The effect of frailty on residential/nursing home admission in the Netherlands independent of chronic diseases and functional limitations

Abstract

The aim of this study was to determine the effect of frailty on the risk of residential/nursing home admission independently of chronic diseases and functional limitations. Frailty consists of multisystem decline and is considered to be a consequence of changes in neuromuscular, endocrine and immune system functioning that occur as people age. Frailty is a combination of multiple impairments in functioning that might lead to functional limitations and disability but it is not clear whether frailty has an independent effect on residential/nursing home admission. Data were used from the Longitudinal Aging Study Amsterdam. The respondents participated at both T 1 (1992/1993) and T 2 (1995/1996), lived independently at T 2 , and were aged 65 and over (n=1,503). Nine frailty markers were assessed at two cycles (T 1 and T 2 ). The frailty markers were defined in two ways: low functioning at T 2 (static frailty); and change in functioning between T 1 and T 2 (dynamic frailty). The outcome variable was residential/nursing home admission between T 2 and T 4 (2001/2002). Cox proportional hazard analyses were used adjusting for chronic diseases, functional limitations, care received, partner status, income, age and sex. Static (RR 1.93, 95%CI 1.36-2.74) and dynamic frailty (RR 1.69, 95%CI 1.19-2.39) were associated with institutionalization in both men and women independently of the effect of chronic diseases and functional limitations. Additional analyses of the total number of both sets of frailty markers present revealed an increased risk of institutionalization when the number increased. In conclusion, frailty is associated with institutionalization, independently of the effect of chronic diseases and functional limitations.

Frailty: an emerging concept for general practice

“…36 As frailty leads to recurrent hospitalisation, institutionalisation, and death, prevention and, where possible, treatment of frailty should be high on the medical agenda. 47 Because frailty appears to be a dynamic process and also potentially reversible, early recognition of frailty and early interventions should be major issues for general practice. 16,37,48 …”

Negotiating and effectuating relocation to sheltered housing in old age: a Swedish study over 11 years

“…Declining health is an important predictor of relocation to sheltered housing in old age (Puts et al 2005; Thomése and Broese van Groenou 2006), especially dementia (Bharucha et al 2004). Moreover, declining health in combination with other factors, such as age and/or sex, cohabitation or not (Nuotio et al 2003;Tomiak et al 2000) are important.…”

Complex health problems among the oldest old in Sweden: increased prevalence rates between 1992 and 2002 and stable rates thereafter

“…For example, frailty has been shown to predict future institutionalization (Puts 2005), and multimorbidity has been found to predict subsequent decline in mobility and ability to perform activities of daily living (ADL) (Gijsen et al 2001;Marengoni et al 2011). Both concepts are valuable for identifying individuals who may benefit from interventions in order to prevent and/or delay disability and/or LTC (e.g., home-help services, home nursing, and institutional living).…”