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Letters to the Editor
of the KCL can be widely used for elderly care in other countries as well as Japan. We thank Akemi Hamaya and Toshiko Yamashita for back-translation, and Kasia Malinowska, Kyoto University, for checking the final English version of the KCL.
Disclosure statement
2
3
The authors declare no conflict of interest.
1
Hidenori Arai1 and Shosuke Satake2 Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, and 2National Center for Geriatrics and Gerontology, Obu, Japan
References 1 Nemoto M, Yabushita N, Kim M, Matsuo T, Seino S, Tanaka K. Assessment of vulnerable older adult’s physical
4
5 6
function according to the Japanese Long-Term Care Insurance (LTCI) system and Fried’s criteria for frailty syndrome. Arch Gerontol Geriatr 2012; 55: 385–391. Tomata Y, Hozawa A, Ohmori-Matsuda K et al. Validation of the Kihon Checklist for predicting the risk of 1-year incident long-term care insurance certification: the Ohsaki Cohort 2006 Study. Nippon Koshu Eisei Zasshi 2011; 58: 3–13. Fukutomi E, Okumiya K, Wada T et al. Importance of cognitive assessments as part of the “Kihon Checklist” developed by the Japanese Ministry of Health, Labour and Welfare for prediction of frailty at a 2-year follow up. Geriatr Gerontol Int 2013; 13: 654–662. Sewo Sampaio PY, Sampaio RA, Yamada M, Ogita M, Arai H. Validation and translation of the Kihon Checklist (frailty index) into Brazilian Portuguese. Geriatr Gerontol Int 2014; 14: 561–569. Umegaki H, Suzuki Y, Yanagawa M, Nonogaki Z, Nakashima H, Endo H. Dysphagia in older adults at high risk of requiring care. Geriatr Gerontol Int 2012; 12: 359–361. Koizumi Y, Hamazaki Y, Okuro M et al. Association between hypertension status and the screening test for frailty in elderly community-dwelling Japanese. Hypertens Res 2013; 36: 639–644.
Operationalization of a frailty index using routine data from the Toulouse Frailty Clinic
Dear Editor, Frailty in older adults is defined as a geriatric syndrome characterized by the loss of reserve capacity in multiple physiological systems, associated with increased vulnerability to adverse outcomes.1,2 A widely accepted instrument to measure frailty is Rockwood’s frailty index (FI), which counts deficits in health (e.g. diseases, disabilities).3,4 Very few studies have used clinical data from routine care to operationalize a FI.5 Therefore, in the current study, routine data from a geriatric day-hospital unit in France were used to create a FI. We studied the distribution of this FI, and we investigated age-related patterns in the FI score. Cross-sectional data were used from frail older patients admitted to the Toulouse Frailty Clinic in France, a geriatric day hospital unit of the Toulouse University Hospital. Community dwelling frail older persons (identified by their general practitioner as frail using the Gerontopole Frailty Screening Tool) are referred to this day hospital for undergoing a comprehensive geriatric assessment.6 Details of the assessment have been described elsewhere.7 Of 488 patients admitted between 1 January and 1 November in 2013, 484 were included. A 35-item FI was constructed, with items on chronic diseases, basic and instrumental disabilities, © 2015 Japan Geriatrics Society
serum vitamin D, cognition, physical performance, obesity, visual and hearing impairment, and malnutrition.8 The FI score indicates the proportion of deficits present (range 0–1). The FI score was calculated for all 484 patients with the recommended minimum of 30 items (just 7.8% had between 1 to 5 missing items). Descriptive statistics were used to study the distribution of the FI. Linear regression analyses were carried out to test linear and non-linear associations between age and the FI score (SPSS 20; IBM, Armonk, NY, USA). The mean age of the 484 included patients was 83.2 years (SD 6.0; range 65–103 years), and there were 305 women (63.0%). The mean FI score was 0.32 (SD 0.14; men 0.33, SD 0.14; women 0.31, SD 0.13). The distribution of the FI ranged from 0.09 to 0.83 with a 99% upper limit of 0.67 (Fig. 1a). The FI score was significantly associated with age (increase in mean FI score of 0.009 per year, 95% CI 0.007–0.011; P < 0.001). The association seemed stronger at more advanced ages (Fig. 1b; quadratic term for age P < 0.01). The distribution of the FI created with routine data from a geriatric day hospital was quite similar compared with previous work using research data.3,8 Within a population of moderate to severe frail older patients, the constructed FI was able to produce a heterogeneous range of results, which implies a more subtle doi: 10.1111/ggi.12403
| 519
EO Hoogendijk et al.
