Background
Aims
Methods
Study design
Context and participants
Design and evaluation of the frail-VIG index
Variable selection and construct development
Predictive validity
Variables and data sources
Domain | Variable | Description | Points | ||
---|---|---|---|---|---|
Functional | IADLs | Money management |
Needs help managing financial matters (bank, shops, restaurants)
| Yes | 1 |
No | 0 | ||||
Telephone use |
Needs help using the telephone
| Yes | 1 | ||
No | 0 | ||||
Medication management |
Needs assistance in preparing or administering medications
| Yes | 1 | ||
No | 0 | ||||
ADLs | Barthel index (BI) |
No dependency (BI ≥ 95)
| 0 | ||
Mild-moderate dependency (BI 90–65)
| 1 | ||||
Moderate-severe dependency (BI 60–25)
| 2 | ||||
Absolute dependency (BI ≤ 20)
| 3 | ||||
Nutritional | Malnutrition |
Weight loss ≥ 5% in the last 6 months
| Yes | 1 | |
No | 0 | ||||
Cognitive | Degree of cognitive impairment |
No cognitive impairment
| 0 | ||
Mild-moderate cognitive impairment (equivalent to GDS ≤ 5)
| 1 | ||||
Severe-very severe cognitive impairment (equivalent to GDS ≥ 6)
| 2 | ||||
Emotional | Depressive syndrome |
Need for antidepressant medication
| Yes | 1 | |
No | 0 | ||||
Insomnia/anxiety |
Frequent need for benzodiazepines or other psychiatric drugs with a sedative effect for insomnia/anxiety
| Yes | 1 | ||
No | 0 | ||||
Social | Social vulnerability |
Do health care professionals perceive the presence of social vulnerability?
| Yes | 1 | |
No | 0 | ||||
Geriatric syndromes | Delirium |
Presence of delirium and/or behaviour disorder requiring antipsychotic drugs in the last
6 months.
| Yes | 1 | |
No | 0 | ||||
Falls |
In the last
6 months
, ≥2 falls or hospitalization due to a fall.
| Yes | 1 | ||
No | 0 | ||||
Ulcers |
Presence of ulcer (pressure or vascular, any grade)
| Yes | 1 | ||
No | 0 | ||||
Polypharmacy |
Taking ≥ 5 drugs
| Yes | 1 | ||
No | 0 | ||||
Dysphagia |
Difficulty swallowing when eating or drinking? Presence of aspiration respiratory infections during the last
6 months
?
| Yes | 1 | ||
No | 0 | ||||
Severe symptoms | Pain |
Need for ≥ 2 conventional analgesics and/or strong opioids for pain control
| Yes | 1 | |
No | 0 | ||||
Dyspnea |
Basal dyspnea impeding the ability to leave the house and/or opioids are frequently needed
| Yes | 1 | ||
No | 0 | ||||
Diseases (+) | Cancer |
Active cancer
| Yes | 1 | |
No | 0 | ||||
Respiratory |
Presence of any type of chronic respiratory disease (COPD, restrictive lung disease...)
| Yes | 1 | ||
No | 0 | ||||
Cardiac |
Presence of any type of chronic heart disease (heart failure, ischemic cardiomyopathy, arrhythmia)
| Yes | 1 | ||
No | 0 | ||||
Neurological |
Presence of any type of neurodegenerative disease (Parkinson, ALS,...) or a history of stroke (ischemic or hemorrhagic).
