How should we grade frailty in nursing home patients?
Abstract
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.
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We selected variables at random (boot-strapping) from a list of eligible variables to make up the Frailty Index and have again shown that the results are insensitive to the precise composition of the index.
“Here, as in some earlier studies, [7,19,31] we have selected variables at random (boot-strapping) from a list of eligible variables to make up the Frailty Index and have again shown that the results are insensitive to the precise composition of the index.”
From A standard procedure for creating a frailty index (2008) · cites this paper as [31]
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- Authors
- Rockwood, K., Abeysundera, M. J., & Mitnitski, A.
- Affiliations
- Dalhousie University (CA)
- Corresponding author
- Rockwood, Kenneth
- Venue
- Journal of the American Medical Directors Association
- Publisher
- Elsevier BV
- Published
- 2007-11
- Volume
- 8
- Issue
- 9
- Pages
- 595-603
- ISSN
- 1525-8610 (ISSN-L)
- OpenAlex
- W2078487625
- Cited by
- 249
- References
- 51
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 6 · 2022: 9 · 2021: 9 · 2020: 11 · 2019: 11 · 2018: 12 · 2017: 12 · 2016: 16 · 2015: 25 · 2014: 21 · 2013: 22 · 2012: 23
- FWCI
- 6.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Medical Directors Association (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- frailty, nursing home residents, older adults, frailty assessment, frailty index, Clinical Frailty Scale, mortality risk, disability, cognitive decline, long-term care, mobility impairment
- MeSH terms
- Aged, 80 and over, Cognition Disorders, Disability Evaluation, Female, Persons with Disabilities, Disabled Persons, Humans, Male, Nursing Homes, Prospective Studies, Geriatric Assessment, Survival Analysis, Frail Elderly, Mobility Limitation
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