Prediction of Death with the Frail-NH in Institutionalized Older Adults: A Longitudinal Study from a Middle-Income Country

Romanini, C; Boas, P. Vilas; Cecato, Juliana Francisca; Robello, E.; Borges, Marcus Kiiti; Martinelli, José Eduardo; Aprahamian, Ivan

doi:10.1007/s12603-020-1464-7

Cited by 3 publications

(12 citation statements)

References 18 publications

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“…Predictive validity was investigated in 14 studies (Table 3 ). FRAIL-NH scores were predictive of mortality ( 25 , 30 , 39 , 44 , 47 , 52 , 56 , 57 , 59 ), falls ( 44 , 57 ), hospitalization ( 26 , 30 , 57 ), length of hospitalization ( 30 , 41 ), and functional or cognitive decline ( 41 , 52 , 57 , 58 ) over a median follow-up of 12 months. Among residents with no activities of daily living (ADL) dependence in a Hong Kong study (n=2,380), FRAIL-NH predicted falls, worsening ADL, hospitalization, and mortality ( 57 ).…”

Section: Resultsmentioning

confidence: 98%

“…The FRAIL-NH scale was applied in studies across 20 countries; the majority in Australia (n=14) ( 21 – 34 ), followed by China (n=6) ( 35 – 40 ), Spain (n=3) ( 41 – 43 ), United States (US) (n=3) ( 44 – 46 ), Brazil (n=2) ( 47 , 48 ), Japan (n=2) ( 49 , 50 ), Singapore (n=2) ( 51 , 52 ), Belgium (n=1) ( 53 ), Canada (n=1) ( 54 ), England (n=1) ( 50 ), Europe and Israel (n=1) ( 55 ), France (n=1) ( 56 ), Hong Kong (n=1) ( 57 ), Italy (n=1) ( 58 ), South Korea (n=1) ( 59 ), and Taiwan (n=1) ( 60 ). One study was an international multicenter study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study, conducted in 8 countries including Czech Republic, England, Finland, France, Germany, Israel, Italy, and the Netherlands ( 55 ).…”

Section: Resultsmentioning

confidence: 99%

“…When applying these definitions, between 15.1% and 79.5% of residents were frail, while 28.5% to 75.0% of residents were most frail. Other common cut-offs used to define frailty were ≥6 (n=5) ( 39 , 42 , 43 , 48 , 60 ) and ≥8 (n=8) ( 37 , 44 – 47 , 54 , 55 , 58 ). Ten studies assessed the sensitivity and specificity of different cut-offs ( 24 , 29 , 35 – 40 , 47 , 52 ), with ≥8 having the highest sensitivity (94.1%) and specificity (82.8%) for classifying residents as frail based on FI ( 37 ), while two studies reported an optimal cut-off of ≥2 using FI and FP, respectively ( 29 , 40 ).…”

Section: Resultsmentioning

confidence: 99%

“…Other common cut-offs used to define frailty were ≥6 (n=5) ( 39 , 42 , 43 , 48 , 60 ) and ≥8 (n=8) ( 37 , 44 – 47 , 54 , 55 , 58 ). Ten studies assessed the sensitivity and specificity of different cut-offs ( 24 , 29 , 35 – 40 , 47 , 52 ), with ≥8 having the highest sensitivity (94.1%) and specificity (82.8%) for classifying residents as frail based on FI ( 37 ), while two studies reported an optimal cut-off of ≥2 using FI and FP, respectively ( 29 , 40 ). Optimal cut-offs were primarily established based on FI, FP, or the Comprehensive Geriatric Assessment (CGA), and determined using Youden Index or receiver operating characteristic curves.…”

Section: Resultsmentioning

confidence: 99%

“…Cross-sectional associations were described in 18 studies (Table 2 ). Fifteen studies reported univariate or bivariate associations ( 23 , 26 , 29 , 31 , 33 , 39 , 43 , 45 , 47 , 52 , 56 – 60 ); while four studies adjusted analyses for age, sex, and other variables ( 22 , 35 , 42 , 55 ). FRAIL-NH scores were associated with older age ( 35 , 39 , 47 , 55 – 57 ), female sex ( 29 , 45 , 55 – 57 ), multimorbidity ( 35 , 43 , 52 , 57 ), cognitive impairment ( 43 , 45 , 52 , 55 , 57 , 59 ), and functional dependence ( 43 , 52 ).…”

Section: Resultsmentioning

confidence: 99%

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The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

