title: Using an accumulation of deficits approach to measure frailty in a population of home care users with intellectual and developmental disabilities: an analytical descriptive study.
abstract: BACKGROUND
  The aging population of adults with intellectual and developmental disabilities (IDD) is growing. In the general aging population, frailty is commonly used to predict adverse health outcomes, including hospital use, death, and admission to long-term care. However, existing frailty measures are less appropriate for aging persons with IDD, given their pre-existing conditions and limitations. An accumulation of deficits approach, which is now widely used to describe frailty in the general population, may be more suitable for persons with IDD. Frailty measures specific to persons with IDD have not been widely studied.
  
  
  METHODS
  Using pre-determined criteria, a frailty index (FI) specific to persons with IDD was developed based on items in the Resident Assessment Instrument - Home Care (RAI-HC), and using the assessments of 7,863 individuals with IDD in Ontario (aged 18-99 years) admitted to home care between April 1(st), 2006 and March 31(st), 2014. FI scores were derived by dividing deficits present by deficits measured, and categorized into meaningful strata using stratum-specific likelihood ratios. A multinomial logistic regression model identified associations between frailty and individual characteristics.
  
  
  RESULTS
  The resulting FI is comprised of 42 deficits across five domains (physiological, psychological, cognitive, social and service use). The mean FI score was 0.22 (SD = 0.13), equivalent to 9 deficits. Over half of the cohort was non-frail (FI score < 0.21), while the remaining were either pre-frail (21 %, FI score between 0.21 and 0.30) or frail (27 %, FI score > 0.30). Controlling for individual characteristics, women were more likely to be frail compared to men (OR = 1.39, 95 % CI: 1.23-1.56). Individuals who were frail were significantly more likely to have a caregiver who was unable to continuing caring (OR = 1.86, 95 % CI: 1.55-2.22) or feeling distressed (OR = 1.54, 95 % CI: 1.30-1.83). Living with a family members was significantly protective of frailty (OR = 0.35, 95 % CI: 0.29-0.41), compared to living alone.
  
  
  CONCLUSIONS
  Using the FI to identify frailty in adults with IDD is feasible and can be incorporated into existing home care assessments. This could offer case managers assistance in identifying at-risk individuals. Future analyses should evaluate this measure's ability to predict future adverse outcomes.
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada, K7L 3N6. k.mckenzie@queensu.ca.
authors.forename: Katherine
authors.initials: K
authors.lastname: McKenzie
authors.affiliation: Department of Public Health Sciences, Queen's University & Ongwanada, 191 Portsmouth Avenue, Kingston, Ontario, Canada, K7M 8A6. helene.kuntz@queensu.ca.
authors.forename: Hélène
authors.initials: H
authors.lastname: Ouellette-Kuntz
authors.affiliation: Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario, P7B 5E1, Canada. lynn.martin@lakeheadu.ca.
authors.forename: Lynn
authors.initials: L
authors.lastname: Martin
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology*; D002658:Developmental Disabilities / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D005260:Female; D016330:Frail Elderly / Q000523:psychology / Q000706:statistics & numerical data; D015577:Geriatric Assessment; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D008134:Long-Term Care / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D018570:Risk Assessment; D012737:Sex Factors; D012944:Social Support