Two residents of a long-term care facility are both physically frail but cognitively healthy

  1. Centers for Medicare & Medicaid Services. Nursing home data compendium 2015. 2015.

    Google Scholar 

  2. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11253156.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  3. Robertson DA, Savva GM, Kenny RA. Frailty and cognitive impairment—A review of the evidence and causal mechanisms. Ageing Res Rev. 2013;12(4):840–51 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23831959. [cited 2019 Feb 19].

    PubMed  Article  PubMed Central  Google Scholar 

  4. Kaehr EW, Pape LC, Malmstrom TK, Morley JE. FRAIL-NH predicts outcomes in long term care. J Nutr Health Aging. 2016;20(2):192–8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26812516. [cited 2019 Feb 20].

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  5. Kanwar A, Singh M, Lennon R, Ghanta K, McNallan SM, Roger VL. Frailty and health-related quality of life among residents of long-term care facilities. J Aging Health. 2013;25(5):792–802 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23801154. [cited 2019 Feb 24].

    PubMed  PubMed Central  Article  Google Scholar 

  6. Yuan Y, Lapane KL, Tjia JT, Baek J, Liu S-H, Ulbricht CM. Physical frailty and cognitive impairment in older adults in United States nursing homes. Dement Geriatr Cogn Disord. 2021;50:60–67. Available from: https://www.karger.com/Article/Abstract/515140. [cited 2021 Jun 10].

  7. Azzopardi RV, Vermeiren S, Gorus E, Habbig A-K, Petrovic M, Van Den Noortgate N, et al. Linking frailty instruments to the international classification of functioning, disability, and health: a systematic review. J Am Med Dir Assoc. 2016;17(11):1066.e1–1066.e11 Available from: https://linkinghub.elsevier.com/retrieve/pii/S1525861016303012. [cited 2019 May 6].

    Article  Google Scholar 

  8. Hill NL, McDermott C, Mogle J, Munoz E, DePasquale N, Wion R, et al. Subjective cognitive impairment and quality of life: a systematic review. Int Psychogeriatr. 2017;29(12):1965–77 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28829003. [cited 2019 Apr 21].

    PubMed  Article  PubMed Central  Google Scholar 

  9. Zhang X, Dou Q, Zhang W, Wang C, Xie X, Yang Y, et al. Frailty as a predictor of all-cause mortality among older nursing home residents: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019; 20(6): 657-663.e4. Available from: https://www.sciencedirect.com/science/article/pii/S1525861018306674?via%3Dihub. [cited 2019 Feb 24]

  10. Liu LK, Guo CY, Lee WJ, Chen LY, Hwang AC, Lin MH, et al. Subtypes of physical frailty: Latent class analysis and associations with clinical characteristics and outcomes. Sci Rep. 2017;7:46417 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28397814. [cited 2019 Feb 24].

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  11. Xue Q-L, Bandeen-Roche K, Varadhan R, Zhou J, Fried LP. Initial manifestations of frailty criteria and the development of frailty phenotype in the Women’s Health and Aging Study II. J Gerontol A Biol Sci Med Sci. 2008;63(9):984–90 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18840805.

    PubMed  Article  PubMed Central  Google Scholar 

  12. Lee PH, Lee YS, Chan DC. Interventions targeting geriatric frailty: a systemic review. J Clin Gerontol Geriatr. 2012;3:47–52 Available from: https://www.sciencedirect.com/science/article/pii/S2210833512000238. [cited 2019 Feb 24]. No longer published by Elsevier.

    CAS  Article  Google Scholar 

  13. Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, et al. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. JBI Database System Rev Implement Rep. 2018;16(1):140–232 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29324562. [cited 2019 Feb 18].

    PubMed  PubMed Central  Article  Google Scholar 

  14. Ng TP, Feng L, Nyunt MSZ, Feng L, Niti M, Tan BY, et al. Nutritional, physical, cognitive, and combination interventions and frailty reversal among older adults: a randomized controlled trial. Am J Med. 2015;128(11):1225–1236.e1 Available from: https://www.sciencedirect.com/science/article/pii/S0002934315005677. [cited 2019 Feb 24].

