Abstract
BackgroundFRAIL-NH has been commonly used to assess frailty in nursing home residents and validated in many ethnic populations; however, it has not been validated in mainland China, where such an assessment tool is lacking. This study aimed to (1) assess the discriminatory performance of FRAIL-NH in two-class frailty (non-frail+ pre-frail vs. frail) and three-class frailty (non-frail vs. pre-frail vs. frail), based on the Frailty Index (FI), (2) determine the appropriate cutoff points for FRAIL-NH that distinguish two-class and three-class frailty, and (3) examine the agreement in classification between FRAIL-NH and FI.MethodsA cross-sectional study of 302 residents aged 60 years or older from six nursing homes in Changsha was conducted. The FRAIL-NH scale and 34-item FI were used to measure frailty. Two-way and three-way receiver operating characteristic (ROC) curves were used to estimate the performance of FRAIL-NH. Cohen’s Kappa statistics were used to examine the agreement between these two measures.ResultsThe agreement between FRAIL-NH and FI ranged from 0.33 to 0.55. Regardless of what FI cutoff points were based on, the volume under the ROC surface (VUS) for FRAIL-NH from the three-way ROC were higher than the VUS of a useless test (1/6), and the area under the ROC curve (AUC) for FRAIL-NH from the two-way ROC were higher than the clinically meaningless value (0.5). When using FI cutoff points of 0.20 for pre-frail and 0.45 for frail, FRAIL-NH cutoff points of 1 and 9 in classifying three-class frailty had the highest VUS and the largest correct classification rates. Whichever FI was chosen, the performance of FRAIL-NH in distinguishing between pre-frailty and frailty, and between non-frailty and pre-frailty was equivalent. According to FRAIL-NH, the proportion of individuals with frailty misclassified as pre-frailty was higher than that of individuals with non-frailty misclassified as pre-frailty.ConclusionFRAIL-NH can be used as a preliminary frailty screening tool in nursing homes in mainland China. FI should be further used especially for those classified as pre-frailty by FRAIL-NH. It is not advisable to simply combine adjacent two classes of FRAIL-NH to create a new frailty variable in research settings.
Highlights
FRAIL-NH has been commonly used to assess frailty in nursing home residents and validated in many ethnic populations; it has not been validated in mainland China, where such an assessment tool is lacking
The two-way receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) for the FRAIL-NH was 0.87, 0.86, and 0.93 when using a Frailty Index (FI) cutoff point of 0.25, 0.21, and 0.45, respectively
The corresponding prevalence of frailty differed (21.5% VS 13.6%), even when using the same measures in the same population. These findings suggest that the cutoff points of FRAIL-NH for frailty as well as the prevalence of frailty could vary depending on the number of classifications
Summary
FRAIL-NH has been commonly used to assess frailty in nursing home residents and validated in many ethnic populations; it has not been validated in mainland China, where such an assessment tool is lacking. The management of frailty in nursing home residents is a significant problem in China. The prevalence of frailty measured by the Tilburg Frailty Indicator (TFI) and the Physical Frailty Phenotype (PPF) from cross-sectional studies is high in nursing home residents in China (55.1–55.7%), and it is expected to increase continuously in the decades [1, 2]. The lack of frailty measures specific for nursing home residents in China has exacerbated this problem because a substantial proportion of pre-frail or frail older adults has not been identified and could not receive timely and appropriate intervention.
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