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Ability of 3 Frailty Measures to Predict Short-Term Outcomes in Older Patients Admitted for Post-Acute Inpatient Rehabilitation

医学 虚弱指数 接收机工作特性 置信区间 逻辑回归 康复 优势比 急症护理 多元分析 多元统计 物理疗法 预测效度 队列 内科学 医疗保健 机器学习 计算机科学 经济 经济增长 临床心理学
作者
Anna K. Stuck,Joel M. Mangold,R. Wittwer,Andreas Limacher,Heike A. Bischoff‐Ferrari
出处
期刊:Journal of the American Medical Directors Association [Elsevier BV]
卷期号:23 (5): 880-884 被引量:8
标识
DOI:10.1016/j.jamda.2021.09.029
摘要

Abstract

Objectives

To evaluate the ability of 3 commonly used frailty measures to predict short-term clinical outcomes in older patients admitted for post-acute inpatient rehabilitation.

Design

Observational cohort study.

Setting and Participants

Consecutive patients (n = 207) admitted to a geriatric inpatient rehabilitation facility.

Methods

Frailty on admission was assessed using a frailty index, the physical frailty phenotype, and the Clinical Frailty Scale (CFS). Predictive capacity of the frailty instruments was analyzed for (1) nonhome discharge, (2) readmission to acute care, (3) functional decline, and (4) prolonged length of stay, using multivariate logistic regression models and receiver operating characteristic (ROC) curves.

Results

The number of patients classified as frail was 91 (44.0%) with the frailty index, 134 (64.7%) using the frailty phenotype, and 151 (73.0%) with the CFS. The 3 frailty measures revealed acceptable discriminatory accuracy for nonhome discharge (area under the curve ≥ 0.7) but differed in their predictive ability: the adjusted odds ratio (OR) for nonhome discharge was highest for the CFS [6.2, 95% confidence interval (CI) 1.8-21.1], compared to the frailty index (4.1, 95% CI 2.0-8.4) and the frailty phenotype (OR 2.9, 95% CI 1.2-6.6). For the other outcomes, discriminatory accuracy based on ROC tended to be lower and predictive ability varied according to frailty measure. Readmission to acute care from inpatient rehabilitation was predicted by all instruments, most pronounced by the frailty phenotype (OR 5.4, 95% CI 1.6-18.8) and the frailty index (OR 2.5, 95% CI 1.1-5.6), and less so by the CFS (OR 1.4, 95% CI 0.5-3.8).

Conclusions and Implications

Frailty measures may contribute to improved prediction of outcomes in geriatric inpatient rehabilitation. The choice of the instrument may depend on the individual outcome of interest and the corresponding discriminatory ability of the frailty measure.
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