Abstract
Objectives
The FRAIL-NH was originally developed for frailty assessment of nursing home (NH)
residents. We aimed to compare concurrent, predictive, and known-groups validity between
FRAIL-NH and FRAIL, using the Frailty Index (FI) as gold standard reference. We also
examined for ceiling effect of both measures in the detection of severe frailty.
Design
A secondary analysis of a prospective cohort study.
Setting & Participants
Older adults (mean age 89.4 years) hospitalized for an acute medical illness in a
1300-bed tertiary hospital.
Measurements
Baseline data on demographics, comorbidities, severity of illness, functional status,
and cognitive status were gathered. We also captured outcomes of mortality, length
of stay (LOS), institutionalization, and functional decline. For concurrent validity,
we compared areas under the operating characteristic curves (AUCs) for both measures
against the FI. For predictive validity, univariate analyses and multiple logistic
regression were used to compare both measures against the adverse outcomes of interest.
For known-groups validity, we compared both measures against comorbidities and functional
status via 1-way analysis of variance, and dementia diagnosis via independent t test. Box plots were also derived to investigate for possible ceiling effect.
Results
Both measures had good concurrent validity (both AUC > 0.8 and P < .001), with FRAIL-NH detecting more frailty cases (79.5% vs 50.0%). Although FRAIL-frail
was superior for in-hospital mortality [6.7% vs 1.0%, P = .031, odds ratio (OR) 9.29, 95% confidence interval (CI) 1.09-79.20, P < .042] and LOS (10 vs 8 days, P = .043), FRAIL-NH-frail better predicted mortality (OR 6.62, 95% CI 1.91-22.94, P = .003) and institutionalization (OR 6.03, 95% CI 2.01-18.09, P = .001) up to 12 months postenrollment. Known-groups validity was good for both measures
with FRAIL-NH yielding greater F values for functional status and dementia. Lastly, box plots revealed a ceiling effect
for FRAIL in the severely frail group.
Conclusions and Implications
This exploratory study highlights the potential for expanding the role of FRAIL-NH
beyond NH to acute care settings. Contrasted to FRAIL, FRAIL-NH had better overall
validity with less ceiling effect in discrimination of severe frailty.
Keywords
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Article info
Publication history
Published online: May 15, 2021
Footnotes
The authors declare no conflicts of interest.
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
