{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:49:52Z","timestamp":1779205792255,"version":"3.51.4"},"reference-count":20,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Older adults who are hospitalized in internal medicine wards often present with a challenging interplay of multimorbidity and geriatric syndromes. The timely identification of clinical and geriatric predictors of in-hospital mortality is crucial for guiding individualized care pathways and ensure appropriate resource allocation. In this study, we investigate the prognostic impact of frailty, delirium\u2014including its motor subtypes\u2014and global comorbidity burden on in-hospital mortality in patients aged 70 years and older. Methods: We conducted a retrospective observational study including 556 consecutive patients aged \u2265 70 years who were admitted to the Internal Medicine Unit of the University Hospital of Parma from January 2019 to July 2019. Demographic, clinical, and geriatric data were collected within 48 h of admission, including Clinical Frailty Scale (CFS), Cumulative Illness Rating Scale (CIRS), and delirium diagnosis with the 4AT tool. Multivariate Cox and logistic regression analyses were performed, including sex-stratified models. Results: The median age was 85 years (IQR 80\u201389), 58% were female, and in-hospital mortality was 11% (n = 61). Non-survivors had higher rates of severe frailty (CFS \u2265 7: 39% vs. 16%, p &lt; 0.001), prevalent delirium (20% vs. 4%, p &lt; 0.001), hypokinetic delirium (20% vs. 5%, p &lt; 0.001), liver disease (23% vs. 11%, p = 0.008), cancer (44% vs. 24%, p &lt; 0.001), and dementia (43% vs. 29%, p = 0.026) and a higher CIRS severity index (\u22653:55% vs. 31%, p &lt; 0.001). In Cox regression, independent predictors of death were prevalent delirium (HR 4.66, 95% CI 2.42\u20138.96), CFS \u2265 7 (HR 2.26, 95% CI 1.32\u20133.87), CIRS-LIVER \u2265 2 (HR 2.05, 95% CI 1.18\u20133.56), and cancer (HR 1.83, 95% CI 1.07\u20133.14). Sex-stratified models showed that in males, prevalent delirium (HR 10.23) and cancer (HR 2.49) predicted mortality, whereas in females, hypokinetic delirium (HR 3.67) and CIRS-LIVER \u2265 2 (HR 2.75) were the strongest predictors. Logistic regression confirmed these associations and additionally identified anemia and CFS \u2265 7 in males and CIRS severity index \u2265 3 in females as significant risk factors. Conclusions: In elderly patients who are admitted to internal medicine wards, prevalent and hypokinetic delirium, severe frailty, and high comorbidity burden, particularly liver disease and cancer, are strong independent predictors of in-hospital mortality, with distinct sex-specific patterns. Early multidimensional geriatric assessment may improve risk stratification and guide targeted interventions.<\/jats:p>","DOI":"10.3390\/jcm14196726","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T08:19:45Z","timestamp":1758701985000},"page":"6726","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical and Geriatric Predictors of In-Hospital Mortality in Older Adults Admitted to Internal Medicine Wards: A Retrospective Observational Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0613-1074","authenticated-orcid":false,"given":"Carmine","family":"Siniscalchi","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Parma University Hospital, 43120 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8484-4598","authenticated-orcid":false,"given":"Pierpaolo","family":"Di Micco","sequence":"additional","affiliation":[{"name":"Internal Medicine, Ward Santa Maria delle Grazie, Pozzuoli Naples Hospital 2 Nord, 80078 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Guerra","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Parma University Hospital, 43120 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2680-2242","authenticated-orcid":false,"given":"Antonio","family":"Nouvenne","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Parma University Hospital, 43120 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicoletta","family":"Cerundolo","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Parma University Hospital, 43120 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Parise","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Parma University Hospital, 43120 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiziana","family":"Meschi","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Parma University Hospital, 43120 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1111\/bcp.13590","article-title":"The relationship between frailty and polypharmacy in older people: A systematic review","volume":"84","author":"Izquierdo","year":"2018","journal-title":"Br. 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