Prevalence of frailty among community dwelling older adults in receipt of low level home support: a cross-sectional analysis of the North Dublin Cohort

Abstract

BackgroundThere is increasing demand for formal government funded home help services to support community-dwelling older people in Ireland, yet limited information exists on the health profiles of this group, especially regarding frailty. Our aim was to profile a large cohort of adults in receipt of low level home help and to determine the prevalence of frailty.MethodsA total 1312 older adults, (≥ 65 years) in receipt of low level home help (< 5 h per week) were reviewed by community nurses and frailty was assessed using the Clinical Frailty Scale (CFS) in this cross-sectional study. Characteristics of the group were compared between males and females and prevalence of frailty was reported according to gender and principal care. Associations between frailty and a number of variables were explored using bivariate and regression analysis.ResultsThe cohort of low level home-help users was a mean age of 82.1 (SD 7.3) years, predominantly female (70.6%) and over half (69.2%) lived alone. The prevalence of frailty in this population was 41.5%, with subjects primarily considered mildly (23.2%) or moderately frail (14.5%) by the CFS. A further 38.4% were classed as vulnerable. The degree of frailty did not differ significantly across the younger categories aged 65–84 years. However, in the oldest age groups, namely 90–94 and >95 years, moderate frailty was significantly higher relative to the younger groups (21% and 34%, p < 0.05, p < 0.01 respectively). Home help hours significantly correlated with frailty (rs = 0.371, p < 0.001) and functional dependency (rs = 0.609, p < 0.001), but only weakly with age (rs = 0.101, p = 0.034). Based on regression analysis, determinants of frailty included greater dependency (Barthel score), higher home help hours, non-self-caring and communication difficulty, all of which significantly contributed to the model, with a r squared value of 0.508.ConclusionA high prevalence of frailty (41.5%) was documented in this population which associated with higher home help utilisation. Frailty was associated with greater functional dependency, but not strongly with chronological age, until after 90 years. These findings highlight opportunities for developing intervention strategies targeted at ageing in place among home help users.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0508-2) contains supplementary material, which is available to authorized users.

Prevalence and Associated Factors of Sarcopenia and Frailty in Parkinson’s Disease: A Cross-Sectional Study

“…In our study, we found that both sarcopenia and frailty were significantly more common in PD patients compared with the general elderly population. The prevalence rates of sarcopenia and frailty in our general population-based sample were within previously reported ranges, contributing to the validity of the screening tools used [4,[6][7][8][9][10][11][12]. The prevalence rates of sarcopenia and frailty were slightly lower in the community-based PD cohort compared to the PD cohort recruited in the tertiary center.…”

Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

“…There is evidence that reduced activities of daily living (ADL) activity is associated with functional deterioration, LTC, and mortality among older people. 23,24 There have been no studies done on the identification of factors that influence admission to long-stay care in Ireland, or on predictors of mortality among community-dwelling older dependent adults. 20 In a systematic review and meta-analysis, Cepoiu-Martin et al found that increased age, functional impairment, behavioural, and psychological problems and being in the severe stages of dementia were significant predictors of LTC placement for people with dementia.…”

“…Scores range from 0 to 20, with a lower score indicating a higher level of dependency. For the purposes of analysis in this study and as used in our previous study, 23 these five categories were collapsed into two: no communication difficulties, which included those recorded as having "no problems" and communication difficulties, which included all others. From the overall score, an individual is categorised as maximum dependency (0-5), high dependency (6-10), medium dependency (11)(12)(13)(14)(15), low dependency (16)(17)(18)(19), and independent (20).…”

“…22 The older population in receipt of home support represent a vulnerable subgroup, characterised by a high prevalence of "cognitive dysfunction" (46%) and frailty (41%). 23,24 There have been no studies done on the identification of factors that influence admission to long-stay care in Ireland, or on predictors of mortality among community-dwelling older dependent adults. The aim of this paper is to identify factors that predict admission to LTC and mortality during a 1-year period, based on a large cohort of communitydwelling older adults receiving formal home support.…”

“…Ability to communicate is recorded in the CSAR form according to five categories: no problems, retains most information and can indicate needs verbally, difficulty speaking but retains information and indicates needs nonverbally, can speak but cannot indicate needs or retain information, and finally, no effective means of communication. For the purposes of analysis in this study and as used in our previous study, 23 was that which was most recently recorded prior to the cessation of home support. When a person was admitted to LTC (nursing home care/institution) or died during the 12-month audit period, this was recorded on the dataset, ie, predefined outcomes of LTC (admission to nursing home or residential care) and death comprise the dependent variables in this paper.…”