M.BAO1, E. CHONG2
MOH Holdings Pte Ltd (MOHH)1, Tan Tock Seng Hospital2
Objectives: The FRAIL-NH was originally developed for evaluating frailty among nursing home (NH) residents. However, the FRAIL-NH may have utility in other clinical settings including the Emergency Department (ED). We aimed to compare concurrent and predictive validity between FRAIL and FRAIL-NH at the ED, using the Frailty Index (FI) as gold standard reference.
Design: A secondary analysis of a quasi-experimental study. Setting: An ED within a 1700-bed tertiary hospital. Participants: Older adults (n=99, mean age 90.0 years) recruited into the Emergency Department Interventions of Frailty (EDIFY) study. Measurements: Data on demographics, premorbid function, frailty status [FI, FRAIL, FRAIL-NH], comorbidities, and cognitive status were gathered. We also captured outcomes of mortality, hospitalizations, and ED-reattendance at 1-, 3-, and 6-month. For concurrent validity, we compared areas under the operating characteristic curves (AUCs) for both measures against the FI. We also performed univariate analyses and multiple logistic regression to compare the frailty measures against adverse outcomes of interest.
Results: Frailty prevalence was 81.8% for FI, 26.3% for FRAIL, and 68.7% for FRAIL-NH. A higher AUC was observed for FRAIL-NH (0.850 vs. 0.801, both P<.001). Only FI was independently predictive of acute hospitalizations at 3-month [Adjusted Odds Ratio (OR) 4.57, 95% Confidence Interval (CI) 1.21-17.23,P=.025] and ED-reattendance [Adjusted OR 3.48, 95%CI 1.02-11.92,P=.047] at 6-month.
Conclusions: Both FRAIL-NH and FRAIL had good concurrent validity for frailty diagnosis at ED. However, both measures did not perform well as predictive tools for adverse health outcomes.