title: Derivation of a frailty index from the interRAI acute care instrument.
abstract: BACKGROUND
  A better understanding of the health status of older inpatients could underpin the delivery of more individualised, appropriate health care.
  
  
  METHODS
  1418 patients aged ≥ 70 years admitted to 11 hospitals in Australia were evaluated at admission using the interRAI assessment system for Acute Care. This instrument surveys a large number of domains, including cognition, communication, mood and behaviour, activities of daily living, continence, nutrition, skin condition, falls, and medical diagnosis.
  
  
  RESULTS
  Variables across multiple domains were selected as health deficits. Dichotomous data were coded as symptom absent (0 deficit) or present (1 deficit). Ordinal scales were recoded as 0, 0.5 or 1 deficit based on face validity and the distribution of data. Individual deficit scores were summed and divided by the total number considered (56) to yield a Frailty index (FI-AC) with theoretical range 0-1. The index was normally distributed, with a mean score of 0.32 (±0.14), interquartile range 0.22 to 0.41. The 99% limit to deficit accumulation was 0.69, below the theoretical maximum of 1.0. In logistic regression analysis including age, gender and FI-AC as covariates, each 0.1 increase in the FI-AC increased the likelihood of inpatient mortality twofold (OR: 2.05 [95% CI 1.70-2.48]).
  
  
  CONCLUSIONS
  Quantification of frailty status at hospital admission can be incorporated into an existing assessment system, which serves other clinical and administrative purposes. This could optimise clinical utility and minimise costs. The variables used to derive the FI-AC are common to all interRAI instruments, and could be used to precisely measure frailty across the spectrum of health care.
authors.affiliation: Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, QLD, Australia. r.hubbard1@uq.edu.au.
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Hubbard
authors.affiliation: Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, QLD, Australia. n.peel@uq.edu.au.
authors.forename: Nancye M
authors.initials: NM
authors.lastname: Peel
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. mayukh.samanta@qimrberghofer.edu.au.
authors.forename: Mayukh
authors.initials: M
authors.lastname: Samanta
authors.affiliation: Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, QLD, Australia. len.gray@uq.edu.au.
authors.forename: Leonard C
authors.initials: LC
authors.lastname: Gray
authors.affiliation: Geriatrics Center, Department of Internal Medicine and School of Public Health, University of Michigan, Ann Arbor, MI, USA. bfries@med.umich.edu.
authors.forename: Brant E
authors.initials: BE
authors.lastname: Fries
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, NS, Canada. Arnold.Mitnitski@Dal.Ca.
authors.forename: Arnold
authors.initials: A
authors.lastname: Mitnitski
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, NS, Canada. Kenneth.Rockwood@Dal.Ca.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D003422:Critical Care / Q000379:methods / Q000523:psychology / Q000592:standards; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000592:standards* / Q000639:trends