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FRAIL-NH predicts outcomes in long term care

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The journal of nutrition, health & aging



To investigate the predictive validity of the short, simple FRAIL-NH frailty screening tool in the long term care population and to then compare the predictive validity with the frailty index (FI) for 6-month adverse health outcomes.


Retrospective study using the Minimum Data Set (MDS) 3.0 and chart review from June-December 2014.


Two Long Term Care Facilities in Saint Louis, MO.


270 patients ages ≥ 65 years old residing in long term care.


Frailty was measured using the FRAIL-NH and Frailty Index (FI) criteria. Adverse outcomes measured at 6-month follow-up included falls, hospitalizations, and hospice enrollment/mortality.


Based on screening tool used frailty prevalence was 48.7% for FRAIL-NH and 30.3% for FI. The FRAIL-NH pre-frail (Adjusted Odds Ratio [AOR]=2.62; 95% Confidence Interval [CI]=1.25–5.54; p=0.11) classification was associated with 6 month risk of falling and mortality/hospice enrollment was associated with the frail classification, AOR=3.96 (1.44–10.87, p=0.007). Combining the pre-frail and frail categories both measures predicted 6 month mortality with the FRAIL-NH being the strongest predictor (AOR=3.36; 95%CI=1.26–8.98; p=0.016) and the FI was a more modest predictor with an AOR of 2.28; 95%CI=1.01–5.15; p=0.047. When directly comparing the FRAIL-NH to the FI, the FRAIL-NH pre-frail were at increased risk of falling, AOR=2.42 (1.11–5.92, p=0.027) and the FRAIL-NH frail were at increased risk of hospice enrollment/death, OR=3.25 (1.04–10.86) p=0.044.


In comparison to the FI, the FRAIL-NH preformed just as well at screening for frailty and was a slightly better predictor of adverse outcomes. The FRAIL-NH is a brief, easy-to-administer frailty screening tool appropriate for long term care patients and predicts increased risk of falls in the pre-frail and mortality/hospice enrollment in the frail.

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Correspondence to Ellen W. Kaehr or John E. Morley.

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Kaehr, E.W., Pape, L.C., Malmstrom, T.K. et al. FRAIL-NH predicts outcomes in long term care. J Nutr Health Aging 20, 192–198 (2016).

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