Abstract
BackgroundThe screening of frail individuals at risk for functional health decline and adverse health outcomes lies in the evolving agenda of home care providers. Such a screening can be based on a frailty index (FI) derived from data collected with interRAI instruments used in clinical routines to define care plans. The objective of this study was to assess the feasibility of deriving an FI from the Resident Assessment Instrument – Home Care adapted for Switzerland (Swiss RAI-HC).MethodsData were collected by the Geneva Institution for Homecare and Assistance in clinical routines. The sample consisted of 3714 individuals aged 65 or older (67.7% females) who had each received a Swiss RAI-HC upon admission in the year of 2015. The FI was derived from 52 variables identified and scored according to published guidelines. Adverse health outcomes were either assessed during follow-up assessments (falls, hospitalizations) or documented from administrative records (mortality).ResultsThe results showed that the FI was distributed normally, with a mean of 0.24 (± 0.13), an interquartile range of 0.16, and values of 0.04 at percentile 1 and 0.63 at percentile 99. The effect of Age was significant (R2 = 0.011) with a slope of β = 0.002, 95% CI = [0.001–0.002]. Sex as well as the Age × Sex interaction were not significant. The FI predicted deaths (OR = 9.99, 95% CI = [3.20–29.99]), hospitalizations (OR = 3.40, 95% CI = [1.78–6.32]), and falls (OR = 5.00, 95% CI = [2.68–9.38]).ConclusionsThe results support the feasibility of an FI derivation from the Swiss RAI-HC, hence replicating previous demonstrations based on interRAI instruments. The results also replicated findings showing that the FI is a good predictor of adverse health outcomes. Yet, the results suggest that home care recipients demonstrate a frailty pattern different from the one reported in community dwellers but comparable to clinical samples. Further work is needed to assess the characteristics of the proposed index in community-dwelling, non-clinical samples for comparability with the existing literature and external validationTrial registrationClinicalTrials.govNCT03139162. Retrospectively registered May 2, 2017.
Highlights
The screening of frail individuals at risk for functional health decline and adverse health outcomes lies in the evolving agenda of home care providers
In Switzerland, the Resident Assessment Instrument – Home Care adapted for Switzerland (Swiss RAI-HC) has been advised for more than a decade for defining care plans for every adult requesting home care
A t-test for independent samples revealed that women (M = 83.5, sd = 7.5) were significantly older than men (M = 81.2, sd = 7.8), with a mean difference of 2.3, 95% confidence interval (95% CI) = [1.75–2.80], t (3712) = 8.54, p < 0.001, yet with a small to moderate significance as Cohen’s effect size value of d = 0.30 suggested
Summary
The screening of frail individuals at risk for functional health decline and adverse health outcomes lies in the evolving agenda of home care providers. Developed countries are witnessing demographic and epidemiologic transitions characterized by population aging [1] and increasing rates of chronic diseases and comorbidities [2] In this evolving context, the “contemporary” patient is often older than 75, is frequently highly multimorbid, and has high risks of functional decline [3]. In Switzerland, 26% of the population aged 65 to 69 declare themselves to be moderately to severely dependent in activities of daily living, a rate that reaches 61% among elders aged 85 or older [6] These rates, which are similar to those reported in Europe [7] and in most developed countries [1], suggest that the appropriate clinical management of the “contemporary” patient should include the prevention, detection, and management of functional decline [2] above and beyond specific disease management [3]. Home care services have a definite role to play in the screening of individuals who are at risk of independence loss
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