Rockwood Frailty Index and Survival in Hospital-at-Home Patients (DOMMOR)

Assessment of One-year Mortality Risk Using the Modified 34-item Rockwood Index

Frailty is a key determinant of prognosis in older adults with complex chronic conditions and in palliative care settings. The Rockwood Frailty Index (RFI), based on the accumulation of health deficits, has demonstrated prognostic value across multiple clinical contexts. This study evaluates the association between the RFI and overall survival in complex chronic and palliative patients (oncologic and non-oncologic) treated in a Hospital-at-Home (HaH) unit.

Study Overview

• Status: Completed
• Conditions: Mortality; Frailty; Palliative Care; Home Care Services, Hospital-Based
• Intervention / Treatment: Other: Patients identified and followed in this cohort received scheduled supportive telephone calls every two weeks if classified in the oncologic palliative care group, and once monthly in the case of comp

Detailed Description

This retrospective longitudinal observational cohort study included patients aged 65 years or older admitted to a Hospital-at-Home (HaH) unit between January 1, 2021 and December 31, 2024. All patients had a recorded modified Rockwood Frailty Index (RFI) at admission and were subsequently followed through a structured case-management program led by nurse case managers via scheduled telephone follow-up.

Patients were classified into three clinical groups: complex chronic patients, non-oncologic palliative patients, and oncologic palliative patients. Non-oncologic palliative status was defined by an RFI ≥0.53, while complex chronic patients had an RFI >0.37 and <0.53. Oncologic palliative patients were classified based on referral from Oncology services regardless of frailty level.

The primary outcome was overall survival, defined as time from discharge from the HaH unit to death from any cause. Survival analyses were conducted using Kaplan-Meier curves and multivariate Cox proportional hazards regression models adjusted for relevant demographic, clinical, and laboratory covariates.

• Study Type: Observational
• Enrollment (Actual): 2610

Contacts and Locations

Study Locations

• Spain
  • Valencia
    • Valencia, Valencia, Spain, 46026
      • Hospital Universitari i Politecnic La Fe

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients aged over 65 years with a high comorbidity burden and functional dependence, and/or with advanced cancer requiring symptom management and end-of-life care.

Description

Inclusion Criteria:

• Age ≥65 years
• Admission to the Hospital-at-Home unit during the study period
• Recorded modified Rockwood Frailty Index at admission
• Participation in the post-discharge case management follow-up program

Exclusion Criteria:

• Incomplete data for frailty index calculation
• Immediate loss to follow-up after discharge

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Older adults with complex chronic diseases or palliative care needs; All patients must had a recorded modified Rockwood Frailty Index (RFI) at admission and were subsequently followed through a structured case-management program led by nurse case managers via scheduled telephone follow-up. Patients were classified into three clinical groups: complex chronic patients, non-oncologic palliative patients, and oncologic palliative patients. Non-oncologic palliative status was defined by an RFI ≥0.53, while complex chronic patients had an RFI >0.37 and <0.53. Oncologic palliative patients were classified based on referral from Oncology services regardless of frailty level.

Other: Patients identified and followed in this cohort received scheduled supportive telephone calls every two weeks if classified in the oncologic palliative care group, and once monthly in the case of comp; Patients in this cohort received scheduled supportive telephone calls every two weeks if classified under palliative care (oncologic or chronic conditions), and once monthly if classified as chronic non-palliative patients.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Survival	Time from discharge from the Hospital-at-Home unit to death from any cause.	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Comparative prognostic performance of the Rockwood Frailty Index versus Charlson Comorbidity Index	Comparison of the prognostic performance of the Rockwood Frailty Index and the Charlson Comorbidity Index for predicting overall survival. Measure: Hazard Ratios (HRs) for overall survival for each index. Unit of Measure: Hazard ratio Measurement Tool / Method: Rockwood Frailty Index; Charlson Comorbidity Index; Cox proportional hazards regression models.	1 year
Association between age and overall survival	Overall survival according to age at baseline. Measure: Hazard Ratio (HR) for overall survival per year increase in age Unit of Measure: Hazard ratio Measurement Tool / Method: Cox proportional hazards regression model	1 year
Association between sex and overall survival	Description: Overall survival according to sex at baseline. Measure: Hazard Ratio (HR) for overall survival comparing sex categories. Unit of Measure: Hazard ratio Measurement Tool / Method: Cox proportional hazards regression model	1 year
Association between overall survival and clinical variables (Charlson Comorbidity Index)	Overall survival according to Charlson Comorbidity Index at baseline. Measure: Hazard Ratio (HR) for overall survival per point increase in Charlson Comorbidity Index. Unit of Measure: Hazard ratio Measurement Tool / Method: Charlson Comorbidity Index; Cox proportional hazards regression model	1 year
Association between overall survival and clinical variables (Barthel Index)	Description: Overall survival according to the Barthel Index at baseline. Measure: Hazard Ratio (HR) for overall survival per point increase in Barthel Index. Unit of Measure: Hazard ratio Measurement Tool / Method: Barthel Index; Cox proportional hazards regression model	1 year
Association between overall survival and laboratory parameters (C-reactive protein)	Overall survival according to C-reactive protein levels at baseline. Measure: Hazard Ratio (HR) for overall survival per unit increase in C-reactive protein. Unit of Measure: Hazard ratio Measurement Tool / Method: Serum C-reactive protein concentration (mg/L); Cox proportional hazards regression model	1 year
Association between overall survival and laboratory parameters (albumin)	Description: Overall survival according to serum albumin levels at baseline. Measure: Hazard Ratio (HR) for overall survival per unit increase in serum albumin. Unit of Measure: Hazard ratio Measurement Tool / Method: Serum albumin concentration (g/dL); Cox proportional hazards regression model	1 year

