The prevalence and health consequences of frailty in a population-based older home care cohort: a comparison of different measures

Abstract

BackgroundEvaluating different approaches to identifying frail home care clients at heightened risk for adverse health outcomes is an important but understudied area. Our objectives were to determine the prevalence and correlates of frailty (as operationally defined by three measures) in a home care cohort, the agreement between these measures, and their predictive validity for several outcomes assessed over one year.MethodsWe conducted a retrospective cohort study with linked population-based administrative and clinical (Resident Assessment Instrument [RAI]) data for all long-stay home care clients (aged 66+) assessed between April 2010–2013 in Ontario, Canada (n = 234,552). We examined two versions of a frailty index (FI), a full and modified FI, and the CHESS scale, compared their baseline characteristics and their predictive accuracy (by calculating the area under the ROC curve [AUC]) for death, long-term care (LTC) admission, and hospitalization endpoints in models adjusted for age, sex and comorbidity.ResultsFrailty prevalence varied by measure (19.5, 24.4 and 44.1 %, for full FI, modified FI and CHESS, respectively) and was similar among female and male clients. All three measures were associated with a significantly increased risk of death, LTC admission and hospitalization endpoints in adjusted analyses but their addition to base models resulted in modest improvement for most AUC estimates. There were significant differences between measures in predictive accuracy, with the full FI demonstrating a higher AUC for LTC admission and CHESS a higher AUC for hospitalization - although none of the measures performed well for the hospitalization endpoints.ConclusionsThe different approaches to detecting vulnerability resulted in different estimates of frailty prevalence among home care clients in Ontario. Although all three measures were significant predictors of the health outcomes examined, the gains in predictive accuracy were often modest with the exception of the full FI in predicting LTC admission. Our findings provide some support for the clinical utility of a comprehensive FI measure and also illustrate that it is feasible to derive such a measure at the population level using routinely collected data. This may facilitate further research on frailty in this setting, including the development and evaluation of interventions for frailty.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0309-z) contains supplementary material, which is available to authorized users.

Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition

“…Frailty status at admission was identified using a 72‐item frailty index based on the measure developed by Hogan et al, and consistent with an approach used for home‐care clients . All included items were derived from the RAI‐MDS 2.0.…”

“…The deficits considered in this study included measures of physical function, activities of daily living, cognitive impairment and clinical status (see Table ). Residents were classified as ‘non‐frail’ (ratio < 0.2), ‘pre‐frail’ (ratio 0.2–0.3), and ‘frail’ (ratio > 0.3) …”

“…Models were adjusted for clustering of residents in homes and based on clinical judgment for important confounders of the relationship between frailty and PIM (i.e., age, sex, comorbidity, and aggressive behaviors). We avoided including items already captured in the frailty index to reduce potential for collinearity between model covariates . Pre‐specified subgroup analyses examined hazards by aggressive behavior status.…”

Relevance of frailty to mortality associated with the use of antipsychotics among community‐residing older adults with impaired cognition

“…The RAI‐HC assessment is mandated on a semiannual basis for all long‐stay home care clients (ie, those receiving ongoing supportive care for >60 days in a single episode). It is administered by trained staff and provides standardized validated data on clients' sociodemographic characteristics, health conditions, physical and cognitive status, behavioral problems, and use of medications and services …”

“…The availability of linked clinical (including cognitive, physical, and behavioral measures) and administrative health data for older adults receiving community‐based care in Ontario has facilitated research on the potential utility of frailty measures in understanding medication risks among vulnerable populations. In an earlier work, we validated a frailty index (FI) easily derived from clinical assessment items captured in these linked population‐based databases . Building on this work, we sought to incorporate this FI to explore possible variations in short‐term antipsychotic‐related risks among community‐residing older adults with cognitive impairment.…”