Assessing the measurement properties of a Frailty Index across the age spectrum in the Canadian Longitudinal Study on Aging

Kanters, David; Griffith, Lauren; Hogan, David B.; Richardson, Julie; Patterson, Christopher; Raina, Parminder

doi:10.1136/jech-2016-208853

Cited by 33 publications

(27 citation statements)

References 37 publications

(31 reference statements)

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“…Our findings confirm many of our hypotheses and are aligned with the existing literature describing accidental falls, assistive devices, and home care [31][32][33][34]. The increased rate of falls among health conditions (e.g., dizziness or lightheadedness, parkinsonism, etc.)…”

Section: Principal Findingssupporting

confidence: 89%

Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study

2020

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Background: Accidental falls among older adults are a leading cause of injury-related hospitalizations. Reducing falls is an ongoing quality improvement priority for home care, given that many home care clients experience falls. In this study, we identify factors associated with the rate of falls among home care clients. Methods: We conducted a population-based, cross-sectional study using secondary data from the Hamilton, Niagara, Haldimand, and Brant health region of Ontario, Canada from January 1-March 31, 2018. We captured person-level characteristics with falls from the Resident Assessment Instrument-Home Care (RAI-HC). Negative binomial regression was used to model the rate of falls. Results: Functional characteristics of home care clients had strong, statistically significant associations with the rate of falls. Declines in activities of daily living, assistive device use for locomotion indoors, polypharmacy, and health conditions, such as dizziness or lightheadedness, and parkinsonism, were associated with a higher rate of falls. Males who used assistive devices had a higher rate of falls compared to females; however, males with neurological and cardiovascular health conditions had a decrease in the rate of falls compared to females. Home care clients with parkinsonism who used a cane and took eight or more drugs had stronger associations with an increased rate of falls compared to those who do not have parkinsonism. Conclusions: Functional characteristics, polypharmacy, and health conditions are associated with increased rates of falls among home care clients. Home care clients who are at a greater risk of falls may require environmental adjustments in their home to reduce or eliminate the possibility of falling.

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Section: Principal Findingssupporting

confidence: 89%

Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study

2020

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“…We showed that individuals who were frail were more likely to have fallen in the past year, and went on to have more falls in the subsequent year. In a mixed sample of community dwelling and older adults resident in long term care in Canada, the FI was also correlated with future falls (r = 0.12; p < 0.001) [53]. In the current study of elderly residents in long term care facilities, the correlation between FI-MDS and prospective falls was slightly stronger (r = 0.21, p = 0.03), perhaps reflecting the higher risk of falls and frailty in general in this cohort.…”

Section: Discussionmentioning

confidence: 99%

Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents

et al. 2019

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BackgroundOrthostatic hypotension (OH; profound falls in blood pressure when upright) is a common deficit that increases in incidence with age, and may be associated with falling risk. Deficit accumulation results in frailty, regarded as enhanced vulnerability to adverse outcomes. We aimed to evaluate the relationships between OH, frailty, falling and mortality in elderly care home residents.MethodsFrom the Minimum Data Set (MDS) document, a frailty index (FI-MDS) was generated from a list of 58 deficits, ranging from 0 (no deficits) to 1.0 (58 deficits). OH was evaluated from beat-to-beat blood pressure and heart rate (finger plethysmography) collected during a 15-min supine-seated orthostatic stress test. Retrospective and prospective falling rates (falls/year) were extracted from facility falls incident reports. All-cause 3-year mortality was determined. Data are reported as mean ± standard error.ResultsData were obtained from 116 older adults (aged 84.2 ± 0.9 years; 44% males) living in two long term care facilities. The mean FI-MDS was 0.36 ± 0.01; FI-MDS was correlated with age (r = 0.277; p = 0.003). Those who were frail (FI ≥ 0.27) had larger Initial (− 17.8 ± 4.2 vs − 6.1 ± 3.3 mmHg, p = 0.03) and Consensus (− 22.7 ± 4.3 vs − 11.5 ± 3.3 mmHg, p = 0.04) orthostatic reductions in systolic arterial pressure. Frail individuals had higher prospective and retrospective falling rates and higher 3-year mortality. Receiver operating characteristic curves evaluated the ability of FI-MDS alone to predict prospective falls (sensitivity 72%, specificity 36%), Consensus OH (sensitivity 68%, specificity 60%) and 3-year mortality (sensitivity 77%, specificity 49%). Kaplan Meier survival analyses showed significantly higher 3-year mortality in those who were frail compared to the non-frail (p = 0.005).ConclusionsFrailty can be captured using a frailty index based on MDS data in elderly individuals living in long term care, and is related to susceptibility to orthostatic hypotension, falling risk and 3-year mortality. Use of the MDS to generate a frailty index may represent a simple and convenient risk assessment tool for older adults living in long term care. Older adults who are both frail and have impaired orthostatic blood pressure control have a particularly high risk of falling and should receive tailored management to mitigate this risk.Electronic supplementary materialThe online version of this article (10.1186/s12877-019-1082-6) contains supplementary material, which is available to authorized users.