30
tionnaires. No additional (time-consuming) clinical measurements are required, and more patients can be reached, because there is a lower risk of non-response. The increasing use of electronic medical records across all healthcare settings offers great potential for automatically creating FI with clinical importance, and could provide opportunities to follow the frailty status of patients over time.10
20
Disclosure statement
60
50
Frequency
40
The authors declare no conflict of interest. 10
0 0.00
0.20
0.40 0.60 Frailty Index score
0.80
1.00
Observed Linear Quadratic
1.00
Frailty Index score
0.80
References
0.60
0.40
0.20
0.00 60.00
70.00
80.00
90.00
100.00
110.00
Age
Figure 1 (a) Distribution and normal curve of the frailty index. (b) Scatter plot of the frailty index by age, including linear and quadratic regression lines (n = 484).
differentiation of frailty stages. Although the mean FI score was a bit higher than in general older populations (consistently with the characteristics of our study sample), the 99% upper limit was still between 0.6 and 0.7, as in previous studies.8,9 We found an age-related (potentially non-linear) pattern in the accumulation of deficits.8 Creating a FI with routine data has several advantages compared with existing frailty instruments and ques-
520 |
Emiel O Hoogendijk,1 Gabor Abellan van Kan,2 Sophie Guyonnet,2,3 Bruno Vellas2,3 and Matteo Cesari2,3 1 Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; 2Gérontopôle, Toulouse University Hospital, and 3INSERM UMR 1027, Paul Sabatier University Toulouse III, Toulouse, France
1 Morley JE, Vellas B, Abellan van Kan G et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14: 392–397. 2 Clegg A, Young J, Iliffe S, Rockwood K. Frailty in elderly people. Lancet 2013; 381: 752–762. 3 Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62: 722–727. 4 Cesari M, Gambassi G, Abellan van Kan G, Vellas B. The frailty phenotype and the frailty index: different instruments for different purposes. Age Ageing 2014; 43: 10–12. 5 Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 2004; 52: 1929–1933. 6 Vellas B, Balardy L, Gillette-Guyonnet S et al. Looking for frailty in community-dwelling older persons: the Gérontopôle Frailty Screening Tool (GFST). J Nutr Health Aging 2013; 17: 629–631. 7 Subra J, Gillette-Guyonnet S, Cesari M, Oustric S, Vellas B. The Platform Team. The integration of frailty into clinical practice: preliminary results from the Gérontopôle. J Nutr Health Aging 2012; 16: 714–720. 8 Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr 2008; 8: 24. 9 Rockwood K, Mitnitski A. Limits to deficit accumulation in elderly people. Mech Ageing Dev 2006; 127: 494–496. 10 Drubbel I, de Wit NJ, Bleijenberg N, Eijkemans RJC, Schuurmans MJ, Numans ME. Prediction of adverse health outcomes in older people using a frailty index based on routine primary care data. J Gerontol A Biol Sci Med Sci 2013; 68: 301–308.
© 2015 Japan Geriatrics Society
Copyright of Geriatrics & Gerontology International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letters to the Editor
of the KCL can be widely used for elderly care in other countries as well as Japan. We thank Akemi Hamaya and Toshiko Yamashita for back-translation, and Kasia Malinowska, Kyoto University, for checking the final English version of the KCL.
Disclosure statement
2
3
The authors declare no conflict of interest.
1
Hidenori Arai1 and Shosuke Satake2 Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, and 2National Center for Geriatrics and Gerontology, Obu, Japan
References 1 Nemoto M, Yabushita N, Kim M, Matsuo T, Seino S, Tanaka K. Assessment of vulnerable older adult’s physical
4
5 6
function according to the Japanese Long-Term Care Insurance (LTCI) system and Fried’s criteria for frailty syndrome. Arch Gerontol Geriatr 2012; 55: 385–391. Tomata Y, Hozawa A, Ohmori-Matsuda K et al. Validation of the Kihon Checklist for predicting the risk of 1-year incident long-term care insurance certification: the Ohsaki Cohort 2006 Study. Nippon Koshu Eisei Zasshi 2011; 58: 3–13. Fukutomi E, Okumiya K, Wada T et al. Importance of cognitive assessments as part of the “Kihon Checklist” developed by the Japanese Ministry of Health, Labour and Welfare for prediction of frailty at a 2-year follow up. Geriatr Gerontol Int 2013; 13: 654–662. Sewo Sampaio PY, Sampaio RA, Yamada M, Ogita M, Arai H. Validation and translation of the Kihon Checklist (frailty index) into Brazilian Portuguese. Geriatr Gerontol Int 2014; 14: 561–569. Umegaki H, Suzuki Y, Yanagawa M, Nonogaki Z, Nakashima H, Endo H. Dysphagia in older adults at high risk of requiring care. Geriatr Gerontol Int 2012; 12: 359–361. Koizumi Y, Hamazaki Y, Okuro M et al. Association between hypertension status and the screening test for frailty in elderly community-dwelling Japanese. Hypertens Res 2013; 36: 639–644.
