Abstract

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Background
Keywords
Findings
Authors
What is already known on this subject?
What does this study add?

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Background

This study validates cut-points for a frailty index (FI) to identify seniors at risk of a hospital-related event and estimates the number of frail seniors living in the community. The FI developed by Rockwood and Mitnitski defines levels of frailty based on scores of 0 to 1.0.

Data and Methods

The cut-point validation was conducted using Stratum-Specific Likelihood Ratios applied to combined 2003 and 2005 Canadian Community Health Survey (CCHS) data, linked to hospital records from the Discharge Abstract Database (2002 to 2007). Based on the validated cut-points, frailty prevalence was estimated using 2009/2010 CCHS data.

Results

Seniors scoring more than .21 on the FI were considered to be at elevated risk of hospital-related events. Four additional frailty levels were identified: non-frail (0 to ≤0.1), pre-frail (>0.1 to ≤.021), more frail (>0.30 to ≤0.35) (women only), and most frail (frail-group subset) (0.45 or more). The number of community-dwelling seniors considered to be frail was estimated at about 1 million (24%) in 2009/2010; another 1.4 million (32%) could be considered pre-frail. Frailty prevalence rose with age; was higher among women than among men; and varied by geographic location.

Interpretation

A cut-point of more than 0.21 can be used to identify frail seniors living in the community.

Keywords

Activities of daily living,  health status indicators, hospital records,  probabilistic linkage, validation studies

Findings

Frailty is an age-related physiological state of increased vulnerability. Frail individuals are less likely to adapt and/or recover to a normal health state after acute illnesses or injuries. Frailty manifests as an accumulation of health problems, including chronic conditions and physical disability. Independent of age, frailty has been found to be predictive of death, hospitalization, institutionalization, falls, and worsening health status. Information about the prevalence of frailty among Canada's community-dwelling seniors is important for policy development and health resource planning, including home care and residential care. [Full Text]

Authors

Melanie Hoover (1-613-951-0346; melanie.hoover@statcan.gc.ca) is with the Health Statistics Division, and Michelle Rotermann, Claudia Sanmartin and Julie Bernier (1-613-951-4556; julie.bernier@statcan.gc.ca) are with the Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6.

What is already known on this subject?

  • Frailty is an age-related physiological state of increased vulnerability.
  • After acute illnesses or injuries, frail individuals are less likely to adapt and/or recover to a normal health state.
  • Frailty index (FI) scores provide information at the individual and population levels, but to estimate the prevalence of frailty at the population level, cut-points are needed.
  • In previous research, various FI cut-points have been used to distinguish frail from non-frail community-dwelling seniors, but no cut-point is universally accepted.

What does this study add?

  • Based on data from the Canadian Community Health Survey, an FI was applied to a nationally representative sample of community-dwelling seniors.
  • Data analysis supported the use of a cut-point of greater than 0.21 to identify frail seniors.
  • In 2009/2010, almost a quarter (24%) of community-dwelling people aged 65 or older were estimated to be frail and at risk of a hospital-related event; another 32% could be considered pre-frail.
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