Relationship between SHARE-FI Frailty Scores and Physical Performance Measures in Older Adult Medicaid Recipients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Setting
2.2. Participants
2.3. Measurements
- Participant demographic information included age, race, sex, level of education, housing environment, and living arrangement.
- The SHARE-FI uses the five constructs from Fried’s frailty phenotype: (1) fatigue (termed exhaustion in the Fried criteria), captured as a binary self-report response indicating whether the respondent has too little energy to complete desired tasks; (2) appetite (termed unintentional weight loss in the Fried criteria), indicating self-reported food intake over the last month (diminished, same, or increased); (3) weakness, assessed by two repetitions of grip dynamometry in each hand; (4) walking difficulties (termed gait speed in the Fried criteria), assessed by the self-reported ability to walk 100 m and climb one flight of stairs; and (5) physical activity, measured via self-report of frequency of engagement in activities requiring low to moderate levels of energy [4]. Using a freely available online calculator individualized for both men and women, a scoring algorithm generates a composite frailty score based on these five assessments, and that score categorizes individuals as non-frail, pre-frail, or frail [8]. For females, scores < 0.315 are considered non-frail, scores from 0.316 to 2.130 are pre-frail, and frail scores are values > 2.131. For males, scores < 1.211 indicate non-frail, scores from 1.212 to 3.005 are pre-frail, and frail scores are values > 3.006.
- The five-repetition chair rise test evaluates the length of time it takes an individual to rise from a chair five times, providing a proxy measurement of lower extremity strength. This test has excellent test-retest reliability (r = 0.89) and inter-rater reliability (r = 0.95) [16]. As a diagnostic tool, completion of five repetitions in more than 15 s is associated with increased risk for falls [16]. Clients completed the five-repetition chair rise using a standard height chair with arms crossed over their chests. Research staff instructed clients to fully stand and sit down five times as fast as possible without using their upper extremities for support.
- The TUG measures the amount of time it takes an individual to rise from a chair, walk to a point 10 feet away, turn, and return to sitting. The TUG is a widely used measure of fall screening among older adults with scores greater than 15 s predicting fall risk at a rate of 87% [5]. The specificity and sensitivity of predicting falls are high with values of 93.3% and 80%, respectively, and the measure has excellent test-retest, inter-rater, and intra-rater reliability [5]. All clients completed one TUG trial using a standard height chair following standardized instructions to complete the test at a comfortable and safe walking speed.
- Argued as the “sixth vital sign”, self-selected gait speed predicts mortality [17,18], hospitalizations [19], health care utilization [20], functional decline [21], and falls [22]. We measured gait speed as the time to complete a three-meter walking distance at a self-selected, comfortable, usual pace with a one-meter acceleration and deceleration length. All clients performed this measure twice with the average speed of the two measures used for analysis.
- The Short Physical Performance Battery (SPPB) [23] is one of the most commonly used physical performance measures for older adults and assesses functional capacity in three conditions: (1) standing balance, (2) walking speed, and (3) chair rise. Total scores range from 0 to 12 and lower scores are associated with hospital re-admission and [24] disability [25]. Scores less than 10 are predictive of all-cause mortality [26].
2.4. Statistical Analysis
3. Results
3.1. Demographics and SHARE-FI Summary Statistics
3.2. Performance Measures
3.3. SHARE-FI as a Predictor of Physical Performance Measures and SHARE-FI
3.4. Relationship between SHARE-FI Self-Report and Gait Speed
4. Discussion
Author Contributions
Funding
Conflicts of Interest
References
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Demographic item | Mean (Std Dev) |
---|---|
Age | 74.19 (8.36) |
Sex (n and %) | |
Female | 109 (78.42) |
Male | 30 (21.58) |
Race (n and %) | |
Other | 9 (6.47) |
African American | 130 (93.53) |
Education (n and %) | |
<High School | 35 (25.18) |
High School | 48 (34.53) |
