Development of the interRAI home care frailty scale

Abstract

BackgroundThe concept of frailty, a relative state of weakness reflecting multiple functional and health domains, continues to receive attention within the geriatrics field. It offers a summary of key personal characteristics, providing perspective on an individual’s life course.There have been multiple attempts to measure frailty, some focusing on physiologic losses, others on specific diseases, disabilities or health deficits. Recently, multidimensional approaches to measuring frailty have included cognition, mood and social components. The purpose of this project was to develop and evaluate a Home Care Frailty Scale and provide a grounded basis for assessing a person’s risk for decline that included functional and cognitive health, social deficits and troubling diagnostic and clinical conditions.MethodsA secondary analysis design was used to develop the Home Care Frailty Scale. The data set consisted of client level home care data from service agencies around the world. The baseline sample included 967,865 assessments while the 6-month follow-up sample of persons still being served by the home care agencies consisted of 464,788 assessments. A pool of 70 candidate independent variables were screened for possible inclusion and 16 problem outcomes referencing accumulating declines and clinical complications served as the dependent variables. Multiple regression techniques were used to analyze the data.ResultsThe resulting Home Care Frailty Scale consisted of a final set of 29 items. The items fall across 6 categories of function, movement, cognition and communication, social life, nutrition, and clinical symptoms. The prevalence of the items ranged from a high of 87% for persons requiring help with meal preparation to 3.7% for persons who have experienced a recent decline in the amount of food eaten.ConclusionsThe interRAI Home Care Frailty Scale is based on a strong conceptual foundation and in our analysis, performed as expected. Given the use of the interRAI Home Care Assessment System in multiple, diverse countries, the Home Care Frailty Scale will have wide applicability to support program planning and policy decision-making impacting home care clients and their formal and informal caregivers throughout the world.

Multicomponent Frailty Assessment Tools for Older People with Psychiatric Disorders: A Systematic Review

“…Participants were most commonly sampled from the Netherlands (29 of 95 studies) 27,58–60,66,74,75,82,84–90,93,94,96,99,100,105,109,111–113,123–126 . The cohorts were predominantly community based generally older adult populations (51 of 95) 3,9,27,40,44,46,48,54–56,58–60,65,67,68,72,74,75,77,79,80,82–86,88,93–97,101,103,104,106,107,109,116,117,121–130 . Only one of the 95 cohorts consisted of “psychogeriatric patients” (80.8% diagnosed with dementia, 5% depression, 11% unspecified, 3% no mental disorder) .…”

“…Hypothesis testing had the greatest number of fair ratings (65 of 70). A total of 42 of 95 studies had at least one aspect of methodological quality rated as poor 41,44–48,50,51,55,56,58,59,61,63,66–68,74,76–78,80,82,84–86,89,96–98,102,103,106,109,110,113,116,117,119,124,127,128 . Criterion validity had the greatest number of poor ratings (30 of 42).…”

“…27,58-60,66,74,75,82,84-90, 93,94,96,99,100,105,109,111-113,123-126 The cohorts were predominantly community based generally older adult populations (51 of 95). 3,9,27,40,44,46,48,[54][55][56][58][59][60]65,67,68,72,74,75,77,79,80,[82][83][84][85][86]88,[93][94][95][96][97]101,103,104,106,107,109,116,117,[121][122][123][124][125][126][127][128][129]…”

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

“…Recent studies convincingly demonstrated that an FI can be derived from data collected with unified instruments from the interRAI suite either with the interRAI Acute Care [ 17 ], interRAI Nursing Homes [ 18 ], or interRAI Home Care [ 19 ]. Aside from FI derivations, scales assessing frailty have also been proposed; among them, the Frailty Scale [ 20 ] built from the interRAI Home Care and the FRAIL-NH scale [ 21 , 22 ] elaborated on the interRAI Nursing Home. The former operationalizes frailty as an accumulation of deficit [ 13 ], and the latter relies on the phenotype model of frailty [ 23 ], which assigns individuals to “robust”, “pre-frail”, and “frail” categories based on a restricted number of variables assessing predefined physiological resources.…”

Frailty Assessment in Acute Care

“…Utilising the frailty index methodology, researchers have developed and tested an operationalised frailty model in different sectors, including acute care(305) and care home (306). Although these two frailty indices were not entirely similar, it is theoretically possible to measure frailty across a patient journey.…”