The frail older person does not exist: development of frailty profiles with latent class analysis

Abstract

BackgroundA fundamental issue in elderly care is targeting those older people at risk and in need of care interventions. Frailty is widely used to capture variations in health risks but there is no general consensus on the conceptualization of frailty. Indeed, there is considerable heterogeneity in the group of older people characterized as frail. This research identifies frailty profiles based on the physical, psychological, social and cognitive domains of functioning and the severity of the problems within these domains.MethodsThis research was a secondary data-analysis of older persons derived from The Older Person and Informal Caregiver Minimum Dataset. Selected respondents were 60 years and older (n = 43,704; 59.6% female). The following variables were included: self-reported health, cognitive functioning, social functioning, mental health, morbidity status, and functional limitations. Using latent class analysis, the population was divided in subpopulations that were subsequently discussed in a focus group with older people for further validation.ResultsWe distinguished six frailty profiles: relatively healthy; mild physically frail; psychologically frail; severe physically frail; medically frail and multi-frail. The relatively healthy had limited problems across all domains. In three profiles older people mostly had singular problems in either the physical or psychological domain and the severity of the problems differed. Two remaining profiles were multidimensional with a combination of problems that extended to the social and cognitive domains.ConclusionsOur research provides an empirical base for meaningful frailty profiles. The profiles showed specific patterns underlying the problems in different domains of functioning. The heterogeneous population of frail older people has differing needs and faces different health issues that should be considered to tailor care interventions. Evaluation research of these interventions should acknowledge the heterogeneity of frailty by profiling.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0776-5) contains supplementary material, which is available to authorized users.

Outcomes of hospital admissions among frail older people: a 2-year cohort study

“…Frailty is a distinctive health state related to ageing, characterised by impaired homeostasis and decreased physiological reserve across multiple body systems, and resulting in increased vulnerability to adverse outcomes from apparently minor stressor events. 1,2 These individuals are at increased risk of 'frailty crises', which are a common cause of acute health service use. Several scoring systems have been developed to quantify frailty and stratify risk in individuals and populations.…”

Evaluation of two frailty indices, with practical application in a vaccine clinical trial

“…35 More recently, researchers have emphasized that frailty also involves psychological and social domains. 3 In addition to the medical comorbidities and SF-36 PF, the proposed index included items from both the SF-36 and EQ-5D questionnaires assessing general health (e.g. 'my health is excellent', 'I get sick easier than other people', 'I expect my health to get worse'), vitality (e.g.…”

“…Frailty is a term used in geriatric medicine to identify older adults who are at increased risk of poor clinical outcomes, such as disability, cognitive decline, falls, hospitalization, requiring longterm assisted care, or increased mortality. [1][2][3] Frailty is defined as clinical vulnerability and is more predictive of health outcomes than chronological age. The aging process varies substantially between individuals because of unique features, such as genetic and environmental factors.…”

“…10 Health care professionals, policy makers and researchers have not achieved consensus on how to define frailty and how to quantitate the grading of frailty. 3 Mitnitski and Rockwood defined frailty status using a frailty index (FI) based on the accumulation of deficits (e.g. symptoms, signs, functional impairments, and laboratory abnormalities).…”

“…Although prior research on frailty focused on chronic conditions, general health status and physical frailty, more recently researchers have emphasized that frailty also involves psychological and social domains. 3 In addition, some studies have incorporated PROs, such as the Short Form-36 (SF-36), into the definition of frailty. For example, Ryb et al defined frailty as having an SF-36 physical functioning (PF) score <75.…”