Preoperative frailty and multidimensional concurrent correlates among older adults scheduled for radical cystectomy: a social ecological model-informed cross-sectional study

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Abstract Background Frailty is common in older adults considered for radical cystectomy (RC), but the nutritional, muscular, functional, psychological, behavioral, and social features that accompany frailty before surgery remain incompletely characterized. Using the Social Ecological Model as an organizational framework, we estimated frailty prevalence and examined concurrent correlates among older adults scheduled for RC. Methods This single-center cross-sectional study consecutively screened 151 adults aged 65 years or older from the elective RC schedule of a tertiary hospital in Nanjing, China. After 11 patients were excluded, three declined participation, and three did not complete all assessments, 134 participants were analyzed. Frailty was measured with the five-item FRAIL scale approximately one week before the planned operation. Given the 33 frail participants, each candidate correlate was examined in a separate Firth logistic regression model adjusted for age and sex. Results Of the 134 participants, 47 (35.1%) were robust, 54 (40.3%) were prefrail, and 33 (24.6%) were frail. In age- and sex-adjusted models, frailty was associated with older age (per 5 years: odds ratio [OR] 2.63, 95% confidence interval [CI] 1.73–4.19), lower Mini Nutritional Assessment–Short Form score (per 1-point decrease: OR 1.31, 95% CI 1.10–1.56), lower skeletal muscle index (per 1 kg/m² decrease: OR 4.51, 95% CI 2.33–9.56), lower grip strength (per 5 kg decrease: OR 2.38, 95% CI 1.69–3.56), lower Short Physical Performance Battery score (per 1-point decrease: OR 1.21, 95% CI 1.00–1.46), lower nine-item activity participation score (per 5-point decrease: OR 2.02, 95% CI 1.35–3.25), and shorter six-minute walk distance (per 50 m decrease: OR 1.55, 95% CI 1.21–2.02). Associations with anxiety symptoms, depressive symptoms, and perceived social support were attenuated after adjustment. Conclusions Frailty and prefrailty were common among patients scheduled for RC and coexisted with nutritional, muscular, and functional deficits. Prospective studies are needed to determine whether these measures predict postoperative recovery and whether targeted optimization improves outcomes.