Aims: To describe the clinical profile of older adults admitted with diabetic foot ulcers (DFUs) and evaluate the association between frailty and health outcomes.
Methods: We conducted a single-centre retrospective observational study of consecutive admissions with active DFUs in individuals aged ≥65 years, to a tertiary vascular unit between January 2023 and December 2024. Mixed aetiology ulcers were included where diabetes was a contributing factor. Frailty was assessed using the Clinical Frailty Scale (CFS), with a score of ≥4 indicating frailty. Outcomes included sepsis, delirium measured using 4A’s Test, major adverse cardiovascular events (MACE), length of stay (LOS), discharge destination, 30-day readmission, surgical intervention, wound healing, and in-hospital mortality. Associations between frailty and outcomes were examined using regression models adjusted for age, sex, and Charlson Comorbidity Index.
Results: 141 admissions were analysed. Median age was 73 years and median CFS score was 4. Higher CFS scores were associated with increased odds of sepsis and delirium, higher delirium severity and longer LOS. Each one-point increase in CFS score was associated with 73% increased odds of sepsis. Delirium risk and severity doubled with one-point increment in CFS. Each one-point increase in CFS score corresponded to one additional inpatient day. No significant associations were observed between frailty and surgical intervention, MACE, discharge destination, or 30-day readmission.
Conclusions: Frailty is a key predictor of sepsis, delirium and prolonged hospitalisation in older adults with DFUs. Routine frailty assessment may enhance risk stratification, guide clinical decision making and support more efficient use of health care resources.