Frailty and recovery in the nursing home setting

The purpose of this project was to develop and test the interRAI-based Nursing Home (NH) Frailty Scale so as to enhance our understanding of this age-related concept. Study cohort consisted of US nursing home residents for year 2012 with a baseline sample of 1,097,189 assessments and a quarterly follow-up sample of 1,007,450. Using a secondary analysis approach, a subset of items in both the interRAI Long-term Care Facilities assessment system and Minimum Data Set (MDS) version 3.0 nursing home assessment system were examined. Logistic regression was used to evaluate items for inclusion and subsequent analyses validated the scale. The interRAI-based NH Frailty Scale was developed from an analysis of more than 100 items from the MDS, with death, hospitalization, and clinical judgment being close to death as dependent measures. The resulting 21-item frailty scale represents domains of function, cognition/communication, clinical symptoms, medical diagnoses, and treatments. Scale scores extended from zero to 14 with the average frailty score of 4.45. Incidence of death within the 120-day follow-up period increased steadily for those with a frailty score of 6 and above. When we saw an improvement on the NH Frailty Scale, we also found lower distress rates on each measure, serving to validate the scale. Because of the large number of frail elders within their facility, US nursing homes are best positioned to assume the leadership and implement routine frailty screening and assessment, based on the MDS, a tool currently in use in nursing homes.