Development of a Frailty Index in the Irish Hip Fracture Database

Area of Science:

• Geriatric Medicine
• Orthopedics
• Public Health

Background:

• Hip fractures in older adults are associated with poor health outcomes.
• Frailty is a key indicator of vulnerability and risk in this population.
• The Irish Hip Fracture Database (IHFD) provides a platform for such research.

Purpose of the Study:

• To derive and validate a frailty index (FI) using the IHFD.
• To explore the association between the FI and adverse outcomes including prolonged length of stay (LOS), delirium, inpatient mortality, and new nursing home admission.
• To assess the FI's predictive value independently of age, sex, and American Society of Anaesthesiology (ASA) score.

Main Methods:

• A 21-item FI was constructed using comorbidities, functional status, and nursing home provenance.
• The FI was categorized into tertiles: low, medium, and high risk.
• Logistic regression analysis was employed to determine independent associations and predictive accuracy (AUC).

Main Results:

• The study analyzed 14,615 hip fracture admissions; complete FI data were available for 12,502.
• Higher FI tertiles were significantly associated with increased proportions of prolonged LOS, delirium, inpatient mortality, and nursing home admission (p < 0.001).
• The FI significantly improved the prediction of delirium, nursing home admission, prolonged LOS, and inpatient mortality when added to traditional risk factors.

Conclusions:

• The 21-item FI derived from the IHFD is a significant predictor of adverse outcomes following hip fracture.
• The FI offers added value beyond traditional risk stratification tools.
• Further prospective studies are needed to evaluate the routine use of FI for directing orthogeriatric resources.