Predictive validity of two frailty tools for mortality in Chinese nursing home residents: frailty index based on common laboratory tests (FI-Lab) versus FRAIL-NH

AbstractPolypharmacy represents a major clinical and public health issue in older persons. We aimed to measure the prevalence of polypharmacy, and the main predictors of drug prescription in nursing home residents. Post hoc analyses of the “Incidence of pNeumonia and related ConseqUences in nursing home Residents” (INCUR) study were conducted. Polypharmacy was defined as the prescription of 5 or more drugs. A frailty index (FI) was computed according to the model proposed by Rockwood and Mitnitski using 36 health deficits, including diseases, signs, symptoms, and disabilities. Linear regression models were performed to identify the main predictors of the number of prescribed drugs. The INCUR study enrolled 800 patients (mean [SD] age 86.2 [4.1] years, 74.1% women). The mean number of medications prescribed at the baseline was 8.5 (SD 4.1). Prevalence of polypharmacy was found 86.4%. The mean FI was 0.38 (SD 0.10). A fully adjusted linear multivariate regression model found an inverse and independent association between age and number of prescribed drugs (beta − 0.07, 95% CI − 0.13, − 0.02; p = 0.005). Conversely, the FI was independently and positively associated with the number of medications (beta 4.73, 95% CI 1.17, 8.29; p = 0.009). The prevalence of polypharmacy is high among older persons living in nursing home. Age and FI are significantly associated with the number of drugs. The number of prescribed drugs tends to decrease with age, whereas a direct association with frailty is reported.

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Is the Tinetti Performance Oriented Mobility Assessment (POMA) a feasible and valid predictor of short-term fall risk in nursing home residents with dementia?

International Psychogeriatrics ◽

10.1017/s1041610209991347 ◽

2009 ◽

Vol 22 (2) ◽

pp. 254-263 ◽

Cited By ~ 41

Author(s):

Carolyn S. Sterke ◽

Sawadi L. Huisman ◽

Ed F. van Beeck ◽

Caspar W. N. Looman ◽

Tischa J. M. van der Cammen

Keyword(s):

Regression Analysis ◽

Nursing Home ◽

Predictive Validity ◽

Nursing Home Residents ◽

Area Under The Curve ◽

Short Term ◽

Severe Dementia ◽

Mobility Assessment ◽

Specific Objective

ABSTRACTBackground:The feasibility and predictive validity of balance and gait measures in more severe stages of dementia have been understudied. We evaluated the clinimetric properties of the Tinetti Performance Oriented Mobility Assessment (POMA) in nursing home residents with dementia with a specific objective of predicting falls in the short term.Methods:Seventy-five ambulatory nursing home residents with dementia, mean age 81 ± 8 years, participated in a prospective cohort study. All participants underwent the full POMA-test. Fall statistics were retrieved from incident reports during a three-months follow-up period. The predictive validity was expressed in terms of sensitivity and specificity. Loglinear regression analysis was used to examine the relationship between POMA scores and the occurrence of a fall.Results:The POMA showed several feasibility problems, with 41% of patients having problems in understanding one or more instructions. The inter-rater reliability of the instrument was good. The predictive validity was acceptable, with a sensitivity of 70–85% and a specificity of 51–61% for the POMA and its subtests, and an area under the curve (AUC) of 0.70 for POMA-Total (95% CI: 0.53–0.81), 0.67 for POMA-Balance (95% CI: 0.52–0.81), and 0.67 for POMA-Gait (95% CI: 0.53–0.81). After loglinear regression analysis, only POMA-T was significant in predicting a fall (adjusted HR = 1.08 per point lower; 95% CI 1.00–1.17).Conclusions:Application of the POMA in populations with moderate to severe dementia is hampered by feasibility problems. Its implementation in clinical practice cannot therefore be recommended, despite an acceptable predictive validity. To refine our findings, large prospective studies on the predictive validity of the POMA in populations with mild, moderate and severe dementia are needed. In addition, the performance of mobility assessment methods that are less dependent on cognition should be evaluated.

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Routine Laboratory Tests in Impaired Nursing Home Residents

JAMA ◽

10.1001/jama.1995.03520380028029 ◽

1995 ◽

Vol 273 (14) ◽

pp. 1092 ◽

Cited By ~ 1

Author(s):

James P. Richardson

Keyword(s):

Nursing Home ◽

Laboratory Tests ◽

Nursing Home Residents ◽

Routine Laboratory

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A Frailty Index Based on Common Laboratory Tests in Comparison With a Clinical Frailty Index for Older Adults in Long-Term Care Facilities

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2015.03.027 ◽

2015 ◽

Vol 16 (10) ◽

pp. 842-847 ◽

Cited By ~ 38

Author(s):

Kenneth Rockwood ◽

Miranda McMillan ◽

Arnold Mitnitski ◽

Susan E. Howlett

Keyword(s):

Older Adults ◽

Laboratory Tests ◽

Long Term Care ◽

Frailty Index ◽

Term Care ◽

Care Facilities ◽

Common Laboratory

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Accessing the discriminatory performance of FRAIL-NH in two-class and three-class frailty and examining its agreement with the frailty index among nursing home residents in mainland China

BMC Geriatrics ◽

10.1186/s12877-019-1314-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Feng Ge ◽

Weiwei Liu ◽

Minhui Liu ◽

Siyuan Tang ◽

Yongjin Lu ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Assessment Tool ◽

Frailty Index ◽

Mainland China ◽

Nursing Home Residents ◽

Kappa Statistics ◽

Cross Sectional ◽

Cutoff Points ◽

Discriminatory Performance

Abstract Background FRAIL-NH has been commonly used to assess frailty in nursing home residents and validated in many ethnic populations; however, it has not been validated in mainland China, where such an assessment tool is lacking. This study aimed to (1) assess the discriminatory performance of FRAIL-NH in two-class frailty (non-frail+ pre-frail vs. frail) and three-class frailty (non-frail vs. pre-frail vs. frail), based on the Frailty Index (FI), (2) determine the appropriate cutoff points for FRAIL-NH that distinguish two-class and three-class frailty, and (3) examine the agreement in classification between FRAIL-NH and FI. Methods A cross-sectional study of 302 residents aged 60 years or older from six nursing homes in Changsha was conducted. The FRAIL-NH scale and 34-item FI were used to measure frailty. Two-way and three-way receiver operating characteristic (ROC) curves were used to estimate the performance of FRAIL-NH. Cohen’s Kappa statistics were used to examine the agreement between these two measures. Results The agreement between FRAIL-NH and FI ranged from 0.33 to 0.55. Regardless of what FI cutoff points were based on, the volume under the ROC surface (VUS) for FRAIL-NH from the three-way ROC were higher than the VUS of a useless test (1/6), and the area under the ROC curve (AUC) for FRAIL-NH from the two-way ROC were higher than the clinically meaningless value (0.5). When using FI cutoff points of 0.20 for pre-frail and 0.45 for frail, FRAIL-NH cutoff points of 1 and 9 in classifying three-class frailty had the highest VUS and the largest correct classification rates. Whichever FI was chosen, the performance of FRAIL-NH in distinguishing between pre-frailty and frailty, and between non-frailty and pre-frailty was equivalent. According to FRAIL-NH, the proportion of individuals with frailty misclassified as pre-frailty was higher than that of individuals with non-frailty misclassified as pre-frailty. Conclusion FRAIL-NH can be used as a preliminary frailty screening tool in nursing homes in mainland China. FI should be further used especially for those classified as pre-frailty by FRAIL-NH. It is not advisable to simply combine adjacent two classes of FRAIL-NH to create a new frailty variable in research settings.

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