Abstract
Background Frailty is a key determinant of health status and outcomes of health care interventions in older adults that is not readily measured in Medicare data. This study aimed to develop and validate a claims-based frailty index (CFI). Methods We used data from Medicare Current Beneficiary Survey 2006 (development sample: n = 5,593) and 2011 (validation sample: n = 4,424). A CFI was developed using the 2006 claims data to approximate a survey-based frailty index (SFI) calculated from the 2006 survey data as a reference standard. We compared CFI to combined comorbidity index (CCI) in the ability to predict death, disability, recurrent falls, and health care utilization in 2007. As validation, we calculated a CFI using the 2011 claims data to predict these outcomes in 2012. Results The CFI was correlated with SFI (correlation coefficient: 0.60). In the development sample, CFI was similar to CCI in predicting mortality (C statistic: 0.77 vs. 0.78), but better than CCI for disability, mobility impairment, and recurrent falls (C statistic: 0.62-0.66 vs. 0.56-0.60). Although both indices similarly explained the variation in hospital days, CFI outperformed CCI in explaining the variation in skilled nursing facility days. Adding CFI to age, sex, and CCI improved prediction. In the validation sample, CFI and CCI performed similarly for mortality (C statistic: 0.71 vs. 0.72). Other results were comparable to those from the development sample. Conclusion A novel frailty index can measure the risk for adverse health outcomes that is not otherwise quantified using demographic characteristics and traditional comorbidity measures in Medicare data.
| Original language | English |
|---|---|
| Pages (from-to) | 980-987 |
| Number of pages | 8 |
| Journal | Journals of Gerontology - Series A Biological Sciences and Medical Sciences |
| Volume | 73 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - Jun 14 2018 |
Bibliographical note
Funding Information:This research was funded by the Paul B. Beeson Clinical Scientist Development Award in Aging (K08AG051187) from the National Institute on Aging, The American Federation for Aging Research, The John A. Hartford Foundation, and The Atlantic Philanthropies. D.K. was supported by the Paul B. Beeson Clinical Scientist Development Award in Aging (K08AG051187) from the National Institute on Aging, The American Federation for Aging Research, The John A. Hartford Foundation, and The Atlantic Philanthropies. L.A.L. was supported by grant R01AG025037 from the National Institute on Aging. He holds the Irving and Edyth S. Usen and Family Chair in Geriatric Medicine at Hebrew SeniorLife. K.R. receives career support from the Dalhousie Medical Research Foundation as the Kathryn Allen Weldon Professor of Alzheimer Research, and has been supported in research on frailty by successive operating grants from the Canadian Institutes of Health Research. The funding sources had no role in the design, collection, analysis, or interpretation of the data, or the decision to submit the manuscript for publication. D.K., S.S., J.A. contributed to conception, design, and acquisition of data for this research. D.K. analyzed data and drafted the manuscript. All authors interpreted data, critically revised the manuscript for important intellectual content, and read and approved the final manuscript for submission.
Publisher Copyright:
© The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.
ASJC Scopus Subject Areas
- Ageing
- Geriatrics and Gerontology