Liau

Lalic

Visvanathan

et al. 2021

The Journal of nutrition, health and aging

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Objectives To investigate frailty prevalence, cross-sectional associations, predictive validity, concurrent validity, and cross-cultural adaptations of the FRAIL-NH scale. Design Systematic review. Setting and Participants Frail residents living in nursing homes. Methods MEDLINE, EMBASE, CINAHL, and Cochrane Library were searched from January 2015 to June 2021 for primary studies that used the FRAIL-NH scale, irrespective of study designs and publication language. Results Overall, 40 studies conducted across 20 countries utilized the FRAIL-NH scale; majority in Australia (n=14), followed by China (n=6), United States (n=3), and Spain (n=3). The scale has been translated and back-translated into Brazilian Portuguese, Chinese, and Japanese. Various cut-offs have been used, with ≥2 and ≥6 being the most common cut-offs for frail and most frail, respectively. When defined using these cut-offs, frailty prevalence varied from 15.1–79.5% (frail) to 28.5–75.0% (most frail). FRAIL-NH predicted falls (n=2), hospitalization or length of stay (n=4), functional or cognitive decline (n=4), and mortality (n=9) over a median follow-up of 12 months. FRAIL-NH has been compared to 16 other scales, and was correlated with Fried’s phenotype (FP), Frailty Index (FI), and FI-Lab. Four studies reported fair-to-moderate agreements between FRAIL-NH and FI, FP, and the Comprehensive Geriatric Assessment. Ten studies assessed the sensitivity and specificity of different FRAIL-NH cutoffs, with ≥8 having the highest sensitivity (94.1%) and specificity (82.8%) for classifying residents as frail based on FI, while two studies reported an optimal cut-off of ≥2 based on FI and FP, respectively. Conclusion In seven years, the FRAIL-NH scale has been applied in 20 countries and adapted into three languages. Despite being applied with a range of cut-offs, FRAIL-NH was associated with higher care needs and demonstrated good agreement with other well-established but more complex scales. FRAIL-NH was predictive of adverse outcomes across different settings, highlighting its value in guiding care for frail residents in nursing homes. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s12603-021-1694-3 and is accessible for authorized users.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

Liau

Lalic

Visvanathan

et al. 2021

The Journal of nutrition, health and aging

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Malnutrition as a major related factor of frailty among older adults residing in long-term care facilities in Korea

Moon

Chung

et al. 2023

PLoS ONE

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Objectives The objectives of this study were 1) to investigate the prevalence and co-existence of frailty and malnutrition and 2) to identify factors related to frailty (including malnutrition) according to the level of frailty. Methods Data collection was conducted from July 11, 2021, to January 23, 2022, in 558 older adults residing in 16 long-term care facilities (LTCFs) in Korea. The FRAIL-NH and Mini-Nutritional Assessment short form were used to measure frailty and nutrition, respectively. The data analysis included descriptive statistics and a multivariate logistic regression. Results The mean age of the participants was 83.68 (± 7.39) years. Among 558 participants, 37 (6.6%), 274 (49.1%), and 247 (44.3%) were robust, prefrail, and frail, respectively. At the same time, 75.8% were categorized as having malnutrition status (malnourished: 18.1%; risk of malnutrition: 57.7%), and 40.9% had co-existing malnutrition and frailty. In the multivariate analysis, malnutrition was identified as the major frailty-related factor. Compared with a normal nutritional status, the incidence of frailty in the malnutrition group was 10.35 times (95% CI: 3.78–28.36) higher than the incidence of robustness and 4.80 times (95% CI: 2.69–8.59) higher than the incidence of prefrail. Conclusion The prevalence of frailty and malnutrition, and their co-existence, among older adults residing in LTCFs was high. Malnutrition is a major factor that increases the incidence of frailty. Therefore, active interventions are needed to improve the nutritional status of this population.

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Frailty and mortality in long-term care facilities for older people in Brazil: a survival analysis

Fonseca

Silva

Carvalho

et al. 2021

Geriatr Gerontol Aging

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OBJECTIVES: To investigate the effect of frailty on 1-year mortality in long term-care facility (LTCF) residents. METHODS: This was a prospective cohort study with survival analysis of 209 participants living in 15 Brazilian LTCFs. Data on chronic diseases, age, sex, medication use, dependence in activities of daily living (ADLs; Katz index), and frailty (FRAIL scale) were collected at baseline, and death after 1 year was the outcome measure. Kaplan-Meier estimate and log-rank test were used to analyze the survival of residents. RESULTS: In the initial assessment, 65.07 of the residents were women, and the median age was 82 (interquartile range, 71–88) years, with 55% being over 80 years old. Overall, 88% had 2 or more diseases, 59.81% were using 5 or more medications, 42.11% were considered frail, 34.92% pre-frail, and 22.97% robust, and 69.94% were dependent in 3 or more ADLs. During the 12-month follow-up, 19.61% of the residents (n=41) died. In the survival analysis for death, there was a statistically significant association with frailty (p=0.03) and dependence in ADLs (p=0.04). CONCLUSIONS: In this population of LTCF residents, frailty and functional dependence were associated with death.

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Prediction of Death with the Frail-NH in Institutionalized Older Adults: A Longitudinal Study from a Middle-Income Country

Cited by 3 publications

References 18 publications

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

Malnutrition as a major related factor of frailty among older adults residing in long-term care facilities in Korea

Frailty and mortality in long-term care facilities for older people in Brazil: a survival analysis

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