Operationalizing frailty among older residents of assisted living facilities

BMC Geriatrics

Research Article

Misha Eliasziw¹  Scott B Patten¹  Elizabeth A Freiheit¹  Colleen J Maxwell²  David B Hogan²  Heidi N Schmaltz³  Laurel A Strain⁴ 

[1] Department of Community Health Sciences, University of Calgary, 3rdFloor TRW, 3280 Hospital Drive NW, Calgary, Alberta, Canada;Department of Community Health Sciences, University of Calgary, 3rdFloor TRW, 3280 Hospital Drive NW, Calgary, Alberta, Canada;Department of Medicine, University of Calgary, HSC 3330 Hospital Drive NW, Calgary, Alberta, Canada;Department of Medicine, University of Calgary, HSC 3330 Hospital Drive NW, Calgary, Alberta, Canada;Department of Sociology, University of Alberta, 5-21 HM Tory Building, Edmonton, Alberta, Canada;

关键词: Gait Speed;    Assisted Living;    Cardiovascular Health Study;    Assisted Living Facility;    Frailty Criterion;   

DOI  :  10.1186/1471-2318-11-23

 received in 2010-10-16, accepted in 2011-05-13,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundFrailty in later life is viewed as a state of heightened vulnerability to poor outcomes. The utility of frailty as a measure of vulnerability in the assisted living (AL) population remains unexplored. We examined the feasibility and predictive accuracy of two different interpretations of the Cardiovascular Health Study (CHS) frailty criteria in a population-based sample of AL residents.MethodsCHS frailty criteria were operationalized using two different approaches in 928 AL residents from the Alberta Continuing Care Epidemiological Studies (ACCES). Risks of one-year mortality and hospitalization were estimated for those categorized as frail or pre-frail (compared with non-frail). The prognostic significance of individual criteria was explored, and the area under the ROC curve (AUC) was calculated for select models to assess the utility of frailty in predicting one-year outcomes.ResultsRegarding feasibility, complete CHS criteria could not be assessed for 40% of the initial 1,067 residents. Consideration of supplementary items for select criteria reduced this to 12%. Using absolute (CHS-specified) cut-points, 48% of residents were categorized as frail and were at greater risk for death (adjusted risk ratio [RR] 1.75, 95% CI 1.08-2.83) and hospitalization (adjusted RR 1.54, 95% CI 1.20-1.96). Pre-frail residents defined by absolute cut-points (48.6%) showed no increased risk for mortality or hospitalization compared with non-frail residents. Using relative cut-points (derived from AL sample), 19% were defined as frail and 55% as pre-frail and the associated risks for mortality and hospitalization varied by sex. Frail (but not pre-frail) women were more likely to die (RR 1.58 95% CI 1.02-2.44) and be hospitalized (RR 1.53 95% CI 1.25-1.87). Frail and pre-frail men showed an increased mortality risk (RR 3.21 95% CI 1.71-6.00 and RR 2.61 95% CI 1.40-4.85, respectively) while only pre-frail men had an increased risk of hospitalization (RR 1.58 95% CI 1.15-2.17). Although incorporating either frailty measure improved the performance of predictive models, the best AUCs were 0.702 for mortality and 0.633 for hospitalization.ConclusionsApplication of the CHS criteria for frailty was problematic and only marginally improved the prediction of select adverse outcomes in AL residents. Development and validation of alternative approaches for detecting frailty in this population, including consideration of female/male differences, is warranted.

【 授权许可】

Unknown   
© Freiheit et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.