Abstract
Objectives
Studies conducted among older people have shown that frailty is a common condition associated with an array of adverse outcomes. The aims of this study were to identify the prevalence and associations of frailty in older people residing in several aged care facilities located in Queensland, Australia.
Methods
The database used for this study was drawn from the Aged Care Funding Instrument (ACFI) database of an Australian aged care provider, and contained data from ten aged care facilities in Queensland, Australia. A modification of an eFI originally developed by Clegg and colleagues and based on Rockwood’s Frailty Index (FI) of cumulative deficits was used to identify frailty.
Results
In total, 592 participants aged 75 years and over were included in the study (66.6% female). Median (IQR) age was 88.0 (9.0) years. Frailty prevalence among the sample was 43.6%, with 46.3% pre-frail and 10.1% not frail. In a multivariate logistic regression analysis incorporating three different models, frailty was significantly associated with three ACFI domains (Nutrition, Depression and Complex Health Care), along with facility size, consistently across two models. In the third model, frailty was also significantly associated with arthritis, diabetes, hypertension, osteoporosis and vision problems, along with male gender.
Conclusion
There is a need to develop frailty identification and management programs as part of standard care pathways for older adults residing in aged care facilities. Aged care facilities should consider regular frailty screening in residential aged care residents, along with interventions addressing specific issues such as dysphagia and depression.
Similar content being viewed by others
References
Dent E, Lien C, Lim WS et al (2017) The Asia-Pacific clinical practice guidelines for the management of frailty. J Am Med Dir Assoc 18:564–575. https://doi.org/10.1016/j.jamda.2017.04.018
Ambagtsheer RC, Beilby JJ, Visvanathan R et al (2019) Should we screen for frailty in primary care settings? A fresh perspective on the frailty evidence base: a narrative review. Prev Med (Baltim) 119:63–69. https://doi.org/10.1016/j.ypmed.2018.12.020
Morley JE, Vellas B, Abellan van Kan G et al (2013) Frailty consensus: a call to action. J Am Med Dir Assoc 14:392–397. https://doi.org/10.1016/j.jamda.2013.03.022
Walston J, Hadley EC, Ferrucci L et al (2006) Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: Summary from the American Geriatrics Society/National Institute on Aging research conference on frailty in older adults. J Am Geriatr Soc 54:991–1001. https://doi.org/10.1111/j.1532-5415.2006.00745.x
Vermeiren S, Vella-Azzopardi R, Beckwée D et al (2016) Frailty and the prediction of negative health outcomes: a meta-analysis. J Am Med Dir Assoc 17:1163.e1–1163.e17. https://doi.org/10.1016/j.jamda.2016.09.010
Tse MMY, Lai C, Lui JYW et al (2016) Frailty, pain and psychological variables among older adults living in Hong Kong nursing homes: can we do better to address multimorbidities? J Psychiatr Ment Health Nurs 23:303–311. https://doi.org/10.1111/jpm.12303
Wyrko Z (2015) Frailty at the front door. Clin Med 15:377–381
Kojima G (2015) Prevalence of frailty in nursing homes: a systematic review and meta-analysis. J Am Med Dir Assoc 16:940–945. https://doi.org/10.1016/j.jamda.2015.06.025
Clegg A, Bates C, Young J et al (2016) Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing 45:353–360. https://doi.org/10.1093/ageing/afw039
Mitnitski A, Mogilner A, Rockwood K (2001) Accumulation of deficits as a proxy measure of aging. Sci World J 1:323–336
Ambagtsheer RC, Beilby J, Dabravolskaj J et al (2018) Application of an electronic Frailty Index in Australian primary care: data quality and feasibility assessment. Aging Clin Exp Res. https://doi.org/10.1007/s40520-018-1023-9
Hoover M, Rotermann M, Sanmartin C et al (2013) Validation of an index to estimate the prevalence of frailty among community-dwelling seniors. Heal Reports 24:10–17
Cesari M, Prince M, Thiyagarajan JA et al (2016) Frailty: an emerging public health priority. J Am Med Dir Assoc 17:188–192. https://doi.org/10.1016/j.jamda.2015.12.016
Hopman P, de Bruin SR, Forjaz MJ et al (2016) Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: a systematic literature review. Health Policy (New York) 120:818–832. https://doi.org/10.1016/j.healthpol.2016.04.002
Ilinca S, Calciolari S (2015) The patterns of health care utilization by elderly Europeans: frailty and its implications for health systems. Health Serv Res 50:305–320. https://doi.org/10.1111/1475-6773.12211
