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BMC Geriatr. 2016 Jul 7;16:133. doi: 10.1186/s12877-016-0309-z.

The prevalence and health consequences of frailty in a population-based older home care cohort: a comparison of different measures.

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Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada.
Division of Geriatric Medicine, University of Calgary, HSC-3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
School of Epidemiology, Public Health & Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
Department of Medicine, Queen's University and St Mary's of the Lake Hospital, 340 Union Street, Kingston, ON, K7L 5A2, Canada.
Division of Geriatric Psychiatry, Queen's University and Providence Care, 752 King Street W., Kingston, ON, K7L 4X3, Canada.
Ottawa Hospital Research Institute, 501 Smyth Road, PO Box201B, Ottawa, ON, K1H 8L6, Canada.
Institute of Health Policy Management & Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada.
Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L 3G1, Canada.



Evaluating different approaches to identifying frail home care clients at heightened risk for adverse health outcomes is an important but understudied area. Our objectives were to determine the prevalence and correlates of frailty (as operationally defined by three measures) in a home care cohort, the agreement between these measures, and their predictive validity for several outcomes assessed over one year.


We conducted a retrospective cohort study with linked population-based administrative and clinical (Resident Assessment Instrument [RAI]) data for all long-stay home care clients (aged 66+) assessed between April 2010-2013 in Ontario, Canada (nā€‰=ā€‰234,552). We examined two versions of a frailty index (FI), a full and modified FI, and the CHESS scale, compared their baseline characteristics and their predictive accuracy (by calculating the area under the ROC curve [AUC]) for death, long-term care (LTC) admission, and hospitalization endpoints in models adjusted for age, sex and comorbidity.


Frailty prevalence varied by measure (19.5, 24.4 and 44.1 %, for full FI, modified FI and CHESS, respectively) and was similar among female and male clients. All three measures were associated with a significantly increased risk of death, LTC admission and hospitalization endpoints in adjusted analyses but their addition to base models resulted in modest improvement for most AUC estimates. There were significant differences between measures in predictive accuracy, with the full FI demonstrating a higher AUC for LTC admission and CHESS a higher AUC for hospitalization - although none of the measures performed well for the hospitalization endpoints.


The different approaches to detecting vulnerability resulted in different estimates of frailty prevalence among home care clients in Ontario. Although all three measures were significant predictors of the health outcomes examined, the gains in predictive accuracy were often modest with the exception of the full FI in predicting LTC admission. Our findings provide some support for the clinical utility of a comprehensive FI measure and also illustrate that it is feasible to derive such a measure at the population level using routinely collected data. This may facilitate further research on frailty in this setting, including the development and evaluation of interventions for frailty.


Frailty; Health outcomes; Home care; Older adults; Predictive validity

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