Acute-Care Frailty Ladder

This study addresses a current gap in the implementation of frailty measures in an acute care setting, which is the need to implement a measure that can serve as an evaluative measure with robust psychometric properties yielding a legitimate total score.

Possible Research Results

Anticipated findingsAn Acute-Care Frailty Ladder for use in an acute care setting will be developed and tested.

Impact of findingsPatient, family members and clinicians can use this ladder to situate a person on this continuum in order to see what the next step is on the ladder to improve the situation or to avoid deterioration. It can be used as an evaluative instrument as it has a legitimate total score permitting change to be quantified. Patients and family members will be able to use the ladder to set goals to improvement.

About the Project

Hospital care for an elderly person, either as an out- or in-patient, indicates a complex health condition that may put the senior at risk for developing or aggravating frailty and subsequently progressing to potentially irreversible functional impairments, limitations and restrictions.

Hospital care is also an opportunity to identify frailty and to provide interventions and services to reverse or delay progression. However, none of the many frailty indices or “measures” currently available is ideal for deployment in the busy hospital setting and none would meet modern robust psychometric standards for creating legitimate total scores.

For more details on the project rationale, hypothesis, objectives and research plan, click here.

Project Team

Principal Investigators:

Nancy Mayo, BSc, MSc, PhD — The Research Institute of the McGill University Health Centre

José Morais, MD — The Research Institute of the McGill University Health Centre

Knowledge Users and Partners:

Helen McCall Hutchinson Fund

Project Contact: Nancy Mayo — nancy.mayo@mcgill.ca

FRA 2015-B-16

Key words: frailty; outcomes; function; disability; physical function; Rasch analysis; measurement 

Rationale

This study addresses a current gap in the implementation of frailty measures in an acute care setting, which is the need to implement a measure that can serve as an evaluative measure with robust psychometric properties yielding a legitimate total score.

Principal Investigators

Nancy Mayo, BSc, MSc, PhD — The Research Institute of the McGill University Health Centre

José Morais, MD — The Research Institute of the McGill University Health Centre

Rationale: Hospital care is also an opportunity to identify frailty and to provide interventions and services to reverse or delay progression. However, none of the many frailty indices or “measures” currently available is ideal for deployment in the busy hospital setting and none would meet modern robust psychometric standards for creating legitimate total scores. This study addresses a current gap in the implementation of frailty measures in an acute care setting, which is the need to implement a measure that can serve as an evaluative measure with robust psychometric properties yielding a legitimate total score.

Hypothesis: Items that represent the frailty construct will fit a unidimensional, hierarchical continuum.

Objectives: (1) Estimate, for an in- and out-patient geriatric population, the prevalence and severity of impairment on existing frailty indicators at two points in time over a one month period; (2) estimate the extent to which these frailty indicators form a unidimensional measure with linearized units; and (3) validate the prototype version of the Acute-Care Frailty Ladder in a new sample of older persons receiving hospital care.

Research plan: A prospective study will be conducted on two samples of 200 and 100 seniors receiving in- or out-patient care. To be included, participants must be: (1) 70 years of age or older and (2) community dwelling prior to hospitalization or clinic visit. More than 40 frailty indicators have been identified from our patient and provider focus groups, chart review, literature; and clinical experience. These include performance-based indicators related to mobility, strength, and endurance such as gait speed, balance, functional walking capacity, functional reach, sit-to-stand, and grip strength. A number of patient reported and self-reported outcomes have also been included as frailty indicators coming from well-known legacy measures of basic and
instrumental activities of daily living, symptoms, and health perception. We will comprehensively assess all consenting seniors over the age of 70 years on these indicators at two time points separated by one month. These items will form the item pool for Rasch analysis to identify the extent to which they form a unidimensional measure. The prototype version of the Acute-Care Frailty Ladder will be tested in a new sample of seniors.

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