    PubMed  Article  PubMed Central  Google Scholar 

  15. Losa-Reyna J, Baltasar-Fernandez I, Alcazar J, Navarro-Cruz R, Garcia-Garcia FJ, Alegre LM, et al. Effect of a short multicomponent exercise intervention focused on muscle power in frail and pre frail elderly: a pilot trial. Exp Gerontol. 2019;115:114–21 Available from: https://www.sciencedirect.com/science/article/pii/S0531556518306776. [cited 2019 Feb 23].

    PubMed  Article  PubMed Central  Google Scholar 

  16. Cadore EL, Casas-Herrero A, Zambom-Ferraresi F, Idoate F, Millor N, Gómez M, et al. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age (Dordr). 2014;36(2):773–85 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24030238. [cited 2019 Mar 18].

    Article  Google Scholar 

  17. Kidd T, Mold F, Jones C, Ream E, Grosvenor W, Sund-Levander M, et al. What are the most effective interventions to improve physical performance in pre-frail and frail adults? A systematic review of randomised control trials. BMC Geriatr. 2019;19:184 Available from: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1196-x. [cited 2020 Aug 24]. BioMed Central Ltd.

    PubMed  PubMed Central  Article  Google Scholar 

  18. Del Brutto OH, Mera RM, Zambrano M, Sedler MJ. Influence of frailty on cognitive decline: a population-based cohort study in rural Ecuador. J Am Med Dir Assoc. 2019;20(2):213–6 Available from: https://www.sciencedirect.com/science/article/pii/S1525861018305346. [cited 2019 Feb 23].

    PubMed  Article  PubMed Central  Google Scholar 

  19. Mitnitski A, Fallah N, Rockwood K. A multistate model of cognitive dynamics in relation to frailty in older adults. Ann Epidemiol. 2011;21(7):507–16 Available from: https://www.sciencedirect.com/science/article/pii/S1047279711000275. [cited 2019 Feb 24].

    PubMed  Article  Google Scholar 

  20. Auyeung TW, JSW L, Kwok T, Woo J. Physical frailty predicts future cognitive decline — A four-year prospective study in 2737 cognitively normal older adults. J Nutr Health Aging. 2011;15(8):690–4 Available from: http://link.springer.com/10.1007/s12603-011-0110-9. [cited 2019 Feb 24].

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  21. Gross AL, Xue QL, Bandeen-Roche K, Fried LP, Varadhan R, McAdams-DeMarco MA, et al. Declines and impairment in executive function predict onset of physical frailty. J Gerontol Ser A Biol Sci Med Sci. 2016;71(12):1624–30 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27084314. [cited 2019 Mar 19].

    Article  Google Scholar 

  22. Kelaiditi E, Cesari M, Canevelli M, Abellan van Kan G, Ousset P-J, Gillette-Guyonnet S, et al. Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) International Consensus Group. J Nutr Health Aging. 2013;17(9):726–34 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24154642. [cited 2019 Apr 2].

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  23. Sargent L, Brown R. Assessing the current state of cognitive frailty: measurement properties. J Nutr Health Aging. 2017;21(2):152–60 Available from: https://link.springer.com/article/10.1007/s12603-016-0735-9. [cited 2020 Nov 17].

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  24. Panza F, Lozupone M, Solfrizzi V, Sardone R, Dibello V, Di Lena L, et al. Different cognitive frailty models and health- and cognitive-related outcomes in older age: from epidemiology to prevention. Perry G, Avila J, Tabaton M, Zhu X, editors. J Alzheimers Dis. 2018;62(3):993–1012 Available from: http://www.medra.org/servlet/aliasResolver?alias=iospress&doi=10.3233/JAD-170963. [cited 2019 Mar 13].

    PubMed  PubMed Central  Article  Google Scholar 

  25. Centers for Medicare & Medicaid Services. Long-term care facility resident assessment instrument 3.0 user’s manual, version 1.14. 2016.