| Yes | 1 | ||
No | 0 | ||||
Digestive |
Presence of any type of chronic digestive disease (chronic liver disease, cirrhosis, chronic pancreatitis, inflammatory bowel disease,…)
| Yes | 1 | ||
No | 0 | ||||
Renal |
Presence of chronic renal failure (GFR < 60)
| Yes | 1 | ||
No | 0 | ||||
Frail-VIG index = |
Statistical methods
Results
Cohort description and analysis of the variables
Variable | Total (n = 590) | Death during the 24-month follow up | p-value | ||
---|---|---|---|---|---|
Yes (n = 338) | No (n = 252) | ||||
Mean age (years) | 86.39 (+/−5.58) | 86.55 (+/−5.76) | 86.17 (+/−5.34) | 0.420 | |
Sex | Men | 251 (42.5%) | 160 (63.7%) | 91 (36.3%) | 0.006 |
Women | 339 (57.5%) | 178 (52.5%) | 161 (47.5%) | ||
Advanced chronic disease | Yes | 260 (44.1%) | 220 (84.6%) | 40(15.4%)) | < 0.001 |
No | 330 (55.9%) | 118 (35.8%) | 212 (64.25%) | ||
Length of hospital stay | Mean days | 5.88 (+/−3.26) | 5.88(+/−3.36) | 5.33(+/−3.12) | 0.982 |
Destination after discharge | Home | 135 (22.9%) | 59 (43.7%) | 76 (56.3%) | < 0.001 |
Residence | 81 (13.7%) | 45 (55.6%) | 36 (44.4%) | ||
Intermediate care facility | 321 (54.4%) | 181 (56.4%) | 140 (43.6%) | ||
Death | 53 (9%) | ||||
IADLs | (0–1–2-3) | 0.85 (+/−1.15) | 0.53 | 1.27 | < 0.001 |
ADLs | Mean Barthel index | 62.81 (+/−29.71) | 57.26 | 70.24 | < 0.001 |
Malnurition | 190 (32.2%) | 175 (92.1%) | 15 (7.9%) | < 0.001 | |
Cognitive Impairment | None | 231 (39.2%) | 112 (48.5%) | 119 (51.5%) | < 0.001 |
Mild/Moderate | 257 (43.6%) | 154 (59.9%) | 103 (40.1%) | ||
Severe | 102 (17.3%) | 72 (70.6%) | 30 (29.4%) | ||
Emotional Status | Euthymic mood | 306 (51.9%) | 175 (57.2%) | 131 (42.8%) | 0.166 |
Depressive syndrome | 251 (42.5%) | 139 (55.4%) | 112 (44.6%) | ||
Not evaluable | 33 (5.6%) | 24 (72.7%) | 9 (27.3%) | ||
Insomnia | 337 (63.9%) | 214 (63.5%) | 123 (36.5%) | < 0.001 | |
Social Vulnerability | 19 (3.2%) | 14 (73.7%) | 5 (26.3%) | 0.142 | |
Geriatric Syndromes | Delirium | 334 (56.6%) | 220 (65.9%) | 114 (34.1%) | < 0.001 |
Falls | 348 (59%) | 197 (56.6%) | 151 (43.4%) | 0.689 | |
Ulcers | 76 (12.9%) | 64 (84.2%) | 12 (15.8%) | < 0.001 | |
Polypharmacy | 474 (80.3%) | 288 (60.8%) | 186 (39.2%) | 0.001 | |
Dysphagia | 255 (43.2%) | 205 (80.4%) | 50 (19.6%) | < 0.001 | |
Severe Symptoms | Pain | 146 (24.7%) | 103 (70.5%) | 43 (29.5%) | < 0.001 |
Dyspnea | 69 (11.7%) | 59 (85.5%) | 10 (14.5%) | < 0.001 | |
Chronic Diseases | Cancer | 87 (14.7%) | 73 (83.9%) | 14 (16.1%) | < 0.001 |
Respiratory | 164 (27.8%) | 107 (65.2%) | 57 (34.8%) | 0.015 | |
Cardiac | 352 (59.7%) | 233 (66.2%) | 119 (33.8%) | < 0.001 | |
Neurological | 155 (26.8%) | 93 (60.0%) | 62 (40.0%) | 0.427 | |
Digestive | 68 (11.5%) | 53 (77.9%) | 15 (22.1%) | < 0.001 | |
Renal | 291 (49.3%) | 208 (71.5%) | 83 (28.5%) | < 0.001 |
Variable selection and results of construct evaluation
Mortality at 24 months
Frail-VIG index category | 0.1 (0–0.15) | 0.2 (0.16–0.25) | 0.3 (0.26–0.35) | 0.4 (0.36–0.45) | 0.5 (0.46–0.55) | 0.6 (0.56–0.65) | 0.7 (0.66–1) | Total | |
---|---|---|---|---|---|---|---|---|---|
12 months Follow-up
| Alive | 22 | 72 | 54 | 113 | 50 | 5 | 0 | 316 |
Deceased | 0 | 1 | 7 | 48 | 73 | 115 | 30 | 274 | |
Deceased (%)
|
0
|
1.4
|
11.4
|
45.3
|
70.7
|
97.5
|
100
|
46.4
| |
24 months Follow-up
| Alive | 19 | 61 | 45 | 88 | 36 | 3 | 0 | 252 |
Deceased | 3 | 12 | 16 | 73 | 87 | 117 | 30 | 338 | |
Deceased (%)
|
13.6
|
16.4
|
26.2
|
45.3
|
70.7
|
97.5
|
100
|
57.3
| |
Total | 22 | 73 | 61 | 161 | 123 | 120 | 30 | 590 |