Abstract
Objectives
To examine the predictive validity of a quick frailty screening tool, the FRAIL-NH,
for adverse health outcomes in nursing home residents, using variables from the Minimum
Data Set (MDS). The screening items were compiled from the MDS for potential direct
application in long-term care facilities using this health information system.
Design
Longitudinal follow-up study of nursing home residents with annual clinical assessment
using the MDS and mortality data between 2005 and 2013.
Setting
Six nursing homes operated by a nongovernmental organization in Hong Kong.
Participants
Participants included 2380 nursing home residents aged 65 years or older at study
baseline.
Measurements
Frailty assessed using the FRAIL-NH model with items from the MDS. The model covers
8 areas: fatigue, resistance, ambulation, incontinence, polypharmacy, weight loss,
nutritional approach, and help with dressing. Adverse health outcomes in subsequent
years were measured: incident falls, worsening activities of daily living (ADL) function,
hospitalization, and death.
Results
Using a cutoff score of 5 on the FRAIL-NH, the prevalence of frailty was 58.5% in
this nursing home sample. Frailty as identified using the FRAIL-NH predicts incident
falls, worsening ADL function, hospitalization, and death (hazard ratios [HR] 2.00–3.73).
This remained significant after adjusting for sociodemographic and other clinical
characteristics. Each level of increase on the FRAIL-NH has strong distinguishing
power on the incidence of adverse outcomes. Intermediate frailty status (score 1–4)
also significantly predicts adverse health outcomes (HR 1.57–2.06).
Conclusion
The FRAIL-NH is a quick screening tool that can be used to identify frail and prefrail
nursing home residents at risk of adverse health outcomes. It can be applied using
variables from the MDS, allowing direct adoption in long-term care facilities already
using this health information system.
Keywords
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Article info
Publication history
Published online: October 23, 2015
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
