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Peer-reviewedCC BY-NC 4.0Neuropsychiatric Disease and Treatment

A Nomogram for Individualized Frailty Identification in Older Inpatients with Schizophrenia: Development and Internal Validation

  • Xiulan Liu1,2,3,4
  • Xiashu Yan3
  • Huimin Zhou3
  • Cuixia Liu3
  • Xucong He5
  • Qiubi Tang6
  • Lexin Yuan7
  • Shuixian Yang3
  • Tao Zheng3
  • Chichen Zhang2,4,8
8 affiliations
  1. 1School of Nursing, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
  2. 2School of Health Management, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
  3. 3Department of Chronic Psychiatry, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
  4. 4Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, Guangdong, People’s Republic of China
  5. 5Geriatric Neuroscience Center, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
  6. 6Neurosurgery Department, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
  7. 7Department of Nursing, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
  8. 8Southern Medical University Center for Health Policy and Governance (Guangdong Provincial Social Science Research Base), Guangzhou, Guangdong, People’s Republic of China
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Abstract

Objective: To investigate the prevalence and associated factors of frailty among older inpatients with schizophrenia, and to develop and internally validate a nomogram for individualized identification of current frailty.

Methods: Between May and September 2025, we enrolled 279 older inpatients with schizophrenia (aged ≥60 years) from a tertiary hospital in Guangzhou using convenience sampling. Data included electronic medical records, patient interviews, and the Fried frailty phenotype assessment. Variables with univariate P < 0.1 or pre-specified clinical importance were refined by least absolute shrinkage and selection operator (LASSO) (10-fold cross-validation, lambda.1se) and binary logistic regression. A nomogram was built and internally validated using bootstrap (1,000 iterations). Performance was evaluated by the area under the receiver operating characteristic curve (AUC; DeLong’s method), calibration (Hosmer–Lemeshow test), and decision curve analysis (DCA). The study was approved by the Institutional Review Board of The Affiliated Brain Hospital of Guangzhou Medical University (Approval No: 2025–034). Written informed consent was obtained from all participants or their legal guardians for those with impaired capacity.

Results: Frailty prevalence was 38.0% (≥3 Fried criteria). Five clinical factors (represented by six variables) were retained: age (OR = 1.070, 95% CI: 1.018–1.124), fall history (OR = 2.480, 95% CI: 1.027–5.987), walking aid (OR = 4.021, 95% CI: 0.996–16.228; borderline significance), sensory impairment (single: OR = 2.145, 95% CI: 1.051–4.377; dual: OR = 3.470, 95% CI: 1.562–7.708), and ADL (OR = 0.967, 95% CI: 0.936–0.999). The model showed acceptable discrimination (AUC 0.767, 95% CI: 0.708–0.826), good calibration (Hosmer–Lemeshow P = 0.552; Brier score 0.182; calibration slope 0.967). DCA showed positive net benefit at thresholds 0.1–0.4.

Conclusion: The nomogram showed acceptable discrimination and good calibration for identifying frailty in older inpatients with schizophrenia. Prospective multicenter external validation is needed.

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Cite

BibTeXRIS
BibTeX
@article{liu2026nomogram,
  title = {{A Nomogram for Individualized Frailty Identification in Older Inpatients with Schizophrenia: Development and Internal Validation}},
  author = {Xiulan Liu and Xiashu Yan and Huimin Zhou and Cuixia Liu and Xucong He and Qiubi Tang and Lexin Yuan and Shuixian Yang and Tao Zheng and Chichen Zhang},
  journal = {Neuropsychiatric Disease and Treatment},
  year = {2026},
  month = nov,
  doi = {10.2147/ndt.s652910},
  url = {https://doi.org/10.2147/ndt.s652910},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - A Nomogram for Individualized Frailty Identification in Older Inpatients with Schizophrenia: Development and Internal Validation
AU  - Xiulan Liu
AU  - Xiashu Yan
AU  - Huimin Zhou
AU  - Cuixia Liu
AU  - Xucong He
AU  - Qiubi Tang
AU  - Lexin Yuan
AU  - Shuixian Yang
AU  - Tao Zheng
AU  - Chichen Zhang
PY  - 2026
DA  - 2026/11/01
JO  - Neuropsychiatric Disease and Treatment
DO  - 10.2147/ndt.s652910
UR  - https://doi.org/10.2147/ndt.s652910
AB  - Objective: To investigate the prevalence and associated factors of frailty among older inpatients with schizophrenia, and to develop and internally validate a nomogram for individualized identification of current frailty.  Methods: Between May and September 2025, we enrolled 279 older inpatients with schizophrenia (aged ≥60 years) from a tertiary hospital in Guangzhou using convenience sampling. Data included electronic medical records, patient interviews, and the Fried frailty phenotype assessment. Variables with univariate P < 0.1 or pre-specified clinical importance were refined by least absolute shrinkage and selection operator (LASSO) (10-fold cross-validation, lambda.1se) and binary logistic regression. A nomogram was built and internally validated using bootstrap (1,000 iterations). Performance was evaluated by the area under the receiver operating characteristic curve (AUC; DeLong’s method), calibration (Hosmer–Lemeshow test), and decision curve analysis (DCA). The study was approved by the Institutional Review Board of The Affiliated Brain Hospital of Guangzhou Medical University (Approval No: 2025–034). Written informed consent was obtained from all participants or their legal guardians for those with impaired capacity.  Results: Frailty prevalence was 38.0% (≥3 Fried criteria). Five clinical factors (represented by six variables) were retained: age (OR = 1.070, 95% CI: 1.018–1.124), fall history (OR = 2.480, 95% CI: 1.027–5.987), walking aid (OR = 4.021, 95% CI: 0.996–16.228; borderline significance), sensory impairment (single: OR = 2.145, 95% CI: 1.051–4.377; dual: OR = 3.470, 95% CI: 1.562–7.708), and ADL (OR = 0.967, 95% CI: 0.936–0.999). The model showed acceptable discrimination (AUC 0.767, 95% CI: 0.708–0.826), good calibration (Hosmer–Lemeshow P = 0.552; Brier score 0.182; calibration slope 0.967). DCA showed positive net benefit at thresholds 0.1–0.4.  Conclusion: The nomogram showed acceptable discrimination and good calibration for identifying frailty in older inpatients with schizophrenia. Prospective multicenter external validation is needed.
SN  - 1176-6328
SN  - 1178-2021
ER  -