JAMDA
Volume 8, Issue 9 , Pages 595-603, November 2007

How should we grade frailty in nursing home patients?

  • Kenneth Rockwood, MD

      Affiliations

    • Division of Geriatric Medicine, Dalhousie University, Department of Medicine, Dalhousie University, Halifax, NS, Canada
    • Corresponding Author InformationAddress correspondence to Kenneth Rockwood, MD, Geriatric Medicine Research Unit, Dalhousie University, Suite 1421, 5955 Veterans’ Memorial Lane, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, B3H 2E1, Canada.
    • ,
  • Melanie Joan Abeysundera, MSc

      Affiliations

    • Geriatric Medicine Research Unit, Dalhousie University, Halifax, NS, Canada
    • ,
  • Arnold Mitnitski, PhD

      Affiliations

    • Department of Medicine, Dalhousie University, Department of Mathematics and Statistics, Dalhousie University, Halifax, NS, Canada.

published online 18 October 2007.

Objectives

To compare 3 methods of describing the frailty of older adults in nursing homes.

Design

Secondary analysis of a prospective cohort study.

Setting

Canadian long-term care institutions.

Participants

Institutionalized older adults in the second clinical examination cohort of the Canadian Study of Health and Aging (CSHA-2; n = 728).

Measures

Frailty was measured using the Cardiovascular Health Survey definition (Frail-CHS); the CSHA- Clinical Frailty Scale (CSHA-CFS) and a frailty index (FI).

Results

The sample was very elderly (87.7 ± 6.7 years), disabled (83%), and showed a high level of mobility impairment (83%). Each frailty measure correlated moderately well with each other (0.61–0.71) and with a disability measure (–0.45 to –0.53) but only weakly with age (0.13–0.19). By each measure, frailty was significantly associated (P < .01) with an increased risk of mortality, disability and cognitive decline. In a model that included both the frailty-CHS definition and the Frailty Index only the latter was associated with a higher risk of mortality (P < .01 for FI, P = .18 for Frail-CHS) and decline in the 3MS (P < .01 for FI, P = .20 for the Frail-CHS definition). Both measures were significantly associated with new onset disability (P < .01). Similar results were found when both the CSHA-CFS and Frailty Index were included in the models. Random combinations of 15 variables used to make up alternate 5-item Frail-CHS definitions showed that any stratification based on 5 variables allowed tertiles of risk to be discriminated.

Conclusions

Frailty is a robust concept and however defined, elderly people who are frail have worse outcomes than those who are not frail. The 3 measures showed varying ability to express grades of frailty.

Keywords: Frailty, nursing homes, frailty index, comorbidity, aged

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 Funds for analysis came from the Canadian Institutes for Health Research (CIHR) grant MOP 628823 and the Dalhousie University Internal Medicine Research Foundation. Kenneth Rockwood is supported by the Dalhousie Medical Research Foundation as Kathryn Allen Weldon Professor of Alzheimer Research.

 The authors assert no financial conflict of interest.

PII: S1525-8610(07)00351-9

doi:10.1016/j.jamda.2007.07.012

JAMDA
Volume 8, Issue 9 , Pages 595-603, November 2007

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