Once frail, always frail? Frailty transitions in home care users with intellectual and developmental disabilities

TitleOnce frail, always frail? Frailty transitions in home care users with intellectual and developmental disabilities
Publication TypeJournal Article
Year of Publication2018
AuthorsMartin L., McKenzie K., Ouellette-Kuntz H.
JournalGeriatrics & Gerontology International
Volume18
Issue4
Pagination547-553
Date PublishedApr
ISBN Number1444-1586
Accession NumberWOS:000429542800004
Keywordsdevelopmental disability, elderly-people, Frailty, health, home care, Intellectual disability, mds, older-adults
Abstract

AimFrailty is understood as a dynamic non-linear process, and used to indicate age-related decline. Recent work has shown that adults with intellectual and developmental disabilities experience higher rates of frailty at much earlier ages than the general population. The present study describes transitions in frailty status (i.e. non-frail, pre-frail, frail) over 1 year, and explores the association between baseline frailty status and worsening/death over time.MethodsResults are based on secondary analysis of 2893 individuals with intellectual and developmental disabilities receiving community-based home care services in Ontario (Canada). Frailty status is based on a validated 42-item frailty index (FI); where FI 0.21 indicates non-frail, 0.21 < FI 0.3 indicates pre-frail and FI >0.30 indicates frail. Baseline characteristics of frailty groups at baseline were compared using the (2)-test/analysis of variance. Relative risk of worsening/dying was calculated using a modified Poisson regression model.ResultsInitially, 67.0% of participants were non-frail, 16.2% were pre-frail and 16.8% were frail. Of those non-frail at baseline, 84.3% remained non-frail, 11.8% worsened and 3.9% died. Among those initially pre-frail, 37.0% remained stable, 35.3% improved, 18.2% worsened and 9.6% died. Although similar proportions of frail individuals improved (37.4%) or remained stable (36.8%), 25.9% had died. After controlling for other factors, being pre-frail at baseline was associated with an increase in the risk of worsening or death (RR 1.24, 95% CI 1.04-1.49).ConclusionsWhile many experience worsening of frailty status, stability and improvement are viable goals of care. Future research should examine the rate at which non-frail, pre-frail and frail individuals accumulate deficits, as well as the impact of home care services on frailty. Geriatr Gerontol Int 2018; 18: 547-553.

DOI10.1111/ggi.13214
Short TitleGeriatrics & gerontology internationalGeriatr Gerontol Int
Alternate JournalGeriatr Gerontol Int