Campitelli MA, Bronskill SE, Hogan DB, et al.
BMC Geriatr 2016;16:133
Publication date: July 7, 2016
Jul 7
BMC Geriatr 2016;16:133.
Campitelli MA, Bronskill SE, Hogan DB, et al.
Summary
Evaluating different approaches to identifying frail home care clients at risk for adverse health outcomes is an important but understudied area. Campitelli et al. aimed to determine the prevalence and correlates of frailty in a home care cohort.
Frailty prevalence varied by measure (19.5%, 24.4% and 44.1% for full frailty index [FI], modified FI and CHESS score, respectively) and was similar among female and male clients. All three measures were associated with a significantly increased risk of death, long-term care (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. The 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.
These 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.