Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
Waitematā District Health Board, Auckland, New Zealand.
PLoS One. 2022 Mar 2;17(3):e0264715. doi: 10.1371/journal.pone.0264715. eCollection 2022.
The development of frailty tools from electronically recorded healthcare data allows frailty assessments to be routinely generated, potentially beneficial for individuals and healthcare providers. We wished to assess the predictive validity of a frailty index (FI) derived from interRAI Community Health Assessment (CHA) for outcomes in older adults residing in retirement villages (RVs), elsewhere called continuing care retirement communities.
Prospective cohort study.
34 RVs across two district health boards in Auckland, Aotearoa New Zealand (NZ). 577 participants, mean age 81 years; 419 (73%) female; 410 (71%) NZ European, 147 (25%) other European, 8 Asian (1%), 7 Māori (1%), 1 Pasifika (<1%), 4 other (<1%).
interRAI-CHA FI tool was used to stratify participants into fit (0-0.12), mild (>0.12-0.24), moderate (>0.24-0.36) and severe (>0.36) frail groups at baseline (the latter two grouped due to low numbers of severely frail). Primary outcome was acute hospitalization; secondary outcomes included long-term care (LTC) entry and mortality. The relationship between frailty and outcomes were explored with multivariable Cox regression, estimating hazard ratios (HRs) and 95% confidence intervals (95%CIs).
Over mean follow-up of 2.5 years, 33% (69/209) of fit, 58% (152/260) mildly frail and 79% (85/108) moderate-severely frail participants at baseline had at least one acute hospitalization. Compared to the fit group, significantly increased risk of acute hospitalization were identified in mildly frail (adjusted HR = 1.88, 95%CI = 1.41-2.51, p<0.001) and moderate-severely frail (adjusted HR = 3.52, 95%CI = 2.53-4.90, p<0.001) groups. Similar increased risk in moderate-severely frail participants was seen in LTC entry (adjusted HR = 5.60 95%CI = 2.47-12.72, p<0.001) and mortality (adjusted HR = 5.06, 95%CI = 1.71-15.02, p = 0.003).
The FI derived from interRAI-CHA has robust predictive validity for acute hospitalization, LTC entry and mortality. This adds to the growing literature of use of interRAI tools in this way and may assist healthcare providers with rapid identification of frailty.
利用电子记录的医疗保健数据开发虚弱工具，可以常规评估虚弱状况，这可能对个人和医疗保健提供者都有益。我们希望评估从 interRAI 社区健康评估（CHA）得出的虚弱指数（FI）对居住在退休村（RV）中的老年人结局的预测效度，RV 也称为持续护理退休社区。
前瞻性队列研究。
新西兰奥克兰两个地区卫生委员会的 34 个 RV。577 名参与者，平均年龄 81 岁；419 名（73%）为女性；410 名（71%）为新西兰欧洲人，147 名（25%）为其他欧洲人，8 名亚洲人（1%），7 名毛利人（1%），1 名太平洋岛民（<1%），4 名其他（<1%）。
使用 interRAI-CHA FI 工具将参与者分为健康（0-0.12）、轻度（>0.12-0.24）、中度（>0.24-0.36）和严重（>0.36）虚弱组，基线时（后两组由于严重虚弱的人数较少而分组）。主要结局为急性住院治疗；次要结局包括长期护理（LTC）入院和死亡。使用多变量 Cox 回归探讨虚弱与结局之间的关系，估计风险比（HR）和 95%置信区间（95%CI）。
在平均 2.5 年的随访中，基线时健康（69/209，33%）、轻度虚弱（152/260，58%）和中度-严重虚弱（85/108，79%）的参与者中有 33%（69/209）至少有一次急性住院治疗。与健康组相比，轻度虚弱（调整后的 HR = 1.88，95%CI = 1.41-2.51，p<0.001）和中度-严重虚弱（调整后的 HR = 3.52，95%CI = 2.53-4.90，p<0.001）组的急性住院治疗风险显著增加。在中度-严重虚弱的参与者中，也观察到中度-严重虚弱组的 LTC 入院（调整后的 HR = 5.60，95%CI = 2.47-12.72，p<0.001）和死亡率（调整后的 HR = 5.06，95%CI = 1.71-15.02，p = 0.003）风险增加。
从 interRAI-CHA 得出的 FI 对急性住院治疗、LTC 入院和死亡率具有良好的预测效度。这增加了越来越多的使用 interRAI 工具的文献，并可能有助于医疗保健提供者快速识别虚弱。
