Predicting 3-Year Survival in Older People with Intellectual Disabilities Using a Frailty Index

• Autores: Josje D. Schoufour, Arnold Mitnitski, Kenneth Rockwood, Heleen M. Evenhuis, Michael A. Echteld
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 63, Nº. 3, 2015, págs. 531-536
• Idioma: inglés
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• Resumen

  • Objectives To analyze the relationship between frailty and survival in older people with intellectual disabilities (IDs).

    Design Population-based longitudinal observational study.

    Setting Three Dutch care provider services.

    Participants Individuals with borderline to profound ID aged 50 and older (N = 982).

    Measurements A frailty index (FI) including 51 health-related deficits was used to measure frailty. Mean follow-up was 3.3 years. The Cox proportional hazards model was used to evaluate the independent effect of frailty on survival. The discriminative ability of the FI was measured using a receiver operating characteristic (ROC) curve.

    Results Greater FI values were associated with greater risk of death, independent of sex, age, level of ID, and Down syndrome. There was a nonlinear increase in risk with increasing FI value. For example, mortality risk was 2.17 times as great (95% confidence interval (CI) = 0.95–4.95) for vulnerable individuals (FI 0.20–0.29) and 19.5 (95% CI = 9.13–41.8) times as great for moderately frail individuals (FI 0.40–0.49) as for relatively fit individuals (FI <0.20). The area under the ROC curve for 3-year survival was 0.78.

    Conclusion Although the predictive validity of the FI should be further determined, it was strongly associated with 3-year mortality. Care providers working with people with ID should be able to recognize frail clients and act in an early stage to stop or prevent further decline.