    Google Scholar 

  26. RTI International. MDS 3.0 quality measures user’s manual. 2017. Available from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/MDS-30-QM-Users-Manual-V11-Final.pdf. [cited 2019 Apr 14].

    Google Scholar 

  27. Luo H, Lum TYS, Wong GHY, Kwan JSK, Tang JYM, Chi I. Predicting adverse health outcomes in nursing homes: a 9-year longitudinal study and development of the FRAIL-Minimum Data Set (MDS) quick screening tool. J Am Med Dir Assoc. 2015;16(12):1042–7 Available from: https://www.sciencedirect.com/science/article/pii/S1525861015006064?via%3Dihub. [cited 2019 Mar 16].

    PubMed  Article  PubMed Central  Google Scholar 

  28. Theou O, Tan ECK, Bell JS, Emery T, Robson L, Morley JE, et al. Frailty levels in residential aged care facilities measured using the frailty index and FRAIL-NH scale. J Am Geriatr Soc. 2016;64(11):e207–12 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27783396. [cited 2019 Feb 19].

    PubMed  Article  PubMed Central  Google Scholar 

  29. Theou O, Sluggett JK, Bell JS, Lalic S, Cooper T, Robson L, et al. Frailty, hospitalization, and mortality in residential aged care. J Gerontol Ser A. 2018;73(8):1090–6 Available from: https://academic.oup.com/biomedgerontology/article/73/8/1090/4372242. [cited 2019 Mar 13].

    Article  Google Scholar 

  30. De Silva TR, Theou O, Vellas B, Cesari M, Visvanathan R. Frailty screening (FRAIL-NH) and mortality in French nursing homes: results from the incidence of pneumonia and related consequences in nursing home residents study. J Am Med Dir Assoc. 2018;19(5):411–4 Available from: https://www.sciencedirect.com/science/article/pii/S1525861017307879?via%3Dihub. [cited 2019 Mar 16].

    PubMed  Article  PubMed Central  Google Scholar 

  31. Yang M, Zhuo Y, Hu X, Xie L. Predictive validity of two frailty tools for mortality in Chinese nursing home residents: frailty index based on common laboratory tests (FI-Lab) versus FRAIL-NH. Aging Clin Exp Res. 2018;30(12):1445–52 Available from: http://www.ncbi.nlm.nih.gov/pubmed/30259498. [cited 2019 Mar 16].

    PubMed  Article  PubMed Central  Google Scholar 

  32. Buckinx F, Croisier J-L, Reginster J-Y, Lenaerts C, Brunois T, Rygaert X, et al. Prediction of the incidence of falls and deaths among elderly nursing home residents: the SENIOR study. J Am Med Dir Assoc. 2018;19(1):18–24 Available from: https://www.sciencedirect.com/science/article/pii/S1525861017303572?via%3Dihub. [cited 2019 Mar 16].

    PubMed  Article  PubMed Central  Google Scholar 

  33. Si H, Jin Y, Qiao X, Tian X, Liu X, Wang C. Comparing diagnostic properties of the FRAIL-NH scale and 4 frailty screening instruments among Chinese institutionalized older adults. J Nutr Health Aging. 2020;24(2):188–93 Available from: https://doi.org/10.1007/s12603-019-1301-z. [cited 2021 Jun 10].

  34. Kaehr E, Visvanathan R, Malmstrom TK, Morley JE. Frailty in nursing homes: the FRAIL-NH scale. J Am Med Dir Assoc. 2015;16(2):87–9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25556303. [cited 2019 Feb 24].

    PubMed  Article  PubMed Central  Google Scholar 

  35. Saliba D, Buchanan J, Edelen MO, Streim J, Ouslander J, Berlowitz D, et al. MDS 3.0: brief interview for mental status. J Am Med Dir Assoc. 2012;13(7):611–7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22796362. [cited 2019 Apr 6].

    PubMed  Article  PubMed Central  Google Scholar 

  36. Morris JN, Fries BE, Mehr DR, Hawes C, Phillips C, Mor V, et al. MDS cognitive performance scale. J Gerontol. 1994;49(4):M174–82 Available from: http://www.ncbi.nlm.nih.gov/pubmed/8014392.

