aged ≥65 years (mean age 75.5, 45.6% men) discharged from acute care hospitals in South Korea in 2017.

Intervention

Discharge to tertiary/general hospitals, general hospitals, long-term care hospitals, or other facilities

Comparator

Discharge to home

Outcome

All-cause mortalityhard clinical

Discharge to long-term care facilities, higher comorbidity burden, and severe frailty are independently associated with a significantly increased risk of mortality in older adults following acute hospitalization.

Main Result

Effect estimate: aHR 2.922 for long-term care hospital discharge versus home (95% CI 2.892–2.952)

Limitations

Use of administrative claims data lacking detailed clinical information such as disease severity, functional status, and cognitive function
Operational definitions of frailty and geriatric syndromes simplified and may omit severity and duration
Observational design cannot establish causality
Discharge destination classification may lack granularity (e.g., no distinction between skilled nursing, assisted living)
Study findings may have limited generalizability beyond Korean healthcare system
Potential residual confounding and unmeasured factors such as social support and patient preferences not accounted for
No sensitivity analyses reported for excluded cases due to missing data

Abstract

Background This study investigated its impact of discharge destination on mortality risk among older adults following acute hospital discharge, focusing on the effects of frailty, geriatric syndromes, and comorbidities. Methods Nationwide claims data from the South Korean National Health Insurance Service of individuals aged ≥65 years who were discharged from acute care hospitals in 2017 were retrospectively analyzed, with participants followed for mortality outcomes over 4 years. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR) for mortality according to discharge destination and geriatric status. Results This study included 1,115,556 participants (mean age, 75.5 years; 45.6% men). The most common discharge destination was home (76.5%), followed by tertiary/general hospitals (15.2%), long-term care hospitals (5.2%), hospitals (2.3%), and other facilities (0.8%). Patients discharged to long-term care hospitals were older, had a higher comorbidity burden, and more frequently had disabilities or geriatric syndromes than their counterparts. Mortality risk was significantly higher among those discharged to tertiary/general hospitals (aHR 1.806, 95% CI: 1.793–1.820), general hospitals (aHR 1.480, 95% CI: 1.453–1.507), and long-term care hospitals (aHR 2.922, 95% CI: 2.892–2.952) than among those discharged to home. Higher Charlson comorbidity index (≥3), more geriatric syndromes, and severe frailty were all independently associated with increased mortality risk. Conclusion Discharge destination, frailty, geriatric syndromes, and comorbidities independently and interactively influenced the mortality risk in older adults after acute hospitalization. Tailored post-discharge management strategies are necessary, particularly for patients with frailty and multimorbidity in community settings.

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