The Evaluation of Feasibility and Predictive Validity of Comprehensive Korean Frailty Instrument: Using the 2008 and 2011 Living Profiles of Older People Survey in Korea

Eunmi Oh; Gwi-Ryung Son Hong

doi:10.12799/jkachn.2017.28.2.206

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Oh and Hong: The Evaluation of Feasibility and Predictive Validity of Comprehensive Korean Frailty Instrument: Using the 2008 and 2011 Living Profiles of Older People Survey in Korea

Original Article

Journal of Korean Academy of Community Health Nursing 2017; 28(2): 206-215.

Published online: 30 June 2017

DOI: https://doi.org/10.12799/jkachn.2017.28.2.206

The Evaluation of Feasibility and Predictive Validity of Comprehensive Korean Frailty Instrument: Using the 2008 and 2011 Living Profiles of Older People Survey in Korea

Eunmi Oh, Gwi-Ryung Son Hong

College of Nursing, Hanyang University, Seoul, Korea.

Corresponding author: Oh, Eunmi. College of Nursing, Hanyang University, 222 Wangsimli-ro, Sungdong-gu, Seoul 04763, Korea. Tel: +82-2-2220-4711, Fax: +82-2-2295-2074, oem76@hanyang.ac.kr

Received 27 March 2017 Revised 17 June 2017 Accepted 17 June 2017

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to verify the predictive validity of Comprehensive Korean Frailty Instrument (CKFI) among older adults.

Methods

A secondary analysis of data from a prospective cohort study was conducted. Frailty was determined in older adults (N=9,188) according to the data in 2008 and the effects of frailty on adverse outcomes (such as institutionalization and death) were evaluated according to the data in 2011. The Cardiovascular Health Study (CHS) index was used to compare with the predictive validity of CKFI.

Results

The prevalence of frailty was 26.3%. With the CKFI, the frail group had a higher risk of negative health outcomes compared to the robust and pre-frail groups after three years. The two of the highest risks identified using the CKFI and CHS index were institutionalization (5.522 times higher) and mortality (3.210 times higher). For both instruments, the survival analysis revealed that the risk of death increased as the degree of frailty increased.

Conclusion

The CKFI consisting of self-report items and multidimensional aspects of frailty can be used as a simple instrument for assessing the frailty of older adults residing in a local community in Korea.

Keywords: Frail elderly, Validation studies, Prevalence, Mortality, Long term adverse effects

Figures and Tables

Figure 1

Kaplan-Meier cumulative survival function on death according to CKFI and CHS index.

Table 1

Final CKFI

Construct domain	Indicator	Item	0 point	1 point
Physical frailty	Physical performance	· Do you feel it is difficult to reach your hand and get something over your head?	No	Yes
	Physical performance	· Do you feel it is difficult to walk up 10 stairs without resting?	No	Yes
	Nutrition	· Do you feel it is difficult to chew hard food stuff such as meat and apples? If you use artificial teeth, describe your feeling assuming that you wear them.	No	Yes
	Sensibility	· Does your current eyesight make you feel uncomfortable with daily activities?	No	Yes
	Sensibility	· Does your current hearing ability make you feel uncomfortable with daily activities?	No	Yes
	Comorbidities	· Do you have three or more chronic diseases that have lasted for at least three months since you were diagnosed by doctors?	No	Yes
Psychological frailty	Mood	· During the last week, did you feel like staying home all day long?	No	Yes
Psychological frailty	Perception of health status	·What do you think about your ordinary health condition?	Good	Average poor
Cognitive frailty	Cognition function	·What do you think about your memory?	Good	Bad
Social frailty	Social network	· Are you living alone at present?	No	Yes
	Social network	· Are you involved in any club (group) activity? (e.g. social gathering, religion, cultural activity, sports, civil or society group, profitable or political group, voluntary group, study group, etc.)	Yes	No
	Social support	· How many people are there around you with whom you feel the relationship is satisfactory?	Two or more	Below one
		· How many people are there around you who have listened to your concerns or worries during the last year?	Two or more	Below one
		· How many times have you received economic assistance from your family or surrounding people, such as allowance and living expenses during the last year?	At least one	None

CKFI=comprehensive Korean frailty instrument.

Table 2

Distribution of Frailty Status at Baseline in 2008 (N=9,188)

Variables	CKFI	CHS index^†
Variables	n (%)	n (%)
Robust	4,354 (47.4)	3,480 (37.9)
Pre-frail	2,413 (26.3)	4,513 (49.1)
Frail	2,421 (26.3)	773 (8.4)
Total score (M±SD)	4.49±2.20	0.97±1.00

^†Excluded 422 (4.6%) individuals who had≥3 missing data (total 5-items); CKFI=comprehensive Korean frailty instrument; CHS index=cardiovascular health study index.

Table 3

Post Three-year Adverse Outcomes Between Pre-frail/Robust and Frail Groups according to CKFI vs. CHS index

Adverse outcomes	Level of frailty	CKFI				CHS index
		OR	95% CI		p	OR	95% CI		p
		OR	Lower	Upper	p	OR	Lower	Upper	p
Institutionalization	Pre-frail/Robust	1				1
Institutionalization	Frail	5.52	3.57	8.54	<.001	1.94	1.02	3.71	.045
Hospitalization	Pre-frail/Robust	1				1
Hospitalization	Frail	2.16	1.52	3.08	<.001	1.30	0.73	2.32	.380
Death	Pre-frail/Robust	1				1
Death	Frail	2.65	2.29	3.07	<.001	3.21	2.64	3.91	<.001
Fall	Pre-frail/Robust	1				1
Fall	Frail	1.61	1.43	1.81	<.001	1.52	1.26	1.83	<.001
Sequelae due to fall	Pre-frail/Robust	1				1
Sequelae due to fall	Frail	1.72	1.15	1.95	<.001	1.69	1.36	2.05	<.001
Functional disability (ADL)	Pre-frail/Robust	1				1
Functional disability (ADL)	Frail	3.41	2.89	4.01	<.001	2.62	2.05	3.34	<.001
Functional disability (IADL)	Pre-frail/Robust	1				1
Functional disability (IADL)	Frail	3.33	2.94	3.77	<.001	3.19	2.65	3.82	<.001
Number of times traveling	Pre-frail/Robust	1				1
Number of times traveling	Frail	2.42	2.13	2.74	<.001	2.61	2.09	3.26	<.001
Cognitive impairment (MMSE-KC)	Pre-frail/Robust	1				1
Cognitive impairment (MMSE-KC)	Frail	1.13	1.00	1.27	.046	1.47	1.22	1.76	<.001
Depressive symptoms (SGDS)	Pre-frail/Robust	1				1
Depressive symptoms (SGDS)	Frail	3.25	2.92	3.62	<.001	2.98	2.51	3.53	<.001

CKFI=comprehensive Korean frailty instrument; CHS index=cardiovascular health study index; ADL=activities of daily living; IADL=instrumental activities of daily living; MMSE-KC=mini-mental state examination in the Korean version of the consortium to establish a registry for alzheimer's disease assessment packet; SGDS=short form of the geriatric depression scale.

Notes

This manuscript is a revision of the first author's doctoral dissertation from Hanyang University.

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