Cargando…
Predicting mortality and hospitalization of older adults by the multimorbidity frailty index
BACKGROUND: Existing operational definitions of frailty are personnel-costly and time-consuming, resulting in estimates with a small sample size that cannot be generalized to the population level. The objectives were to develop a multimorbidity frailty index using Taiwan’s claim database, and to und...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690585/ https://www.ncbi.nlm.nih.gov/pubmed/29145407 http://dx.doi.org/10.1371/journal.pone.0187825 |
_version_ | 1783279631350104064 |
---|---|
author | Wen, Yao-Chun Chen, Liang-Kung Hsiao, Fei-Yuan |
author_facet | Wen, Yao-Chun Chen, Liang-Kung Hsiao, Fei-Yuan |
author_sort | Wen, Yao-Chun |
collection | PubMed |
description | BACKGROUND: Existing operational definitions of frailty are personnel-costly and time-consuming, resulting in estimates with a small sample size that cannot be generalized to the population level. The objectives were to develop a multimorbidity frailty index using Taiwan’s claim database, and to understand its ability to predict adverse event. METHODS: This is a retrospective cohort study. Subjects aged 65 to 100 years who have full National Health Insurance coverage in 2005 were included. We constructed the multimorbidity frailty index using cumulative deficit approach and categorized study population according to the multimorbidity frailty index quartiles: fit, mild frailty, moderate frailty and severe frailty. The multimorbidity frailty index included deficits from outpatient and inpatient diagnosis. Associations with all-cause mortality, unplanned hospitalization and intensive care unit admission were assessed using Kaplan-Meier curves and Cox regression analyses. RESULTS: The multimorbidity frailty index incorporated 32 deficits, with mean multimorbidity frailty index score of 0.052 (standard deviation = 0.060) among 86,133 subjects included. Compared to subjects in fit category, subjects with severe frailty were associated with a 5.0-fold (adjusted hazard ratio, aHR 4.97; 95% confidence interval, 95% CI 4.49–5.50) increased risk of death at 1 year after adjusting for age and gender. Subjects with moderate frailty or mild frailty was associated with 3.1- (adjusted HR 3.08; 95% CI 2.80–3.39) or 1.9- (adjusted HR 1.86; 95% CI 1.71–2.01) folds increased risk, respectively.4.49–5.50). The risk trend of unplanned hospitalization and intensive care unit admission is similar among the study population. Besides, the association between the frailty categories and all three outcomes was slightly stronger among women. CONCLUSION: The multimorbidity frailty index was highly associated with all-cause mortality, unplanned hospitalization and ICU admission. It could serve as an efficient tool for stratifying older adults into different risk groups for planning care management programs. |
format | Online Article Text |
id | pubmed-5690585 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-56905852017-11-30 Predicting mortality and hospitalization of older adults by the multimorbidity frailty index Wen, Yao-Chun Chen, Liang-Kung Hsiao, Fei-Yuan PLoS One Research Article BACKGROUND: Existing operational definitions of frailty are personnel-costly and time-consuming, resulting in estimates with a small sample size that cannot be generalized to the population level. The objectives were to develop a multimorbidity frailty index using Taiwan’s claim database, and to understand its ability to predict adverse event. METHODS: This is a retrospective cohort study. Subjects aged 65 to 100 years who have full National Health Insurance coverage in 2005 were included. We constructed the multimorbidity frailty index using cumulative deficit approach and categorized study population according to the multimorbidity frailty index quartiles: fit, mild frailty, moderate frailty and severe frailty. The multimorbidity frailty index included deficits from outpatient and inpatient diagnosis. Associations with all-cause mortality, unplanned hospitalization and intensive care unit admission were assessed using Kaplan-Meier curves and Cox regression analyses. RESULTS: The multimorbidity frailty index incorporated 32 deficits, with mean multimorbidity frailty index score of 0.052 (standard deviation = 0.060) among 86,133 subjects included. Compared to subjects in fit category, subjects with severe frailty were associated with a 5.0-fold (adjusted hazard ratio, aHR 4.97; 95% confidence interval, 95% CI 4.49–5.50) increased risk of death at 1 year after adjusting for age and gender. Subjects with moderate frailty or mild frailty was associated with 3.1- (adjusted HR 3.08; 95% CI 2.80–3.39) or 1.9- (adjusted HR 1.86; 95% CI 1.71–2.01) folds increased risk, respectively.4.49–5.50). The risk trend of unplanned hospitalization and intensive care unit admission is similar among the study population. Besides, the association between the frailty categories and all three outcomes was slightly stronger among women. CONCLUSION: The multimorbidity frailty index was highly associated with all-cause mortality, unplanned hospitalization and ICU admission. It could serve as an efficient tool for stratifying older adults into different risk groups for planning care management programs. Public Library of Science 2017-11-16 /pmc/articles/PMC5690585/ /pubmed/29145407 http://dx.doi.org/10.1371/journal.pone.0187825 Text en © 2017 Wen et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Wen, Yao-Chun Chen, Liang-Kung Hsiao, Fei-Yuan Predicting mortality and hospitalization of older adults by the multimorbidity frailty index |
title | Predicting mortality and hospitalization of older adults by the multimorbidity frailty index |
title_full | Predicting mortality and hospitalization of older adults by the multimorbidity frailty index |
title_fullStr | Predicting mortality and hospitalization of older adults by the multimorbidity frailty index |
title_full_unstemmed | Predicting mortality and hospitalization of older adults by the multimorbidity frailty index |
title_short | Predicting mortality and hospitalization of older adults by the multimorbidity frailty index |
title_sort | predicting mortality and hospitalization of older adults by the multimorbidity frailty index |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690585/ https://www.ncbi.nlm.nih.gov/pubmed/29145407 http://dx.doi.org/10.1371/journal.pone.0187825 |
work_keys_str_mv | AT wenyaochun predictingmortalityandhospitalizationofolderadultsbythemultimorbidityfrailtyindex AT chenliangkung predictingmortalityandhospitalizationofolderadultsbythemultimorbidityfrailtyindex AT hsiaofeiyuan predictingmortalityandhospitalizationofolderadultsbythemultimorbidityfrailtyindex |