Frailty as predictor of death among Nursing Home residents

Introduction: Frailty is a geriatric syndrome known to be associated to several adverse outcomes in Nursing Homes (NHs) residents. Aim of the study is to evaluate the impact of frailty as predictor of death in 1-year follow-up among NHs residents. Method(s): Longitudinal multicenter cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study including 4023 participants from 50 NHs in Europe and 7 in Israel. Participants were assessed through the interRAI long-term care facility instrument, which allows comprehensive, standardized evaluation of persons living in NH. Frailty was defined according to the FRAIL-NH scale. Polypharmacy and hyperpolypharmacy were defined as the concurrent use of >= 5 and >= 10 different medications. Cognitive function was assessed through the Cognitive Performance Scale (CPS). Factors associated with death during 1-year follow-up were evaluated through Cox's proportional hazard model (adjusted for demographics and facilities) before and after stratification with frailty status. Result(s): A total of 1187 (29.5%) NHs residents died during 1-year follow-up. Death was associated with age (aHR 1.04, 95% CI 1.02-1.05), female sex (aHR 0.65, 95% CI 0.56-0.7), frailty (aHR 1.54, 95% CI 1.23-1.94), but not with multimorbidity, polypharmacy/ hyperpolyharmacy and cognitive status. After stratification for frailty, only non-frail patients on hyperpolypharmacy regimen showed an increased risk of death (aHR 1.29, 95% CI 1.01-1.84). Key conclusions: In the present study, frailty is the single most important factor associated to death during 1-year follow-up among NHs residents, and could be an effect-modifiers on other factors associated with death among NHs residents.

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