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  37. Hartmaier SL, Sloane PD, Guess HA, Koch GG, Mitchell CM, Phillips CD. Validation of the minimum data set cognitive performance scale: agreement with the mini-mental state examination. J Gerontol Ser A Biol Sci Med Sci. 1995;50(2) Available from: https://pubmed.ncbi.nlm.nih.gov/7874589/. [cited 2021 Jan 27].

  38. Paquay L, De Lepeleire J, Schoenmakers B, Ylieff M, Fontaine O, Buntinx F. Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental Scale Exam for the detection of cognitive impairment in nursing home residents. Int J Geriatr Psychiatry. 2007;22(4):286–93 Available from: www.interrai.org. [cited 2021 Jun 10].

    PubMed  Article  PubMed Central  Google Scholar 

  39. SAS Version 9.4. SAS Institute Inc., Cary, NC.

  40. Muthén LK, Muthén BO. Mplus user’s guide. 8th ed. Los Angeles: Muthén & Muthén; 2017.

    Google Scholar 

  41. Collins LM, Lanza ST. Latent class and latent transition analysis: with applications in the social, behavioral, and health sciences. Hoboken: Wiley; 2013.

    Google Scholar 

  42. von Haehling S, Bernabei R, Anker SD, Morley JE, Vandewoude MF, Rockwood K, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23764209. [cited 2019 Mar 18].

    Article  Google Scholar 

  43. Rosado-Artalejo C, Carnicero JA, Losa-Reyna J, Guadalupe-Grau A, Castillo-Gallego C, Gutierrez-Avila G, et al. Cognitive performance across 3 frailty phenotypes: toledo study for healthy aging. J Am Med Dir Assoc. 2017;18(9):785–90 Available from: https://www.sciencedirect.com/science/article/pii/S1525861017302232. [cited 2019 Feb 23].

    PubMed  Article  PubMed Central  Google Scholar 

  44. Ávila-Funes JA, Amieva H, Barberger-Gateau P, Le Goff M, Raoux N, Ritchie K, et al. Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. J Am Geriatr Soc. 2009;57(3):453–61 Available from: http://doi.wiley.com/10.1111/j.1532-5415.2008.02136.x. [cited 2019 Mar 19].

    PubMed  Article  PubMed Central  Google Scholar 

  45. Nakai Y, Makizako H, Kiyama R, Tomioka K, Taniguchi Y, Kubozono T, et al. Association between chronic pain and physical frailty in community-dwelling older adults. Int J Environ Res Public Health. 2019;16(8) Available from: https://pubmed.ncbi.nlm.nih.gov/31013877/. [cited 2021 Jun 10].

  46. Handforth C, Clegg A, Young C, Simpkins S, Seymour MT, Selby PJ, et al. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol. 2015;26(6):1091–101 Available from: https://pubmed.ncbi.nlm.nih.gov/25403592/. [cited 2021 Jun 10].

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  47. Vitale C, Spoletini I, Rosano GM. Frailty in heart failure: implications for management. Card Fail Rev. 2018;4(2):104. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125710/. [cited 2021 Jun 10].

  48. Kong L-N, Lyu Q, Yao H-Y, Yang L, Chen S-Z. The prevalence of frailty among community-dwelling older adults with diabetes: a meta-analysis. Int J Nurs Stud. 2021;119:103952 Available from: https://pubmed.ncbi.nlm.nih.gov/34022743/. [cited 2021 Jun 10].

    PubMed  Article  PubMed Central  Google Scholar 

  49. Mezuk B, Edwards L, Lohman M, Choi M, Lapane K. Depression and frailty in later life: a synthetic review. Int J Geriatr Psychiatry. 2012;27(9):879–92 Available from: http://doi.wiley.com/10.1002/gps.2807. [cited 2019 Aug 20].