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“…The frailty index, multiplied by 100 for easier interpretation (0‐100), was used as the main outcome of interest in this study. The frailty index included 76 potential deficits related to physical function, health and chronic conditions, cognition, activities of daily living, body mass index category, and depression, based on the work of Kanters et al…”

Section: Methodsmentioning

confidence: 97%

“…In older adults, poor oral health has been associated with numerous diseases, including cardiovascular disease, respiratory disease, and diabetes, as well as incident frailty . Frailty is a clinical state in which there is an increase in an individualʼs vulnerability for developing dependency and/or mortality when exposed to a stressor . Increased frailty increases the risk of adverse health outcomes across age‐groups, including falls, hospitalizations, dependency, and death .…”

mentioning

confidence: 99%

Oral Health, Diet, and Frailty at Baseline of the Canadian Longitudinal Study on Aging

Bassim

Mayhew

Kanters

et al. 2020

J American Geriatrics Society

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OBJECTIVES: Poor diet due to poor oral health was proposed as a potential mediator of the association between poor oral health and frailty. This study explores the cross-sectional associations between poor oral health, poor diet, and frailty in Canadian adults, aged 45 to 85 years, and then tests whether the expected oral health-frailty association is changed by taking into account the pathway through poor diet. DESIGN: Cross-sectional study. SETTING: The baseline wave of the Canadian Longitudinal Study on Aging, a nationally representative population study. PARTICIPANTS: Data from 28 738 community-dwelling participants, aged 45 to 85 years. MEASUREMENTS: We characterized poor oral health (cumulative count of 24 items of oral health problems), poor diet (scale of poor food consumption from 7 healthy foods groups), and frailty (cumulative frailty index of 76 items). Regression-based path analyses were used to investigate associations between poor oral health, poor diet, and frailty, adjusted for age group, sex, income, smoking, living alone, education, physical activity, social support, and dental visit. RESULTS: Poorer oral health was associated with low income, smoking, low physical activity, low social support, and no dental visit. There were associations between poorer oral health and poorer diet (effect size β adjusted = .40; 95% confidence interval [CI] = .20-.61) and between poorer oral health and increased frailty (β adjusted = .85; 95% CI = .68-1.02). The indirect effect through the path of poor diet was approximately 0.01 (95% CI = 0.01-0.02) (ie, explaining 1% of the effect of poor oral health on frailty). CONCLUSIONS: Poor oral health was associated with poor diet and frailty. Each additional oral health problem was associated with an increase of approximately 1 frailty index point, even after full adjustment for poor diet. The indirect effect of poor oral health through poor diet was modest. Though poor oral health was associated with poorer diet quality, a more direct effect of poor oral health on increasing frailty may be indicated. J Am Geriatr Soc 68:959-966, 2020.

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Assessing the measurement properties of a Frailty Index across the age spectrum in the Canadian Longitudinal Study on Aging

Cited by 33 publications

References 37 publications

Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study

Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study

Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents

Oral Health, Diet, and Frailty at Baseline of the Canadian Longitudinal Study on Aging

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