Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living

Abstract

BackgroundFew studies have directly compared the competing approaches to identifying frailty in more vulnerable older populations. We examined the ability of two versions of a frailty index (43 vs. 83 items), the Cardiovascular Health Study (CHS) frailty criteria, and the CHESS scale to accurately predict the occurrence of three outcomes among Assisted Living (AL) residents followed over one year.MethodsThe three frailty measures and the CHESS scale were derived from assessment items completed among 1,066 AL residents (aged 65+) participating in the Alberta Continuing Care Epidemiological Studies (ACCES). Adjusted risks of one-year mortality, hospitalization and long-term care placement were estimated for those categorized as frail or pre-frail compared with non-frail (or at high/intermediate vs. low risk on CHESS). The area under the ROC curve (AUC) was calculated for select models to assess the predictive accuracy of the different frailty measures and CHESS scale in relation to the three outcomes examined.ResultsFrail subjects defined by the three approaches and those at high risk for decline on CHESS showed a statistically significant increased risk for death and long-term care placement compared with those categorized as either not frail or at low risk for decline. The risk estimates for hospitalization associated with the frailty measures and CHESS were generally weaker with one of the frailty indices (43 items) showing no significant association. For death and long-term care placement, the addition of frailty (however derived) or CHESS significantly improved on the AUC obtained with a model including only age, sex and co-morbidity, though the magnitude of improvement was sometimes small. The different frailty/risk models did not differ significantly from each other in predicting mortality or hospitalization; however, one of the frailty indices (83 items) showed significantly better performance over the other measures in predicting long-term care placement.ConclusionsUsing different approaches, varying degrees of frailty were detected within the AL population. The various approaches to defining frailty were generally more similar than dissimilar with regard to predictive accuracy with some exceptions. The clinical implications and opportunities of detecting frailty in more vulnerable older adults require further investigation.

Association of frailty in hospitalized and institutionalized elderly in the community-dwelling

“…The absence of a universal criterion accepted by researchers to evaluate frailty prevents the comparison between different studies, because the publications use different instruments (Frailty Index, Cardiovascular Health Study, Armstrong Index, FI-CGA) (22)(23)(24) . A systematic review, between 1990 and 2010 (23) , investigated the association between geriatric syndromes (including frailty) and hospitalization and admission to long term care facilities, with various definitions of frailty.…”

“…Despite the different stages of frailty, measured with different instruments, association between frailty, death, hospitalization and institutionalization were established. The authors report that residents with more severe levels of frailty are more likely to die, become hospitalized, and require institutionalization in long-term care facilities (22) . A prospective cohort study involving 752 elderly, aged 75 years or older, to investigate the predictive validity of the frailty index based on the geriatric assessment (CGA-FI) found that the increase of values in the index was associated with the growth of the risk of death, institutionalization, and length of hospital stay (24) .…”

Association between Frailty and Dementia: A Population-Based Study

“…Persons without any of these frailty symptoms were considered as robust (the reference group). The Cardiovascular Health Study criteria for frailty have been widely used in the literature and have good predictive validity for adverse health outcomes [1]. …”

“…Frailty is considered an age-associated syndrome that leads to difficulties in daily activities and increased risk for institutionalization and mortality [1]. According to the definition by Fried et al [2], frailty is characterized by several physical symptoms, including weight loss, exhaustion, poor hand-grip strength, slow walking speed and physical inactivity.…”

An Evaluation of the Central Nervous System Medication Use and Frailty among Residents of Aged Care Homes in Malaysia

“…Aged care homes have grown rapidly [3]. Compared to their community counterparts, aged care home residents appear to be frailer, with higher rates of illness and disability [4,5]. In a medical context, frailty is defined as a syndrome of diminished strength or endurance, and reduced physiologic function that increases an individual's vulnerability to various stressors [6].…”