Derivation of a frailty index from the resident assessment instrument - home care adapted for Switzerland: a study based on retrospective data analysis

Catherine Ludwig, Catherine Busnel, Catherine Ludwig, Catherine Busnel

Abstract

Background: The screening of frail individuals at risk for functional health decline and adverse health outcomes lies in the evolving agenda of home care providers. Such a screening can be based on a frailty index (FI) derived from data collected with interRAI instruments used in clinical routines to define care plans. The objective of this study was to assess the feasibility of deriving an FI from the Resident Assessment Instrument - Home Care adapted for Switzerland (Swiss RAI-HC).

Methods: Data were collected by the Geneva Institution for Homecare and Assistance in clinical routines. The sample consisted of 3714 individuals aged 65 or older (67.7% females) who had each received a Swiss RAI-HC upon admission in the year of 2015. The FI was derived from 52 variables identified and scored according to published guidelines. Adverse health outcomes were either assessed during follow-up assessments (falls, hospitalizations) or documented from administrative records (mortality).

Results: The results showed that the FI was distributed normally, with a mean of 0.24 (± 0.13), an interquartile range of 0.16, and values of 0.04 at percentile 1 and 0.63 at percentile 99. The effect of Age was significant (R2 = 0.011) with a slope of β = 0.002, 95% CI = [0.001-0.002]. Sex as well as the Age × Sex interaction were not significant. The FI predicted deaths (OR = 9.99, 95% CI = [3.20-29.99]), hospitalizations (OR = 3.40, 95% CI = [1.78-6.32]), and falls (OR = 5.00, 95% CI = [2.68-9.38]).

Conclusions: The results support the feasibility of an FI derivation from the Swiss RAI-HC, hence replicating previous demonstrations based on interRAI instruments. The results also replicated findings showing that the FI is a good predictor of adverse health outcomes. Yet, the results suggest that home care recipients demonstrate a frailty pattern different from the one reported in community dwellers but comparable to clinical samples. Further work is needed to assess the characteristics of the proposed index in community-dwelling, non-clinical samples for comparability with the existing literature and external validation TRIAL REGISTRATION: ClinicalTrials.gov NCT03139162 . Retrospectively registered May 2, 2017.

Keywords: Aging; Frailty; Home care; Resident assessment instrument.

Conflict of interest statement

Ethics approval and consent to participate

The protocol was qualified as a retrospective study using coded data on non-genetic health personal data and received approval from the Ethical Committee of Canton Geneva, Switzerland (Project ID N° 2017–00357). Consent for data use for clinical, epidemiological, and research purposes in agreement with the relevant cantonal law on personal data protection (LIPAD, Art.41) is part of the terms and conditions that imad applied prior to any Swiss RAI-HC assessment. Thus, personal or proxy-written informed consent was obtained for each participant for data use and analysis.

Consent for publication

Personal or proxy-written informed consent was obtained for each participant for research results dissemination as part of the terms and conditions applied by imad and in accordance with Art.41 of the LIPAD.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Frequency of deficit report by item for each of the 52 items considered for the FI. Health dimensions/physiological systems (N = 10) are color-coded
Fig. 2
Fig. 2
Distribution of the frailty index by Sex and for the entire sample. M: Mean; 95% CI: 95% Confidence intervals of the mean estimated by bootstrapping (N = 1000). The box-and-whisker plot represents the values for the total sample, including the median, the values at percentiles 25 and 75, and the values at percentiles 1 and 99 (extremes)
Fig. 3
Fig. 3
Receiver operating curves (ROC) for FI in relation to mortality, hospitalizations, and falls. Dashed line represents chance level. AUC = area under the curve. 95% CI = 95% confidence interval of AUC; p = p-values

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