Derivation of a Frailty Index from the interRAI-HC to Assess Frailty among Older Adults Receiving Home Care and Assistance (the “fraXity” Study)

Abstract

Background: Today, the value of screening for frailty among older adults is undisputed; to this endeavor, care at-home professionals are the “frailty whistleblowers” of choice. Yet, they need quick at-hand tools for routine use. To this aim, this study proposes a frailty index (FI) directly derived from the interRAI-HC MDS. The FI is used to assess frailty in a panel of home service recipients to document the rate of frailty among types of users. Methods: “fraXity” relies on a case-control design comparing community dwelling older adults receiving home care or assistance to peers who do not receive formal home services. The participants (N = 231) received the interRAI-HC at home from trained nurses. MDS data were used to derive a FI by following published guidelines. Regression modeling was used to assess group differences in the outcomes of interest. Results: The FI was normally distributed, with a mean of 0.19 (SD 0.10), and a value of 0.46 at the 99th percentile. The effect of age was significant (B = 0.003, 95% CI = (0.001–0.005)). As compared to the control group (FI = 0.14 ± 0.07, m ± SD), the FI was higher among individuals who received assistance (B = 0.04, 95% CI = (0.02–0.07)) and care (B = 0.11, 95% CI = (0.08–0.14)). These differences were adjusted for age. Conclusions: The results replicate demonstrations of MDS-based FI derivations and support the usefulness of a FI to distinguish different types of home service recipients. The study is a proof of concept supporting the need of a comprehensive assessment of health needs for all individuals who apply for homes services, including those admitted only for assistance. Further work is needed to evaluate the cost-benefit ratio of implementing the proposed methodology in homecare practice. Trial Registration: ClinicalTrials.gov, NCT03883425, registered on March 20, 2019.