The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

Abstract

Objective: To determine whether an Elders Risk Assessment (ERA) index can predict incident hip fractures without the need for physician-patient encounter or bone mineral density testing. Patients and Methods: A retrospective cohort study was conducted in a community-based cohort of 12,650 patients aged 60 years and older. An ERA score was computed for each subject at index time (January 1, 2005). Incidents of hip fracture from January 1, 2005, through December 31, 2006, were obtained from electronic medical records. We divided the cohort into 5 groups, with the lowest ERA scores forming group A (Ͻ15%); 15% to 49%, group B; 50% to 74%, group C; 75% to 89%, group D; and the top 11%, group E. With group A as a reference group, we used logistic regression to compute odds ratios of sustaining hip fracture during a 2-year period (January 1, 2005, through December 31, 2006) for groups B, C, D, and E. Sensitivity and specificity of each possible ERA score were calculated, and a receiver operating characteristic curve was created. Results: Two hundred sixty-five patients (2.1%) sustained at least 1 hip fracture from January 1, 2005, through December 31, 2006. Odds ratios (95% confidence intervals) for groups B, C, D, and E were 1.6 (0.7-3.4), 4.5 (2.2-9.4), 6.9 (3.3-14.3), and 18.4 (8.9-37.9), respectively. The area under the receiver operating characteristic curve was 74.5%. Conclusion: An electronic medical record-based, easily derived ERA index might be useful in hip fracture risk stratification.

Comparison between frailty index of deficit accumulation and fracture risk assessment tool (FRAX) in prediction of risk of fractures

“…Previous studies investigating the relationship between a FI and fractures reported significant results [23][24][25][26], which was in line with our findings. For example, the Canadian Multicentre Osteoporosis Study (CaMos) using a 30-item FI to predict 10-year fracture risk reported significant associations between the FI and fractures in adults, with a HR of 1.18 for hip fracture and 1.30 for clinical vertebral fractures (pvalues b 0.05) for per-0.10 increase in FI [26].…”

“…The FI could grade and predict the risk of fractures based on the degree of frailty in the elderly, which had been explored in previous studies [23][24][25][26]. However, limited evidence comparing the predictive accuracy of the FI and FRAX in the risk of fractures is available.…”

Suggestions for health information technology trials for respiratory disorders in low- and middle-income country settings: what can we learn from trials in high-income country settings?

“… 6 To investigate a possible effect on hospital admissions or emergency visits in patients with several chronic (including respiratory) conditions, an individually randomised controlled trial was performed in the United States, comparing daily telemonitoring (including biometry, symptom registration and video consultation by Internet) with usual care during 1 year. This well-conducted study among 205 elderly people with multi-morbidity (defined as a Charlson Comorbidity Index 7 >2.9) and a high risk for hospitalisation (a score >15 on the Elder risk assessment index) 8 did not result in significant benefit of the intervention. No statistically relevant difference was found between the intervention group of patients (63.7%) and the control group (57.3%) in the number of hospitalisations or emergency visits ( P =0.35).…”

Discharge Planning: Screening Older Patients for Multidisciplinary Team Referral

“…It has been validated as a predictor for hip fractures [18], and to predict mortality and Aged Care placement in community-dwelling adults [19]. An Elders Risk Assessment Index of 16 or more has also been hypothesised in the literature as a measuring instrument to select patients for referral to a transitional care programme for community dwelling adults [20].…”