    PubMed  Article  PubMed Central  Google Scholar 

  50. Buchman AS, Schneider JA, Leurgans S, Bennett DA. Physical frailty in older persons is associated with Alzheimer disease pathology. Neurology. 2008;71(7):499–504 Available from: /pmc/articles/PMC2676981/. [cited 2021 Feb 23].

    PubMed  PubMed Central  Article  Google Scholar 

  51. Petermann-Rocha F, Lyall DM, Gray SR, Esteban-Cornejo I, Quinn TJ, Ho FK, et al. Associations between physical frailty and dementia incidence: a prospective study from UK Biobank. Lancet Heal Longev. 2020;1(2):e58–68 Available from: www.thelancet.com/. [cited 2021 Feb 23].

    Article  Google Scholar 

  52. Porter B, Arthur A, Savva GM. How do potentially inappropriate medications and polypharmacy affect mortality in frail and non-frail cognitively impaired older adults? A cohort study. BMJ Open. 2019;9(5) Available from: /pmc/articles/PMC6530304/?report=abstract. [cited 2020 Nov 4].

  53. Stock KJ, Hogan DB, Lapane K, Amuah JE, Tyas SL, Bronskill SE, et al. Antipsychotic use and hospitalization among older assisted living residents: does risk vary by frailty status? Am J Geriatr Psychiatry. 2017;25(7):779–90 Available from: https://www.sciencedirect.com/science/article/pii/S1064748117302087?via%3Dihub. [cited 2019 Feb 24].

    PubMed  Article  PubMed Central  Google Scholar 

  54. An R, Lu L. Antidepressant use and functional limitations in U.S. older adults. J Psychosom Res. 2016;80:31–6 Available from: https://www.sciencedirect.com/science/article/pii/S0022399915300167. [cited 2019 Aug 28].

    PubMed  Article  PubMed Central  Google Scholar 

  55. Mallery L, MacLeod T, Allen M, McLean-Veysey P, Rodney-Cail N, Bezanson E, et al. Systematic review and meta-analysis of second-generation antidepressants for the treatment of older adults with depression: questionable benefit and considerations for frailty. BMC Geriatr. 2019;19:306 Available from: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1327-4. [cited 2021 Feb 23]. BioMed Central.

    PubMed  PubMed Central  Article  Google Scholar 


Page 2

  All
(n = 871,801)
Percentage
Age (years)
 65 - < 75 21.4
 75- < 85 34.3
 ≥ 85 44.3
Female 65.3
Racial/ethnic minority 18.8
Nursing home location
 Rural 23.5
 Urban 76.5
Admission source
 Community 17.8
 Acute hospital 63.8
 Othera 18.4
Physical frailty
 Robust 9.6
 Pre-frail 25.0
 Frail 65.4
Cognitive impairment
 None/Mild 33.6
 Moderate 30.1
 Severe 36.4
Active diagnosis
 Cancer 6.8
 Heart failure 18.9
 Hypertension 76.3
 Diabetes mellitus 31.3
 Alzheimer’s disease 12.0
 Cerebrovascular accident/Transient ischemic attack/Stroke 13.9
 Non-Alzheimer’s/other dementiab 39.2
 Multiple sclerosis 0.5
 Parkinson’s disease 5.8
 Seizure disorder/Epilepsy 5.8
 Arthritis 26.1
 Osteoporosis 11.7
 Hip fracture 5.4
 Other fracture 8.2
 Asthma/Chronic obstructive pulmonary disease/Chronic lung disease 19.6
 Anxiety disorder 21.8
 Depression 36.3
Any presence of pain 40.9
In past 7 days or since admission, receipt of …
 Antipsychotics 19.2
 Antianxiety medications 18.4
 Antidepressant 43.9

  1. aIncluded another nursing home/swing bed, psychiatric hospital, inpatient rehabilitation facility, ID/DD facility, long-term care hospitals, hospice, and other unspecified admission sources
  2. bIncluded non-Alzheimer’s dementia (e.g. vascular or multi-infarct dementia), mixed dementia; frontotemporal dementia (e.g. Pick’s disease), and dementia related to stroke, Parkinson’s or Creutzfeldt-Jakob diseases