The Frailty In Residential Sector over Time (FIRST) study: methods and baseline cohort description

Abstract

Background The Frailty In Residential Sector over Time (FIRST) Study is a 3-year prospective cohort study investigating the health of residents living in residential aged care services (RACS) in South Australia. The study aims to examine the change in frailty status and associated health outcomes. Methods This interim report presents data from March 2019–October 2020. The study setting is 12 RACS from one organisation across metropolitan and rural South Australia involving 1243 residents. All permanent (i.e. respite or transition care program excluded) residents living in the RACS for at least 8 weeks were invited to participate. Residents who were deemed to be medically unstable (e.g. experiencing delirium), have less than 3 months to live, or not fluent in English were excluded. Data collected included frailty status, medical diagnoses, medicines, pain, nutrition, sarcopenia, falls, dementia, anxiety and depression, sleep quality, quality of life, satisfaction with care, activities of daily living, and life space use at baseline and 12-months. Data Linkage will occur over the 3 years from baseline. Results A total of 561 permanent residents (mean age 87.69 ± 7.25) were included. The majority of residents were female (n = 411, 73.3%) with 95.3% (n = 527) being classified as either frail (n = 377, 68.2%) or most-frail (n = 150, 27.1%) according to the Frailty Index (FI). Most residents were severely impaired in their basic activities of daily living (n = 554, 98.8%), and were at-risk of malnutrition (n = 305, 55.0%) and at-risk of sarcopenia (n = 492, 89.5%). Most residents did not experience pain (n = 475, 85.4%), had normal daytime sleepiness (n = 385, 69.7%), and low anxiety and depression scores (n = 327, 58.9%). Conclusion This study provides valuable information on the health and frailty levels of residents living in RACS in South Australia. The results will assist in developing interventions that can help to improve the health and wellbeing of residents in aged care services. Trial registration Prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000500156).

Epigenetic age is associated with baseline and 3-year change in frailty in the Canadian Longitudinal Study on Aging

“…In our sample of the CLSA, the change in frailty over 3 years was normally distributed, on average increasing about 20% (i.e., 0.006) of what has been previously described as a clinically meaningful difference (i.e., 0.03) [ 34 , 35 ]. After adjusting for the minimum age at recruitment, this is similar to what has previously been reported for community samples in the USA, Canada and Europe [ 37 – 40 ].…”

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

“…The FRAIL-NH scale has been compared to 16 other scales (Table 4 ). FRAIL-NH was correlated with FI ( 24 , 29 , 35 , 44 ), FP ( 40 ), and FI-Lab ( 39 ). Four studies reported fair to moderate agreements between FRAIL-NH and FI ( 35 , 37 ), FP ( 40 ), and CGA ( 38 ).…”

“…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.…”

“…By 6 months, those with severe impairment were over twice as likely to be frail ( 45 ). Other applications of FRAIL-NH include: establishing baseline comparability of participants in studies ( 24 , 27 , 28 , 32 , 33 , 54 ); baseline screening as proxy to physical health for RCT recruitment ( 50 ); describing COVID-19 seroprevalence in frail residents ( 48 ); characterizing frailty status in residents interviewed on perceptions of frailty ( 21 , 34 ); examining changes in FRAIL-NH scores at annual routine screening ( 46 ); and the prospective use of FRAIL-NH in acute care ( 52 ).…”

“…Of the 18 cross-sectional studies, 15 studies provided clear inclusion criteria (Table S3) ( 22 – 24 , 29 , 31 , 33 , 35 – 38 , 40 , 42 , 43 , 45 , 54 ). All studies described resident characteristics and settings in detail ( 22 – 24 , 29 , 31 , 33 , 35 – 38 , 40 , 42 , 43 , 45 , 48 , 54 , 55 , 60 ).…”