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Frailty index associated with all-cause mortality, long-term institutionalization, and hip fracture

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Key summary points

AbstractSection Aim

Can frailty be diagnosed using previously recorded medical data in Korean older people?

AbstractSection Findings

The prevalence of frailty among Korean older persons was 3.4%. Frail older persons showed higher mortality, long-term care facility institutionalization, and hip fracture than those of robust older persons.

AbstractSection Message

Frailty can be diagnosed using previously recorded electronic medical record (EMR) data in Korean older persons.

Abstract

Purpose

To assess the association between frailty, measured using a frailty diagnosis tool, and adverse outcomes using regular health checkup data and National Health Insurance claim data of 66-year-old Koreans.

Methods

We evaluated all Koreans born between 1942 and 1946 who received a 66-year lifetime transition period health examination and regular biennial general and cancer screenings between 2008 and 2012. These patients were observed until December 31, 2015. The Lifetime Transition Period Health Examination version of the Korean Frailty Index (THE frailty index) was used to examine adverse geriatric outcomes based on levels of frailty. THE frailty index scores were used to classify participants as “robust” (0–2), “pre-frail” (3–4), or “frail” (more than 5). The main outcomes included the risks of all-cause mortality, long-term care facility institutionalization, and hip fracture.

Results

Among 725,759 Korean men and women, the prevalence of frail and pre-frail conditions was 3.4% and 26.6%, respectively. After an average of 4.4 years of follow-up, frail older persons had significantly higher mortality rates [men: hazard ratio (HR) 2.031 (95% confidence interval [CI], 1.894–2.178); women: HR 2.092 (95% CI 1.920–2.279)], long-term care facility institutionalization [men: HR 2.997 (95% CI 2.750–3.268); women: HR 3.057 (95% CI 2.866–3.261)], and hip fracture [men: HR 2.230 (95% CI 1.854–2.681); women: HR 2.356 (95% CI 2.086–2.660)] than those of robust older persons.

Conclusions

Aged frail persons diagnosed using the THE frailty index had higher all-cause mortality, more frequent entry into long-term care facilities, and greater risk of hip fracture.

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References

  1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol: Ser A 56(3):M146–M157. https://doi.org/10.1093/gerona/56.3.M146

    Article  CAS  Google Scholar 

  2. Lacas A, Rockwood K (2012) Frailty in primary care: a review of its conceptualization and implications for practice. BMC Med 10(1):4. https://doi.org/10.1186/1741-7015-10-4

    Article  PubMed  PubMed Central  Google Scholar 

  3. Davies BR, Baxter H, Rooney J, Simons P, Sephton A, Purdy S et al (2018) Frailty assessment in primary health care and its association with unplanned secondary care use: a rapid review. BJGP Open 15:85. https://doi.org/10.3399/bjgpopen18x101325

    Article  Google Scholar 

  4. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762. https://doi.org/10.1016/S0140-6736(12)62167-9

    Article  PubMed  Google Scholar 

  5. Reuben DB, Frank JC, Hirsch SH, McGuigan KA, Maly RC (1999) A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an intervention to increase adherence to recommendations. J Am Geriatr Soc 47(3):269–276

    Article  CAS  PubMed  Google Scholar 

  6. Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P (2011) Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 343:d6553

    Article  PubMed  PubMed Central  Google Scholar 

  7. Parker SG, McCue P, Phelps K, McCleod A, Arora S, Nockels K et al (2018) What is comprehensive geriatric assessment (CGA)? An umbrella review. Age Ageing 47(1):149–155. https://doi.org/10.1093/ageing/afx166

    Article  CAS  PubMed  Google Scholar 

  8. Theou O, Brothers TD, Mitnitski A, Rockwood K (2013) Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. J Am Geriatr Soc 61(9):1537–1551. https://doi.org/10.1111/jgs.12420

    Article  PubMed  Google Scholar 

  9. van der Vorst A, Zijlstra GR, De Witte N, De Lepeleire J, Kempen GI, Schols JM et al (2018) Can proxy assessments serve as a first screener for identifying people at risk for multidimensional frailty? Eur Geriatr Med 9(4):501–507

    Article  PubMed  Google Scholar 

  10. Garm A, Park G, Song X (2017) Using an electronic comprehensive geriatric assessment and health coaching to prevent frailty in primary care: the CARES model. Med Clin Rev 3(S1):9

    Google Scholar 

  11. Kim DH, Schneeweiss S, Glynn RJ, Lipsitz LA, Rockwood K, Avorn J (2017) Measuring frailty in medicare data: development and validation of a claims-based frailty index. J Gerontol: Ser A 15:85. https://doi.org/10.1093/gerona/glx229

    Article  Google Scholar 

  12. Clegg A, Bates C, Young J, Ryan R, Nichols L, Ann Teale E et al (2016) Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing 45(3):353–360. https://doi.org/10.1093/ageing/afw039