Operationalization of a frailty index using routine data from the Toulouse Frailty Clinic
Dear Editor, Frailty in older adults is defined as a geriatric syndrome characterized by the loss of reserve capacity in multiple physiological systems, associated with increased vulnerability to adverse outcomes.1,2 A widely accepted instrument to measure frailty is Rockwood’s frailty index (FI), which counts deficits in health (e.g. diseases, disabilities).3,4 Very few studies have used clinical data from routine care to operationalize a FI.5 Therefore, in the current study, routine data from a geriatric day-hospital unit in France were used to create a FI. We studied the distribution of this FI, and we investigated age-related patterns in the FI score. Cross-sectional data were used from frail older patients admitted to the Toulouse Frailty Clinic in France, a geriatric day hospital unit of the Toulouse University Hospital. Community dwelling frail older persons (identified by their general practitioner as frail using the Gerontopole Frailty Screening Tool) are referred to this day hospital for undergoing a comprehensive geriatric assessment.6 Details of the assessment have been described elsewhere.7 Of 488 patients admitted between 1 January and 1 November in 2013, 484 were included. A 35-item FI was constructed, with items on chronic diseases, basic and instrumental disabilities, © 2015 Japan Geriatrics Society
serum vitamin D, cognition, physical performance, obesity, visual and hearing impairment, and malnutrition.8 The FI score indicates the proportion of deficits present (range 0–1). The FI score was calculated for all 484 patients with the recommended minimum of 30 items (just 7.8% had between 1 to 5 missing items). Descriptive statistics were used to study the distribution of the FI. Linear regression analyses were carried out to test linear and non-linear associations between age and the FI score (SPSS 20; IBM, Armonk, NY, USA). The mean age of the 484 included patients was 83.2 years (SD 6.0; range 65–103 years), and there were 305 women (63.0%). The mean FI score was 0.32 (SD 0.14; men 0.33, SD 0.14; women 0.31, SD 0.13). The distribution of the FI ranged from 0.09 to 0.83 with a 99% upper limit of 0.67 (Fig. 1a). The FI score was significantly associated with age (increase in mean FI score of 0.009 per year, 95% CI 0.007–0.011; P < 0.001). The association seemed stronger at more advanced ages (Fig. 1b; quadratic term for age P < 0.01). The distribution of the FI created with routine data from a geriatric day hospital was quite similar compared with previous work using research data.3,8 Within a population of moderate to severe frail older patients, the constructed FI was able to produce a heterogeneous range of results, which implies a more subtle doi: 10.1111/ggi.12403
| 519
EO Hoogendijk et al.
30
tionnaires. No additional (time-consuming) clinical measurements are required, and more patients can be reached, because there is a lower risk of non-response. The increasing use of electronic medical records across all healthcare settings offers great potential for automatically creating FI with clinical importance, and could provide opportunities to follow the frailty status of patients over time.10
20
Disclosure statement
60
50
Frequency
40
The authors declare no conflict of interest. 10
0 0.00
0.20
0.40 0.60 Frailty Index score
0.80
1.00
Observed Linear Quadratic
1.00
Frailty Index score
0.80
References
0.60
0.40
0.20
0.00 60.00
70.00
80.00
90.00
100.00
110.00
Age
Figure 1 (a) Distribution and normal curve of the frailty index. (b) Scatter plot of the frailty index by age, including linear and quadratic regression lines (n = 484).
differentiation of frailty stages. Although the mean FI score was a bit higher than in general older populations (consistently with the characteristics of our study sample), the 99% upper limit was still between 0.6 and 0.7, as in previous studies.8,9 We found an age-related (potentially non-linear) pattern in the accumulation of deficits.8 Creating a FI with routine data has several advantages compared with existing frailty instruments and ques-
520 |
Emiel O Hoogendijk,1 Gabor Abellan van Kan,2 Sophie Guyonnet,2,3 Bruno Vellas2,3 and Matteo Cesari2,3 1 Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; 2Gérontopôle, Toulouse University Hospital, and 3INSERM UMR 1027, Paul Sabatier University Toulouse III, Toulouse, France
1 Morley JE, Vellas B, Abellan van Kan G et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14: 392–397. 2 Clegg A, Young J, Iliffe S, Rockwood K. Frailty in elderly people. Lancet 2013; 381: 752–762. 3 Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62: 722–727. 4 Cesari M, Gambassi G, Abellan van Kan G, Vellas B. The frailty phenotype and the frailty index: different instruments for different purposes. Age Ageing 2014; 43: 10–12. 5 Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 2004; 52: 1929–1933. 6 Vellas B, Balardy L, Gillette-Guyonnet S et al. Looking for frailty in community-dwelling older persons: the Gérontopôle Frailty Screening Tool (GFST). J Nutr Health Aging 2013; 17: 629–631. 7 Subra J, Gillette-Guyonnet S, Cesari M, Oustric S, Vellas B. The Platform Team. The integration of frailty into clinical practice: preliminary results from the Gérontopôle. J Nutr Health Aging 2012; 16: 714–720. 8 Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr 2008; 8: 24. 9 Rockwood K, Mitnitski A. Limits to deficit accumulation in elderly people. Mech Ageing Dev 2006; 127: 494–496. 10 Drubbel I, de Wit NJ, Bleijenberg N, Eijkemans RJC, Schuurmans MJ, Numans ME. Prediction of adverse health outcomes in older people using a frailty index based on routine primary care data. J Gerontol A Biol Sci Med Sci 2013; 68: 301–308.
© 2015 Japan Geriatrics Society
Copyright of Geriatrics & Gerontology International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
