title: Predicting 3-year survival in older people with intellectual disabilities using a Frailty Index.
abstract: OBJECTIVE
  To analyze the relationship between frailty and survival in older people with intellectual disabilities (IDs).
  
  
  METHODS
  Population-based longitudinal observational study.
  
  
  METHODS
  Three Dutch care provider services.
  
  
  METHODS
  Individuals with borderline to profound ID aged 50 and older (N=982).
  
  
  METHODS
  A frailty index (FI) including 51 health-related deficits was used to measure frailty. Mean follow-up was 3.3 years. The Cox proportional hazards model was used to evaluate the independent effect of frailty on survival. The discriminative ability of the FI was measured using a receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  Greater FI values were associated with greater risk of death, independent of sex, age, level of ID, and Down syndrome. There was a nonlinear increase in risk with increasing FI value. For example, mortality risk was 2.17 times as great (95% confidence interval (CI)=0.95-4.95) for vulnerable individuals (FI 0.20-0.29) and 19.5 (95% CI=9.13-41.8) times as great for moderately frail individuals (FI 0.40-0.49) as for relatively fit individuals (FI<0.20). The area under the ROC curve for 3-year survival was 0.78.
  
  
  CONCLUSIONS
  Although the predictive validity of the FI should be further determined, it was strongly associated with 3-year mortality. Care providers working with people with ID should be able to recognize frail clients and act in an early stage to stop or prevent further decline.
authors.affiliation: Intellectual Disability Medicine, Department of General Practice, Erasmus University Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Josje D
authors.initials: JD
authors.lastname: Schoufour
authors.forename: Arnold
authors.initials: A
authors.lastname: Mitnitski
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
authors.forename: Heleen M
authors.initials: HM
authors.lastname: Evenhuis
authors.forename: Michael A
authors.initials: MA
authors.lastname: Echteld
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D008607:Intellectual Disability / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors
keywords: frailty; older people with ID; survival