Claims-Based Frailty Index and Its Relationship With Commonly Used Clinical Frailty Measures

• Published in: The journals of gerontology. Series A, Biological sciences and medical sciences Biological sciences and medical sciences, 2024-07, Vol.79 (7)
• Main Authors: Sison, Stephanie Denise M, Shi, Sandra M, Oh, Gahee, Jeong, Sohyun, McCarthy, Ellen P, Kim, Dae Hyun
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Female; Frail Elderly; Frailty - diagnosis; Geriatric Assessment - methods; Humans; Independent Living; Insurance Claim Review; Male; Medicare; United States
• ISSN: 1079-5006; 1758-535X; 1758-535X
• DOI: 10.1093/gerona/glae094

The relationship of claims-based frailty index (CFI), a validated measure to identify frail individuals using Medicare data, and frailty measures used in clinical practice has not yet been fully explored. We identified community-dwelling participants of the 2015 National Health and Aging Trends Study (NHATS) whose CFI scores could be calculated using linked Medicare claims. We calculated 9 commonly used clinical frailty measures from their NHATS in-person examination: Study of Osteoporotic Fracture Index (SOF), FRAIL Scale, Frailty Phenotype, Clinical Frailty Scale (CFS), Vulnerable Elder Survey-13 (VES-13), Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), Edmonton Frail Scale (EFS), and 40-item Frailty Index (FI). Using equipercentile method, CFI scores were linked to clinical frailty measures. C-statistics and test characteristics of CFI to identify frailty as defined by each clinical frailty measure were calculated. Of the 3 963 older adults, 44.5% were ≥75 years, 59.4% were female, and 82.3% were non-Hispanic White. A CFI of 0.25 was equipercentile to the following clinical frailty measure scores: SOF 1.4, FRAIL 1.8, Phenotype 1.8, CFS 5.4, VES-13 5.7, TFI 4.6, GFI 5.0, EFS 6.0, and FI 0.26. The C-statistics of using CFI to identify frailty as defined by each clinical measure were ≥0.70, except for CFS and VES-13. The optimal CFI cutpoints to identify frailty per clinical frailty measure ranged from 0.212 to 0.242, with sensitivity and specificity of 0.37-0.83 and 0.66-0.84, respectively. Understanding the relationship of CFI and commonly used clinical frailty measures can enhance the interpretability and potential utility of CFI.