Collaborators and Investigators

• Sponsor: Instituto de Investigacion Sanitaria La Fe
• Investigators: Principal Investigator: Vicente Ruiz Garcia, MD, PhD, Hospital at Home Unit - Hospital UiP La Fe Valencia Avda Fernando Abril Martorell 106 Torre B Planta 1 Valencia 26206 (SPAIN); Study Chair: Elisa Soriano Melchor, MD, PhD, Hospital at Home Unit - Hospital UiP La Fe Valencia Avda Fernando Abril Martorell 106 Torre B Planta 1 Valencia 26206 (SPAIN)

Publications and helpful links

General Publications

• Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489-95. doi: 10.1503/cmaj.050051.
• Kojima G, Iliffe S, Walters K. Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age Ageing. 2018 Mar 1;47(2):193-200. doi: 10.1093/ageing/afx162.
• Amblas-Novellas J, Martori JC, Molist Brunet N, Oller R, Gomez-Batiste X, Espaulella Panicot J. [Frail-VIG index: Design and evaluation of a new frailty index based on the Comprehensive Geriatric Assessment]. Rev Esp Geriatr Gerontol. 2017 May-Jun;52(3):119-127. doi: 10.1016/j.regg.2016.09.003. Epub 2016 Oct 28. Spanish.
• Hall A, Boulton E, Kunonga P, Spiers G, Beyer F, Bower P, Craig D, Todd C, Hanratty B. Identifying older adults with frailty approaching end-of-life: A systematic review. Palliat Med. 2021 Dec;35(10):1832-1843. doi: 10.1177/02692163211045917. Epub 2021 Sep 14.
• Ko W, Jeong H, Yim HW. Frailty Index Predicts Future All-cause Mortality and Quality of Life: A 2-Year Follow-up Study Among Korean Older Adults From a Population-based Cohort Study. J Prev Med Public Health. 2025 Nov;58(6):572-580. doi: 10.3961/jpmph.25.210. Epub 2025 Nov 10.
• Salminen M, Viljanen A, Eloranta S, Viikari P, Wuorela M, Vahlberg T, Isoaho R, Kivela SL, Korhonen P, Irjala K, Lopponen M, Viikari L. Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people. Aging Clin Exp Res. 2020 Oct;32(10):2013-2019. doi: 10.1007/s40520-019-01383-4. Epub 2019 Oct 25.
• Martinez-Velilla N, Herce PA, Herrero AC, Gutierrez-Valencia M, Saez de Asteasu ML, Mateos AS, Zubillaga AC, Beroiz BI, Jimenez AG, Izquierdo M. Heterogeneity of Different Tools for Detecting the Prevalence of Frailty in Nursing Homes: Feasibility and Meaning of Different Approaches. J Am Med Dir Assoc. 2017 Oct 1;18(10):898.e1-898.e8. doi: 10.1016/j.jamda.2017.06.016. Epub 2017 Jul 27.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2021
• Primary Completion (Actual): December 31, 2024
• Study Completion (Actual): December 31, 2024

Study Registration Dates

• First Submitted: April 8, 2026
• First Submitted That Met QC Criteria: April 8, 2026
• First Posted (Actual): April 14, 2026

Study Record Updates

• Last Update Posted (Actual): April 21, 2026
• Last Update Submitted That Met QC Criteria: April 16, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Survival; Frailty; Hospital at home; Complex Chronic Patients; Rockwood Index
• Additional Relevant MeSH Terms: Pathologic Processes; Pathological Conditions, Signs and Symptoms; Frailty
• Other Study ID Numbers: 2024-0459-1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data (IPD) underlying the results reported in publications will be shared. The shared IPD will include baseline demographic and clinical characteristics, outcome measures, and relevant covariates. Data will be made available upon reasonable request after publication of the study results, subject to institutional approval and in accordance with applicable data protection and privacy regulations.
• IPD Sharing Time Frame: Starting after publication of the study results; duration of availability will be determined according to institutional policies.
• IPD Sharing Access Criteria: Qualified researchers who submit a reasonable research proposal will be able to access the de-identified individual participant data (IPD) and supporting documentation (such as the data dictionary). Access will be granted after review and approval by the study investigators and the corresponding institution. Data will be provided in a de-identified format and shared through secure data transfer methods. Researchers may be required to sign a data use agreement to ensure compliance with ethical standards, data protection regulations, and intended use of the data.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No