The effect of frailty on residential/nursing home admission in the Netherlands independent of chronic diseases and functional limitations.

The aim of this study was to determine the effect of frailty on the risk of residential/nursing home admission independently of chronic diseases and functional limitations. Frailty consists of multisystem decline and is considered to be a consequence of changes in neuromuscular, endocrine and immune system functioning that occur as people age. Frailty is a combination of multiple impairments in functioning that might lead to functional limitations and disability but it is not clear whether frailty has an independent effect on residential/nursing home admission. Data were used from the Longitudinal Aging Study Amsterdam. The respondents participated at both T1 (1992/1993) and T2 (1995/1996), lived independently at T2, and were aged 65 and over (n=1,503). Nine frailty markers were assessed at two cycles (T1 and T2). The frailty markers were defined in two ways: low functioning at T2 (static frailty); and change in functioning between T1 and T2 (dynamic frailty). The outcome variable was residential/nursing home admission between T2 and T4 (2001/2002). Cox proportional hazard analyses were used adjusting for chronic diseases, functional limitations, care received, partner status, income, age and sex. Static (RR 1.93, 95%CI 1.36-2.74) and dynamic frailty (RR 1.69, 95%CI 1.19-2.39) were associated with institutionalization in both men and women independently of the effect of chronic diseases and functional limitations. Additional analyses of the total number of both sets of frailty markers present revealed an increased risk of institutionalization when the number increased. In conclusion, frailty is associated with institutionalization, independently of the effect of chronic diseases and functional limitations.