Abstract
Background: A claims-based frailty index (CFI) was developed based on a deficit-accumulation approach using self-reported health information. This study aimed to independently validate the CFI against physical performance and adverse health outcomes. Methods: This retrospective cohort study included 3,642 community-dwelling older adults who had at least 1 health care encounter in the year prior to assessments of physical performance in the 2008 Health and Retirement Study wave. A CFI was estimated from Medicare claims data in the past year. Gait speed, grip strength, and the 2-year risk of death, institutionalization, disability, hospitalization, and prolonged (>30 days) skilled nursing facility (SNF) stay were evaluated for CFI categories (robust: <0.15, prefrail: 0.15-0.24, mildly frail: 0.25-0.34, moderate-to-severely frail: ≥0.35). Results: The prevalence of robust, prefrail, mildly frail, and moderate-to-severely frail state was 52.7%, 38.0%, 7.1%, and 2.2%, respectively. Individuals with higher CFI had lower mean gait speed (moderate-to-severely frail vs robust: 0.39 vs 0.78 m/s) and weaker grip strength (19.8 vs 28.5 kg). Higher CFI was associated with death (moderate-to-severely frail vs robust: 46% vs 7%), institutionalization (21% vs 5%), activity of daily living disability (33% vs 9%), instrumental activity of daily living disability (100% vs 22%), hospitalization (79% vs 23%), and prolonged SNF stay (17% vs 2%). The odds ratios per 1-SD (=0.07) difference in CFI were 1.46-2.06 for these outcomes, which remained statistically significant after adjustment for age, sex, and a comorbidity index. Conclusion: The CFI is useful to identify individuals with poor physical function and at greater risks of adverse health outcomes in Medicare data.
| Original language | English |
|---|---|
| Article number | gly197 |
| Pages (from-to) | 1271-1276 |
| Number of pages | 6 |
| Journal | Journals of Gerontology - Series A Biological Sciences and Medical Sciences |
| Volume | 74 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Jul 12 2019 |
Bibliographical note
Funding Information:D.H.K. is supported by the Paul B. Beeson Clinical Scientist Development Award in Aging (K08AG051187) from the National Institute on Aging, American Federation for Aging Research, John A. Hartford Foundation, and Atlantic Philanthropies. He is also supported by the Boston Claude D. Pepper Older Americans Independence Center (P30AG013679). L.A.L. was supported by grants P01AG04390, R01AG041785, and 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 (PJT-156114 and CNA-137794) and philanthropic support from the Fountain Family Innovation Fund of the Queen Elizabeth II Health Sciences Research Foundation (Halifax, Nova Scotia). 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.
Funding Information:
The HRS is a nationally representative, longitudinal survey to study changes in health and well-being in adults over age 50 years in the United States, sponsored by the National Institute on Aging (grant number NIA U01AG009740) and conducted by the University of Michigan (11). The core survey was conducted every 2 years to assess health, psychosocial, and financial status from respondents or their proxy (approximately 9%) (11). The survey data have been linked to Medicare data to obtain information on health care costs and utilizations in over 80% of the respondents (12). We used inpatient, outpatient, skilled nursing facility (SNF), home health agency, carrier, and durable medical equipment data sets, which contained the International Classification of Diseases (ICD) diagnosis and procedure codes, Current Procedural Terminology (CPT) codes (codes for medical services and procedures), and Healthcare Common Procedure Coding System (HCPCS) codes (codes for supplies, equipment, and devices).
Publisher Copyright:
© 2018 The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
ASJC Scopus Subject Areas
- Ageing
- Geriatrics and Gerontology