Some College | 35 (25.18) |
4-year Degree or Higher | 21 (15.11) |
Housing Environment | |
House | 42 (30.22) |
Apt/Townhome/Condo | 48 (34.53) |
Senior Living Building | 49 (35.25) |
Living Arrangement | |
Alone | 86 (61.87) |
Spouse/Partner | 11 (7.91) |
Other | 42 (30.22) |
Physical Performance Measure | Overall | Non-Frail | Pre-Frail | Frail | p-Value ^ | ||||
---|---|---|---|---|---|---|---|---|---|
n = 139 | n = 28 (20.14%) | n = 48 (34.53%) | n = 63 (45.32%) | ||||||
Mean | Std | Mean | Std | Mean | Std | Mean | Std | ||
Frailty Score (SHARE-FI) * | 1.89 | 1.44 | −0.16 | 0.71 | 1.51 | 0.51 | 3.1 | 0.85 | <0.0001 |
Hand Grip Dynamometry (kg) | 23.96 | 9.94 | 31.38 | 9.93 | 26.7 | 8.74 | 18.59 | 7.68 | <0.0001 |
Females | 21.39 | 7.65 | 26.41 | 6.30 | 24.66 | 6.45 | 17.66 | 6.95 | <0.0001 |
Males | 33.33 | 11.69 | 38.00 | 10.21 | 34.45 | 11.99 | 24.94 | 9.87 | |
Average Gait Speed (m/s) | 0.55 | 0.26 | 0.73 | 0.21 | 0.56 | 0.26 | 0.46 | 0.23 | <0.0001 |
Gait Category | n | % | n | % | n | % | n | % | <0.0001 |
<0.5 m/s | 58 | 41.73 | 4 | 14.29 | 18 | 37.5 | 36 | 57.14 | |
[0.5–0.6] m/s | 21 | 15.11 | 5 | 17.86 | 4 | 8.33 | 12 | 19.05 | |
[0.6–0.8] m/s | 36 | 25.9 | 9 | 32.14 | 15 | 31.25 | 12 | 19.05 | |
[0.8–1.0] m/s | 19 | 13.67 | 6 | 21.43 | 11 | 22.92 | 2 | 3.17 | |
≥1.0 m/s | 5 | 3.6 | 4 | 14.29 | 0 | 0 | 1 | 1.59 | |
Time to Complete 5 Stands (s) | 21.22 | 8.12 | 18.79 | 5.03 | 20.74 | 7.44 | 24.69 | 10.72 | 0.0522 |
SPPB Test Scores Total Score | 4.78 | 2.75 | 6.96 | 2.43 | 5.33 | 2.57 | 3.38 | 2.21 | <0.0001 |
Balance Test Score | 1.99 | 1.36 | 2.79 | 1.1 | 2.31 | 1.46 | 1.4 | 1.13 | <0.0001 |
Gait Speed Test Score | 2.09 | 1.12 | 2.89 | 0.92 | 2.29 | 1.13 | 1.57 | 0.93 | <0.0001 |
Chair Stand Test Score | 0.71 | 0.84 | 1.29 | 0.98 | 0.73 | 0.71 | 0.43 | 0.73 | <0.0001 |
Tug Score (s) | 27.96 | 20.6 | 18.22 | 8.2 | 24.77 | 16.05 | 36.53 | 25.68 | 0.0002 |
Tug Category | n | % | n | % | n | % | n | % | <0.0001 |
<15 s | 25 | 17.99 | 12 | 42.86 | 10 | 20.83 | 3 | 4.76 | |
≥15 s | 114 | 82.01 | 16 | 57.14 | 38 | 79.17 | 60 | 95.24 | |
Unable to Complete 5 Stands | 69 | 49.64 | 6 | 21.43 | 20 | 41.67 | 43 | 68.25 | <0.0001 |
Outcome | Predictor = Continuous SHARE-FI Score | Predictor = Frailty Categories as Determined by SHARE-FI Score | |||||||
---|---|---|---|---|---|---|---|---|---|
1 Point Increase: Increasing Frailty Score | Frail vs. Pre-Frail | Frail vs. Non-Frail | Pre-Frail vs. Non-Frail | ||||||
Estimate (β) | 95% CI | p-Value | Estimate (95% CI) ^ | p-Value ^ | Estimate (95% CI) ^ | p-Value ^ | Estimate (95% CI) ^ | p-Value ^ | |
TUG Score (s) | 4.93 | (2.42, 7.44) | 0.0002 | 11.76 (2.32, 21.20) | 0.0104 | 18.31 (7.42, 29.21) | 0.0003 | 6.56 (−4.47, 17.58) | 0.3383 |
SPPB Balance Test Score | −0.35 | (−0.50, −0.20) | <0.0001 | −0.92 (−1.48, −0.35) | 0.0006 | −1.39 (−2.06, −0.72) | <0.0001 | −0.47 (−1.18, 0.23) | 0.2519 |
SPPB Gait Speed Test Score | −0.31 | (−0.43, −0.19) | <0.0001 | −0.72 (−1.17, −0.27) | 0.0003 | −1.32 (−1.86, −0.78) | <0.0001 | −0.60 (−1.16, −0.04) | 0.0335 |
SPPB Chair Test Score | −0.20 | (−0.29, −0.11) | <0.0001 | −0.30 (−0.65, 0.05) | 0.1130 | −0.86 (−1.28, −0.44) | <0.0001 | −0.56 (−0.19, −0.12) | 0.0089 |
SPPB Total Score | −0.87 | (−1.15, −0.58) | <0.0001 | −1.95 (−3.03, −0.87) | 0.0001 | −3.58 (−4.87, −2.30) | <0.0001 | −1.63 (−2.97, −0.29) | 0.0128 |
Average Gait Speed (m/s) | −0.06 | (−0.09, −0.03) | <0.0001 | −0.11 (−0.22, 0.00) | 0.0579 | −0.27 (−0.40, −0.14) | <0.0001 | −0.16 (−0.30, −0.03) | 0.0121 |
Unable to Complete 5 Stands * | 1.70 | (1.29, 2.25) | 0.0002 | 3.01 (1.18, 7.66) | 0.0057 | 7.88 (2.25, 27.57) | 0.0003 | 0.38 (0.11, 1.37) | 0.1818 |
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Danilovich, M.K.; Diaz, L.; Corcos, D.M.; Ciolino, J.D. Relationship between SHARE-FI Frailty Scores and Physical Performance Measures in Older Adult Medicaid Recipients. Geriatrics 2018, 3, 51. https://doi.org/10.3390/geriatrics3030051
Danilovich MK, Diaz L, Corcos DM, Ciolino JD. Relationship between SHARE-FI Frailty Scores and Physical Performance Measures in Older Adult Medicaid Recipients. Geriatrics. 2018; 3(3):51. https://doi.org/10.3390/geriatrics3030051
Chicago/Turabian StyleDanilovich, Margaret K., Laura Diaz, Daniel M. Corcos, and Jody D. Ciolino. 2018. "Relationship between SHARE-FI Frailty Scores and Physical Performance Measures in Older Adult Medicaid Recipients" Geriatrics 3, no. 3: 51. https://doi.org/10.3390/geriatrics3030051