Use of the Frailty Index and FRAIL-NH Scale for the Assessment of the Frailty Status of Elderly Individuals Admitted in a Long-term Care Hospital in Korea

Abstract

Background: Numerous elderly individuals with multimorbidity and impaired function are admitted in long-term care hospitals (LTCHs) in Korea. In this study, we aimed to describe the frailty status of elderly patients admitted in a LTCH using the FRAIL-NH scale and to identify the clinical relevance of frailty status on clinical outcomes, including death.

Methods: We retrospectively reviewed the medical records of 100 elderly patients who were hospitalized and died in an LTCH from March 2011 to February 2017. The monthly assessment results obtained from the inpatients' data set (IDS) were used as main data sources for the 6-item FRAIL-NH scale and frailty index that was composed of 22 newly established items.

Results: The mean frailty index of the patients included in the analysis (mean age, 81.5±7.2 years; men, 53%) was 0.60 (standard deviation [SD], 0.10; range, 0.28-0.80). The distribution of the FRAIL-NH score in this population was in accordance with the 22-item frailty index, which shows a standardized beta of 0.571 (p<0.001, R=0.572). When the patients were categorized based on the FRAIL-NH score, the mean survival durations of the more fail group (FRAIL-NH >10, n=49) and less frail group (FRAIL-NH ≤10, n=51) were 529.3 days (SD, 453.4) and 888 days (SD, 679.9), respectively. Similarly, the frailty index was associated with earlier mortality.

Conclusion: Frailty is extremely common in elderly patients admitted in an LTCH and can be easily measured using the FRAIL-NH scale that utilizes the IDS of LTCHs in Korea. Since frailty is associated with earlier mortality, the assessment of frailty status in patients admitted in LTCHs may be helpful in clinical decision-making.

Keywords: Aged care facilities; Frail elderly; Frailty index; Long-term care.

Fig. 1.

Frequency distribution of the patients according to the FRAIL-NH score (A) and frailty index (B).

Fig. 2.

Frequency of the score* of each sub item included in the FRAIL-NH scale in the study. *Scoring scheme: (1) transferring: 0 for unassisted transfer, 1 for needs some help or observation in transferring, and 2 for substantial or complete help in transferring; (2) mobility: 0 for patients who can get out from their room without help, 1 for needs some help or observation in getting out from their room, and 2 for substantial or complete help in getting out from their room; (3) continence: 0 for unassisted toilet use, 1 for needs some help or observation during toilet use, and 2 for substantial or complete help during toilet use; (4) weight loss within the last 3 months: 0 for no weight loss, 1 for 1-3 kg of weight loss, and 2 for >3 kg of weight loss; (5) feeding: 0 for unassisted feeding, 1 for needs some help or observation during feeding, and 2 for substantial or complete help during feeding; (6) dressing: 0 for getting on or off their clothes without assistance, 1 for requiring some help or observation during dressing, and 2 for substantial or complete help during dressing

Fig. 3.

Survival curve of the 100 patients in the less frail group (FRAIL-NH ≤10) and more frail group (FRAIL-NH >10). A significant difference was observed in the survival duration, with a p-value of 0.002.