Frailty Index and Mortality in Nursing Home Residents in France : Results From the INCUR Study

The objective of this study was to examine whether the capacity of an age-related deficit accumulation index (the so-called Frailty Index [FI] proposed by Rockwood) to predict mortality in a nursing home population. Design, Setting, and Participants: Data are from a longitudinal cohort study (ie, the Incidence of pNeumonia and related ConseqUences in nursing home Residents [INCUR]) of 773 older persons (74.4% women) living in 13 French nursing homes. Measurements: The FI was computed as the ratio between actual and 30 potential deficits the participant might have presented at the baseline visit (range between 0 [no deficit] and 1 [30 deficits]). Death events were monitored and detected over a 12-month follow-up. The risk of death was estimated using Cox proportional hazards models. Results: Mean age of participants was 86.2 (SD 7.5) years, with a mean FI of 0.35 (SD 0.11). At the end of the follow-up, 135 (17.4%) death events were recorded. A positive association between the FI and mortality (per 0.01 FI increment: age- and gender-adjusted hazard ratio 1.018, 95% confidence interval 1.002-1.035, P =.03) was reported. The use of the traditional 0.25 cut-point for detecting the frailty status is inadequate in this population. Conclusion: The FI is able to predict mortality even in very old and complex elders, such as nursing home residents.