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

Abstract

BackgroundFRAIL-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.MethodsA 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.ResultsThe 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.ConclusionFRAIL-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.

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

“…Study designs included observational studies (n=31), experimental studies (n=6), qualitative studies (n=2), and a methodological study (n=1) (Table 1 ). Six articles utilized data from an Australian cohort study ( 23 , 25 , 26 , 29 – 31 ), five from an Australian randomized controlled trial (RCT) ( 22 , 27 , 28 , 32 , 33 ), three from a Spanish longitudinal study ( 41 – 43 ), and three from a Chinese cross-sectional study ( 35 – 37 ). The number of participants ranged from 13 to 571,139, with a mean age range of 79.0 ± 8.8 to 89.4 ± 4.6 years.…”

Prevalência E Fatores Associados À Síndrome Da Fragilidade Em Idosos Institucionalizados: Revisão Integrativa Da Literatura

“…De acordo com o Rockwood Clinical Frailty Index, as prevalências encontradas foram de 64,8%, 67%, 30,3%, 60,8%, 71,8% e 36,4 (TABUE-TEGUO et al, 2015;CESARI et al, 2016;KAEHR et al, 2016;THEOU et al, 2016;MARTÍNEZ-VELILLA et al, 2017;BUCKINX et al, 2018b). Já de acordo com a FRAIL-NH, foram 13,7%, 58,5%, 48,7%, 37,5%, 42,7% e 23,7% (GE et al, 2019;LUO et al, 2015;KAEHR et al, 2016;THEOU et al, 2016;MARTÍNEZ-VELILLA et al, 2017;BUCKINX et al, 2018b).…”

“…Os estudos apontaram maior frequência de associação da fragilidade com o aumento da idade, especialmente entre os mais longevos, com idade ≥ 80 anos (DE LA RICA-ESCUIN et al, 2014;BORGES et al, 2015;DEN UIJL et al, 2015;LUO et al, 2015;TABUE-TEGUO et al, 2015;BUCKINX et al, 2016;2018a;2018b;CESARI et al, 2016;FERREIRA et al, 2016;KAEHR et al, 2016;THEOU et al, 2016;HASAN et al, 2017;LAWRENCE et al, 2017;MARTÍNEZ-VELILLA et al, 2017;OVERBEEK et al, 2018;GE et al, 2019;FURTADO et al, 2020;LIU et al, 2020). Estima-se que, para cada ano a mais de vida, haja aumento médio de 0,8% na pontuação da fragilidade (FHON et al, 2018).…”

“…Em relação ao estado civil, os idosos que vivem sem companheiro apresentam maior vulnerabilidade de se tornarem frágeis quando comparados àqueles que possuem um parceiro (BORGES et al, 2015;BUCKINX et al, 2016;2018a;KAEHR et al, 2016;OVERBEEK et al, 2018;GE et al, 2019;FURTADO et al, 2020;LIU et al, 2020). Em um estudo realizado por Fhon et al (2018), os idosos que não possuíam companheiro obtiveram escore médio de fragilidade de 10,4% maior do que os idosos com companheiro.…”

“…Quanto ao nível educacional, identificou-se maior probabilidade da síndrome nos idosos que se declararam analfabetos ou com tempo de escolaridade menor que 8 anos (BORGES et al, 2015;LUO et al, 2015;TABUE-TEGUO et al, 2015 MARTÍNEZ-VELILLA et al, 2017;GE et al, 2019;MURUKESU et al, 2019;FURTADO et al, 2020). De acordo com os resultados apontados por Fhon et al (2018), para cada ano de escolaridade adicional, há redução de 1,2% no escore de fragilidade (GRDEN et al, 2017), evento explicado pelas melhores condições de acesso a informações, recursos financeiros e de saúde, além de oportunidades no mercado de trabalho (GRDEN et al, 2017;GUTIÉRREZ-VALENCIA et al, 2018).…”