Abstract
Background
Electronic frailty indices (eFIs) are increasingly used to identify patients at risk for morbidity and mortality. Whether eFIs capture the spectrum of frailty change, including decline, stability, and improvement is unknown.
Methods
In a nationwide retrospective birth-cohort of US Veterans, a validated eFI, including 31 health deficits, was calculated annually using medical record and insurance claims data (2002-2012). K-means clustering was used to assign patients into frailty trajectories measured five years prior to death.
Results
There were 214,250 Veterans born between 1927-1934 (mean (SD) age at death = 79.4 (2.8) years, 99.2% male, 90.3% white) with an annual eFI in the five years before death. Nine frailty trajectories were identified. Those starting at non-frail or pre-frail had two stable trajectories (non-frail to pre-frail, n=29,786 and stable pre-frail, n=28,499) and two rapidly increasing trajectories (pre-frail to moderately frail, n=28,244 and pre-frail to severely frail, n=22,596). Those who were mildly frail at baseline included one gradually increasing trajectory (mildly to moderately frail, n=33,806) and one rapidly increasing trajectory (mildly to severely frail, n=15,253). Trajectories that started at moderately or severely frail included two gradually increasing trajectories (moderately to severely frail, n=27,662 and progressing severely frail, n=14,478) and one recovering trajectory (moderately frail to mildly frail, n=13,926).
Conclusions
Nine frailty trajectories, including one recovering trajectory, were identified in this cohort of older US Veterans. Future work is needed to understand whether prevention and treatment strategies can improve frailty trajectories and contribute to compression of morbidity towards the end of life.
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