Frailty, walking ability and self-rated health in predicting institutionalization: an 18-year follow-up study among Finnish community-dwelling older people

Abstract

Background In clinical practice, there is a need for an instrument to screen older people at risk of institutionalization. Aims To analyze the association of frailty, walking-ability and self-rated health (SRH) with institutionalization in Finnish community-dwelling older people. Methods In this prospective study with 10-and 18-year follow-ups, frailty was assessed using FRAIL Scale (FS) (n = 1087), Frailty Index (FI) (n = 1061) and PRISMA-7 (n = 1055). Walking ability was assessed as self-reported ability to walk 400 m (n = 1101). SRH was assessed by a question of general SRH (n = 1105). Cox regression model was used to analyze the association of the explanatory variables with institutionalization. Results The mean age of the participants was 73.0 (range 64.0-97.0) years. Prevalence of institutionalization was 40.8%. In unadjusted models, frailty was associated with a higher risk of institutionalization by FS in 10-year follow-up, and FI in both follow-ups. Associations by FI persisted after age-and gender-adjustments in both follow-ups. By PRISMA-7, frailty predicted a higher risk of institutionalization in both follow-ups. In unadjusted models, inability to walk 400 m predicted a higher risk of institutionalization in both follow-ups and after adjustments in 10-year follow-up. Poor SRH predicted a higher risk of institutionalization in unadjusted models in both follow-ups and after adjustments in 10-year follow-up. Discussion Simple self-reported items of walking ability and SRH seemed to be comparable with frailty indexes in predicting institutionalization among community-dwelling older people in 10-year follow-up. Conclusions In clinical practice, self-reported walking ability and SRH could be used to screen those at risk.

Chronic conditions and multimorbidity associated with institutionalization among Finnish community-dwelling older people: an 18-year population-based follow-up study

“…By omitting the participants still living at home at the end of the follow-up period, we also ascertained that we had complete data on the participants’ acquired conditions during their lifetime. The excluded participants were, however, in better health than the included participants and this explains why there were no differences in baseline variables of self-rated health, self-reported walking ability or frailty between the institutionalized and not institutionalized participants, contrary to what we found in our previous work [ 12 ].…”

“…Other factors associated with a higher risk of institutionalization include higher age, living alone, low socioeconomic status, use of home care, low number of specialist visits, low self-rated health (SRH), low body mass index (BMI), cognitive and functional impairment including walking difficulties and falls, and several chronic conditions, such as Parkinson's disease, mood disorders, stroke and multimorbidity [4][5][6][7][8][9][10][11][12]. Among the oldest old women (> 90 years), Parkinson's disease, depression, hip fracture, and multimorbidity, in addition to dementia, predict a higher risk of institutionalization [13].…”

A practical laboratory index to predict institutionalization and mortality – an 18-year population-based follow-up study

“…The LI did not predict institutionalization which seems to be better predicted with clinical FIs [1,16]. Routine laboratory parameters do not predict dementia or cognitive impairment which are considered the most common causes for institutionalization [28][29][30][31][32].…”

“…We have earlier demonstrated that clinical frailty tools are applicable screening instruments among Finnish community-dwelling older people [15,16]. Frailty was associated with higher mortality according to three different clinical frailty screening tools.…”

“…Symptoms, signs, diseases, disabilities, medications, or laboratory measurements can be combined in an index to measure frailty [1,[6][7][8], which is calculated as the proportion of individual's deficits in relation to the total amount of deficits chosen [1,[9][10][11][12][13][14]. Frailty indexes (FI) are strongly associated with the risk of death, institutionalization, and worsening health status, especially when at least 30 variables are included although different FIs consider different deficits [1,13,15,16]. FIs show a consistent, sub-maximal limit at about 2/3 of the deficits that are considered [1,[17][18][19].…”