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KMID : 0379220150350020451
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Journal of Korea Gerontological Society
2015 Volume.35 No. 2 p.451 ~ p.474
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A Frailty Instrument to Predict Disability, Institutionalization, and Mortality: Findings from the Living Profiles of Older People Survey
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Kim Chang-O
Sunwoo Duk
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Abstract
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Although frail older adults are regarded as a high-risk group for institutionalization, there is no consensus on a clear definition of frailty in South Korea. The aim of this study was to develop a frailty instrument which has high predictive validity, discrimination and calibration ability for adverse health outcomes such as disability, institutionalization, and mortality. For this purpose, nine potential frailty indicators from a literature review and 3 potential instruments were tested using longitudinal data from the Living Profiles of Older People Survey which was conducted from 2008 to 2011 with 7,513 elderly people. During the three years of follow-up, 9.5% and 4.1% of study participants lost at least one ADL and IADL, respectively, 1.6% received the National Long-Term Care Service (NLTCS), and 6.3% died. Results showed that, when we defined frailty as the presence of two or more of the following components: 1) weakness of grip strength (physical component), 2) exhaustion (psychological component), and 3) social isolation (social component), the frailty instrument was independently predictive (over 3 years) of worsening IADL, worsening ADL disability, becoming eligible for the NLTCS, and death, with relative ratios 1.9 (OR 1.89, 95% CI 1.39-2.57), 1.9 (OR 1.92, 95% CI 1.34-2.74), 3.2 (OR 3.22, 95% CI 1.92-5.39), and 1.6 (HR 1.58, 95% CI 1.21-2.05), respectively, after adjustment for multiple covariates such as health, disease, existing disability, and social characteristics. In addition, risk assessment remained strong when it was estimated by other measures of model discrimination (c 0.63-0.72) and calibration (p≥.051). Because it takes only 3 minutes or less to complete the entire measurement, this frailty instrument could be used by community-based healthcare programs to screen elderly people who are at risk of receiving care from the NLTCS.
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KEYWORD
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frailty , long-term care , predictive validity , discrimination , calibration
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