Derivation of a frailty index from the resident assessment instrument – home care adapted for Switzerland: a study based on retrospective data analysis

Abstract

BackgroundThe screening of frail individuals at risk for functional health decline and adverse health outcomes lies in the evolving agenda of home care providers. Such a screening can be based on a frailty index (FI) derived from data collected with interRAI instruments used in clinical routines to define care plans. The objective of this study was to assess the feasibility of deriving an FI from the Resident Assessment Instrument – Home Care adapted for Switzerland (Swiss RAI-HC).MethodsData were collected by the Geneva Institution for Homecare and Assistance in clinical routines. The sample consisted of 3714 individuals aged 65 or older (67.7% females) who had each received a Swiss RAI-HC upon admission in the year of 2015. The FI was derived from 52 variables identified and scored according to published guidelines. Adverse health outcomes were either assessed during follow-up assessments (falls, hospitalizations) or documented from administrative records (mortality).ResultsThe results showed that the FI was distributed normally, with a mean of 0.24 (± 0.13), an interquartile range of 0.16, and values of 0.04 at percentile 1 and 0.63 at percentile 99. The effect of Age was significant (R2 = 0.011) with a slope of β = 0.002, 95% CI = [0.001–0.002]. Sex as well as the Age × Sex interaction were not significant. The FI predicted deaths (OR = 9.99, 95% CI = [3.20–29.99]), hospitalizations (OR = 3.40, 95% CI = [1.78–6.32]), and falls (OR = 5.00, 95% CI = [2.68–9.38]).ConclusionsThe results support the feasibility of an FI derivation from the Swiss RAI-HC, hence replicating previous demonstrations based on interRAI instruments. The results also replicated findings showing that the FI is a good predictor of adverse health outcomes. Yet, the results suggest that home care recipients demonstrate a frailty pattern different from the one reported in community dwellers but comparable to clinical samples. Further work is needed to assess the characteristics of the proposed index in community-dwelling, non-clinical samples for comparability with the existing literature and external validationTrial registration ClinicalTrials.gov NCT03139162. Retrospectively registered May 2, 2017.Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0604-3) contains supplementary material, which is available to authorized users.

Association between dysphagia risk and unplanned hospitalization in older patients receiving home medical care

“…In Ludwig and Busnel's study of home medical care in Switzerland, patients with a higher frailty score had a higher chance of an unplanned hospitalization (OR 3.40, 95% CI 1.78-6.32) when compared with low frailty score patients. 21 Comparatively, the present participants were frailer (mean FI 0.34 AE 0.11) than the previous study population (mean FI 0.24 AE 0.13). We hypothesize that in frailer populations, the DSS is a stronger predictor of unplanned hospitalizations than frailty itself, and should be included in the management of this group of patients.…”

“…Some previous investigations of risk factors for unplanned hospitalizations reported that frailty was an independent predictor of hospitalization in home medical care. In Ludwig and Busnel's study of home medical care in Switzerland, patients with a higher frailty score had a higher chance of an unplanned hospitalization (OR 3.40, 95% CI 1.78–6.32) when compared with low frailty score patients . Comparatively, the present participants were frailer (mean FI 0.34 ± 0.11) than the previous study population (mean FI 0.24 ± 0.13).…”

“…We considered 0.35 as the cut-off value between frailty (0.35-1.00) and no frailty (0-0.35) based on previous validated studies. 21 Participant background characteristics were compared between the high and low DSS groups using Student's t-test for continuous variables, or χ 2 analysis for categorical variables. The association between the DSS score and first hospitalization, defined as an acute admission, was analyzed by Cox regression analysis with adjustment for factors that were significantly different between the high and low DSS groups.…”

“…The MNA‐SF was divided into three categories: malnutrition (score ≤7), risk of malnutrition (score 8–11) and good nutritional status (score 12–14). We considered 0.35 as the cut‐off value between frailty (0.35–1.00) and no frailty (0–0.35) based on previous validated studies …”

Derivation of a Frailty Index from the interRAI-HC to Assess Frailty among Older Adults Receiving Home Care and Assistance (the “fraXity” Study)

“…A cut point of FI > 0.21 is preferred for studies conducted in community-based population [27][28][29][30][31][32]. A FI can be computed from routinely collected health data, whether from CGAs [26,33,34], primary care electronic health records [35] or minimum datasets [MDS] gathered with Resident Assessment Instruments (RAI) [36,37] designed for acute care [38][39][40], home care [29,[41][42][43][44] and nursing homes [45]. The rationale underlying deriving the FI from clinical datasets is to provide a measure of frailty that demonstrates substantial agreement across studies [25,46] and high predictive validity of undesirable health outcomes [47,48].…”