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Predicting mortality and hospitalization of older adults by the multimorbidity frailty index

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  • Yao-Chun Wen
  • Liang-Kung Chen
  • Fei-Yuan Hsiao

Abstract

Background: Existing operational definitions of frailty are personnel-costly and time-consuming, resulting in estimates with a small sample size that cannot be generalized to the population level. The objectives were to develop a multimorbidity frailty index using Taiwan’s claim database, and to understand its ability to predict adverse event. Methods: This is a retrospective cohort study. Subjects aged 65 to 100 years who have full National Health Insurance coverage in 2005 were included. We constructed the multimorbidity frailty index using cumulative deficit approach and categorized study population according to the multimorbidity frailty index quartiles: fit, mild frailty, moderate frailty and severe frailty. The multimorbidity frailty index included deficits from outpatient and inpatient diagnosis. Associations with all-cause mortality, unplanned hospitalization and intensive care unit admission were assessed using Kaplan-Meier curves and Cox regression analyses. Results: The multimorbidity frailty index incorporated 32 deficits, with mean multimorbidity frailty index score of 0.052 (standard deviation = 0.060) among 86,133 subjects included. Compared to subjects in fit category, subjects with severe frailty were associated with a 5.0-fold (adjusted hazard ratio, aHR 4.97; 95% confidence interval, 95% CI 4.49–5.50) increased risk of death at 1 year after adjusting for age and gender. Subjects with moderate frailty or mild frailty was associated with 3.1- (adjusted HR 3.08; 95% CI 2.80–3.39) or 1.9- (adjusted HR 1.86; 95% CI 1.71–2.01) folds increased risk, respectively.4.49–5.50). The risk trend of unplanned hospitalization and intensive care unit admission is similar among the study population. Besides, the association between the frailty categories and all three outcomes was slightly stronger among women. Conclusion: The multimorbidity frailty index was highly associated with all-cause mortality, unplanned hospitalization and ICU admission. It could serve as an efficient tool for stratifying older adults into different risk groups for planning care management programs.

Suggested Citation

  • Yao-Chun Wen & Liang-Kung Chen & Fei-Yuan Hsiao, 2017. "Predicting mortality and hospitalization of older adults by the multimorbidity frailty index," PLOS ONE, Public Library of Science, vol. 12(11), pages 1-10, November.
  • Handle: RePEc:plo:pone00:0187825
    DOI: 10.1371/journal.pone.0187825
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    References listed on IDEAS

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    1. Shu-Yu Lin & Wei-Ju Lee & Ming-Yueh Chou & Li-Ning Peng & Shu-Ti Chiou & Liang-Kung Chen, 2016. "Frailty Index Predicts All-Cause Mortality for Middle-Aged and Older Taiwanese: Implications for Active-Aging Programs," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-13, August.
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    Cited by:

    1. Mark O’Donovan & Duygu Sezgin & Zubair Kabir & Aaron Liew & Rónán O’Caoimh, 2020. "Assessing Global Frailty Scores: Development of a Global Burden of Disease-Frailty Index (GBD-FI)," IJERPH, MDPI, vol. 17(16), pages 1-17, August.
    2. Chih-Hsuan Su & Shih-Yi Lin & Chia-Lin Lee & Chu-Sheng Lin & Pi-Shan Hsu & Yu-Shan Lee, 2022. "Prediction of Mortality in Older Hospitalized Patients after Discharge as Determined by Comprehensive Geriatric Assessment," IJERPH, MDPI, vol. 19(13), pages 1-10, June.
    3. Ana María Porcel-Gálvez & Sergio Barrientos-Trigo & Eugenia Gil-García & Olivia Aguilera-Castillo & Antonio Juan Pérez-Fernández & Elena Fernández-García, 2020. "Factors Associated with In-Hospital Mortality in Acute Care Hospital Settings: A Prospective Observational Study," IJERPH, MDPI, vol. 17(21), pages 1-10, October.

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