Validation of a Claims-Based Frailty Index Against Physical Performance and Adverse Health Outcomes in the Health and Retirement Study.

TitleValidation of a Claims-Based Frailty Index Against Physical Performance and Adverse Health Outcomes in the Health and Retirement Study.
Publication TypeJournal Article
Year of Publication2019
AuthorsKim, DH, Glynn, RJ, Avorn, J, Lipsitz, LA, Rockwood, K, Pawar, A, Schneeweiss, S
JournalJournals of Gerontology, Series A: Biological Sciences and Medical Sciences
ISSN Number1758-535X
KeywordsFrailty, Medicare expenditures, Medicare linkage, Medicare/Medicaid/Health Insurance

Background: A claims-based frailty index (CFI) was developed based on a deficit-accumulation approach using self-reported health information. This study aimed to independently validate the CFI against physical performance and adverse health outcomes.

Methods: This retrospective cohort study included 3,642 community-dwelling older adults who had at least 1 health care encounter in the year prior to assessments of physical performance in the 2008 Health and Retirement Study wave. A CFI was estimated from Medicare claims data in the past year. Gait speed, grip strength, and the 2-year risk of death, institutionalization, disability, hospitalization, and prolonged (>30 days) skilled nursing facility stay were evaluated for CFI categories (robust: <0.15, pre-frail: 0.15-0.24, mildly frail: 0.25-0.34, moderate-to-severely frail: ≥0.35).

Results: The prevalence of robust, pre-frail, mildly frail, and moderate-to-severely frail state was 52.7%, 38.0%, 7.1%, and 2.2%, respectively. Individuals with higher CFI had lower mean gait speed (moderate-to-severely frail vs robust: 0.39 vs 0.78 m/sec) and weaker grip strength (19.8 vs 28.5 kg). Higher CFI was associated with death (moderate-to-severely frail vs robust: 46% vs 7%), institutionalization (21% vs 5%), activity-of-daily-living disability (33% vs 9%), instrumental-activity-of-daily-living disability (100% vs 22%), hospitalization (79% vs 23%), and prolonged skilled nursing facility stay (17% vs 2%). The odds ratios per 1-standard deviation (=0.07) difference in CFI were 1.46-2.06 for these outcomes, which remained statistically significant after adjustment for age, sex, and a comorbidity index.

Conclusion: The CFI is useful to identify individuals with poor physical function and at greater risks of adverse health outcomes in Medicare data.

User Guide Notes

Alternate JournalJ. Gerontol. A Biol. Sci. Med. Sci.
Citation Key9803
PubMed ID30165612
PubMed Central IDPMC6625579
Grant ListK08 AG051187 / AG / NIA NIH HHS / United States