A comparison of 3 frailty measures and adverse outcomes in the intake home care population: a retrospective cohort study
Open accessAbstract
BACKGROUND: In Ontario, Canada, nearly all home care patients are assessed with a brief clinical assessment (interRAI Contact Assessment [interRAI CA]) on admission. Our objective was to compare 3 frailty measures that can be operationalized using the interRAI CA. METHODS: We conducted a retrospective cohort study using linked patient-level assessment and administrative data for all Ontario adult (≥ 18 yr) home care patients assessed with the interRAI CA in 2014. We employed multivariable logistic models to compare the Changes in Health, End-stage disease and Signs and Symptoms Scale for the Contact Assessment (CHESS-CA), Assessment Urgency Algorithm (AUA) and the Frailty Index for the Contact Assessment (FI-CA) that was created for this study. Our outcomes of interest were death, hospital admission and emergency department visits within 90 days, and assessor-rated need for comprehensive geriatric assessment (CGA). RESULTS: In 2014, there were 228 679 unique adult home care patients in Ontario assessed with the interRAI CA. Controlling for age, sex and health region, being in a higher frailty level defined by any measure increased the likelihood of experiencing adverse outcomes. Among all assessments, CHESS-CA was best suited for predicting death and hospital admission, and either AUA or FI-CA for predicting perceived need for CGA. Previous emergency department visits were more predictive of future visits than frailty. Model fit was independent of whether the assessment was completed over the phone or in person. INTERPRETATION: Frailty measures from the interRAI CA identified patients at higher risk for death, hospital admission and perceived need for CGA. In jurisdictions where the CHESS-CA and AUA are already built into the electronic home care platform, such as Ontario, patients identified as high risk should be prioritized for proactive referral and care planning, and may benefit from greater involvement of primary care and other health professionals in the circle of care.
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In many countries, patients receiving home care services typically live with comorbid conditions and have high functional and cognitive impairment rates.
“In many countries worldwide, patients receiving home care services typically live with comorbid conditions, with high functional and cognitive impairment rates [30–32].”
From The hospital-to-home care transition experience of home care clients: an exploratory study using patient journey mapping (2023) · cites this paper as [30]
Table 2 (labelled Interpretation; page unavailable) reports substantial functional limitations and cognitive impairment among Ontario home-care patients, including 54.8% needing help bathing and 20.8% with impaired cognitive skills. Table 1 lists several disease diagnoses, but does not establish how often patients have comorbid conditions. The Study design and Results describe an Ontario cohort, not patients across many countries. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn Ontario, Canada, 7.3% of patients died, 16.6% were hospitalized, and 44.4% visited the emergency department within 90 days of being admitted to home care.
“Sinn and colleagues observed that in Ontario, Canada, 7.3% of patients died, 16.6% were hospitalized, and 44.4% visited the emergency department within 90 days of being admitted to home care [30].”
From The hospital-to-home care transition experience of home care clients: an exploratory study using patient journey mapping (2023) · cites this paper as [30]
The Results report all three percentages for Ontario home care patients within 90 days of their assessment date. The claim instead starts the 90-day period at admission to home care; the Setting section says assessments can also include existing home care patients returning from hospital. (LLM, conf=0.86)
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Self-citation
- Authors
- Sinn, C.-L. J., Heckman, G., Poss, J. W., Onder, G., Vetrano, D. L., & Hirdes, J.
- Affiliations
- Università Cattolica del Sacro Cuore (IT)
- ORCID
- Venue
- CMAJ Open
- Publisher
- CMA Joule Inc.
- Published
- 2020-10
- Volume
- 8
- Issue
- 4
- Pages
- E796-E809
- ISSN
- 2291-0026 (ISSN-L)
- PMC
- PMC7721251
- OpenAlex
- W3109433748
- Cited by
- 25
- References
- 35
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 15 · 2022: 4 · 2021: 2
- FWCI
- 2.75
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- CMAJ Open (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- McMaster University
- Government of Canada
- University of Waterloo
- Université de Montréal
- Canadian Frailty Network
- 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 assessment, home care, comprehensive geriatric assessment, hospitalization, emergency department visits, mortality, risk prediction
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Home Care Services, Hospitalization, Humans, Long-Term Care, Male, Middle Aged, Ontario, Predictive Value of Tests, Retrospective Studies, Reproducibility of Results, Geriatric Assessment, Prevalence, Survival Analysis, Frail Elderly, Outcome Assessment, Health Care, Health Status Disparities, Young Adult
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