Identifying core adverse health outcomes for frailty assessment in older adults using administrative data

Measurement of frailty can be based on the ability to predict adverse health outcomes. Although frailty research is progressing rapidly, a unique work that analyzes together outcomes related to frailty condition is still lacking in literature. This article aims to fill this gap, selecting a parsimonious set of outcomes relevant in frailty studies that exploit administrative healthcare data.

Starting with an extensive literature review, we identified several health outcomes that can be measured with administrative healthcare databases. We computed the prevalence and correlation of these outcomes in a local health unit in North-East Italy. We performed a factor analysis and estimated a graphical model to examine the conditional independence relationships between the outcomes.

Our analysis revealed two primary outcome groups: adverse events (characterized by various forms of hospital use) and adverse conditions (such as dementia and disability). Femur fracture emerged as a distinct outcome, while death showed positive associations with all other outcomes. Considering overlaps and relationships, we selected a core set of six representative outcomes: death, high priority access to the emergency room, femur fracture, hospitalization, disability, and dementia.

This study identified six central and non-redundant adverse health outcomes related to frailty that can be easily derived from routinely available administrative healthcare data. These findings provide a methodologically grounded selection of outcomes that are clinically meaningful and feasible, offering a solid foundation for developing population-based frailty indices.