Cameron ID, Fairhall N, Gill L et al (2015) Developing interventions for frailty. Adv Geriatr. https://doi.org/10.1155/2015/845356
Partridge JSL, Harari D, Dhesi JK (2012) Frailty in the older surgical patient: a review. Age Ageing 41:142–147. https://doi.org/10.1093/ageing/afr182
Department of Health (2016) Aged Care Funding Instrument (ACFI) User Guide. Commonwealth of Australia 2016. https://agedcare.health.gov.au/sites/default/files/documents/02_2018/final_acfi_user_guide_2017.pdf. Accessed 21 Aug 2019
Ekberg O, Hamdy S, Woisard V et al (2002) Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 17:139–146. https://doi.org/10.1007/s00455-001-0113-5
Clavé P, Shaker R (2015) Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol 12:259–270. https://doi.org/10.1038/nrgastro.2015.49
Serra-Prat M, Palomera M, Gomez C et al (2012) Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study. Age Ageing 41:376–381. https://doi.org/10.1093/ageing/afs006
Azzolino D, Damanti S, Bertagnoli L et al (2019) Sarcopenia and swallowing disorders in older people. Aging Clin Exp Res 31:799–805. https://doi.org/10.1007/s40520-019-01128-3
Hathaway B, Vaezi A, Egloff AM et al (2014) Frailty measurements and dysphagia in the outpatient setting. Ann Otol Rhinol Laryngol 123:629–635. https://doi.org/10.1177/0003489414528669
Hägglund P, Fält A, Hägg M et al (2019) Swallowing dysfunction as risk factor for undernutrition in older people admitted to Swedish short-term care: a cross-sectional study. Aging Clin Exp Res 31:85–94. https://doi.org/10.1007/s40520-018-0944-7
Takeuchi K, Aida J, Ito M et al (2014) Nutritional status and dysphagia risk among community-dwelling frail older adults. J Nutr Health Aging 18:1–6
Buigues C, Padilla-Sánchez C, Garrido JF et al (2015) The relationship between depression and frailty syndrome: a systematic review. Aging Ment Health 19:762–772. https://doi.org/10.1080/13607863.2014.967174
Syed Elias SM, Neville C, Scott T (2015) The effectiveness of group reminiscence therapy for loneliness, anxiety and depression in older adults in long-term care: a systematic review. Geriatr Nurs (Minneap) 36:372–380. https://doi.org/10.1016/j.gerinurse.2015.05.004
Park SH, Han KS, Kang CB (2014) Effects of exercise programs on depressive symptoms, quality of life, and self-esteem in older people: a systematic review of randomized controlled trials. Appl Nurs Res 27:219–226. https://doi.org/10.1016/j.apnr.2014.01.004
Osgood NJ (1992) Environmental factors in suicide in long-term care facilities. Suicide Life Threat Behav 22:98–106. https://doi.org/10.1111/j.1943-278X.1992.tb00478.x
Mezuk B, Rock A, Lohman MC et al (2014) Suicide risk in long-term care facilities: a systematic review. Int J Geriatr Psychiatry 29:1198–1211. https://doi.org/10.1002/gps.4142
Segal JB, Chang H, Du Y et al (2017) Development of a claims-based frailty indicator anchored to a well-established frailty phenotype. Med Care 55:716–722
Hogan DB, Freiheit EA, Strain LA et al (2012) Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living. BMC Geriatr 12:56
Funding
Lutheran Services Queensland provided the main source of support for this work. ED received support from an Australian National Health and Medical Research Council (NHMRC) Grant: #1112672. RA is also supported by the NHMRC Centre of Research Excellence in Transdisciplinary Frailty Research to Achieve Healthy Ageing (Grant:#1102208).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
CS and ED are employees of Lutheran Services Queensland.
Statement of human and animal rights
Ethics approval for this study was sought from the Human Research Ethics Committee of Torrens University Australia (application H11/19) and declared exempt under National Statement, 5.1.22 (secondary use of de-identified administrative data). The study adhered to the Australian National Statement on Ethical Conduct in Human Research.
Informed consent
Due to the pragmatic nature of the study and administrative data source, a waiver of obtaining consent was approved by the Human Research Ethics Committee of Torrens University Australia.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Ambagtsheer, R.C., Beilby, J., Seiboth, C. et al. Prevalence and associations of frailty in residents of Australian aged care facilities: findings from a retrospective cohort study. Aging Clin Exp Res 32, 1849–1856 (2020). https://doi.org/10.1007/s40520-019-01379-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40520-019-01379-0