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kim L, Kim J-A, Kim S (2014) A guide for the utilization of health insurance review and assessment service national patient samples. Epidemiol Health 36:e2014008. https://doi.org/10.4178/epih/e2014008

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cho B, Lee CM (2011) Current situation of national health screening system in Korea. J Korean Med Assoc 54(7):666–669

    Article  Google Scholar 

  15. Hwang HS, Kwon IS, Park BJ, Cho B, Yoon JL, Won CW (2010) The validity and reliability of Korean frailty index. J Korean Geriatr Soc 14(4):191–202

    Article  Google Scholar 

  16. Han ES, Lee Y, Kim J (2014) Association of cognitive impairment with frailty in community-dwelling older adults. Int Psychogeriatr 26(1):155–163

    Article  PubMed  Google Scholar 

  17. Shamliyan T, Talley KM, Ramakrishnan R, Kane RL (2013) Association of frailty with survival: a systematic literature review. Ageing Res Rev 12(2):719–736

    Article  PubMed  Google Scholar 

  18. Kojima G (2015) Frailty as a predictor of future falls among community-dwelling older people: a systematic review and meta-analysis. J Am Med Dir Assoc 16(12):1027–1033

    Article  PubMed  Google Scholar 

  19. Kojima G (2016) Frailty as a predictor of fractures among community-dwelling older people: a systematic review and meta-analysis. Bone 90:116–122

    Article  PubMed  Google Scholar 

  20. Kojima G (2018) Frailty as a predictor of nursing home placement among community-dwelling older adults: a systematic review and meta-analysis. J Geriatr Phys Ther 41(1):42–48

    Article  PubMed  Google Scholar 

  21. Kojima G (2016) Frailty as a predictor of hospitalisation among community-dwelling older people: a systematic review and meta-analysis. J Epidemiol Community Health 70(7):722–729

    Article  PubMed  Google Scholar 

  22. Lai S-W, Lin C-H, Liao K-F, Su L-T, Sung F-C, Lin C-C (2012) Association between polypharmacy and dementia in older people: a population-based case–control study in Taiwan. Geriatr Gerontol Int 12(3):491–498. https://doi.org/10.1111/j.1447-0594.2011.00800.x

    Article  PubMed  Google Scholar 

  23. Xue Q-L, Varadhan R (2013) What is missing in the validation of frailty instruments? J Am Med Dir Assoc 15(2):141–142. https://doi.org/10.1016/j.jamda.2013.11.007

    Article  Google Scholar 

  24. Chumlea WC (2013) Response to the letter to the editor: “frailty consensus: a call to action”. J Am Med Dir Assoc 15(2):142–143. https://doi.org/10.1016/j.jamda.2013.11.011

    Article  Google Scholar 

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Acknowledgements

The National Health Information Database was provided by the National Health Insurance Service (NHIS) of Korea. The authors thank the National Health Insurance Service for its cooperation.

Funding

This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Family Medicine, Chonnam National University Hwasun Hospital, 322-Seoyang-ro, Hwasun-eup, Hwasun-Gun, Jeollanam-do, 58128, South Korea

    Yeon-Pyo Kim & Yu-Ri Choe

  2. Big Data Screening Department, National Health Insurance Service, 32, Geongang-ro, Wonju-Si, Gangwon-do, 26464, South Korea

    Jong-Heon Park

  3. Department of Family Medicine, Senior Health Care Center, Kyung Hee University Medical Center, Seoul, 02447, South Korea

    Sunyoung Kim & Chang-Won Won

  4. Department of Family Medicine, Hanyang University Hospital, 222-1, Wangsimni-ro, Seongdong-Gu, Seoul, 04763, South Korea

    Hwan-Sik Hwang

Authors
  1. Yeon-Pyo Kim
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  2. Yu-Ri Choe
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  3. Jong-Heon Park
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  4. Sunyoung Kim
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  5. Chang-Won Won
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  6. Hwan-Sik Hwang
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Corresponding author

Correspondence to Hwan-Sik Hwang.

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Conflict of interest

This study made use of the National Health Information Database (NHIS-2018-4-015) created by the National Health Insurance Service (NHIS). The authors declare no conflict of interest with regard to the NHIS.

Ethical approval

This study adhered to the Personal Information Act and the Personal Information Processing Guideline of the NHIS and the Institutional Review Board of Hanyang University Hospital (HYUH 2015-06-011).

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For this type of study, formal consent is not required.

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Kim, YP., Choe, YR., Park, JH. et al. Frailty index associated with all-cause mortality, long-term institutionalization, and hip fracture. Eur Geriatr Med 10, 403–411 (2019). https://doi.org/10.1007/s41999-019-00196-y

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  • DOI: https://doi.org/10.1007/s41999-019-00196-y

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