Development and validation of a modified Frailty Risk Index as a predictor of mortality in rural elderly people

Background. Frailty is a reversible age-related condition characterised by declines across multiple physiologic systems and associated with an increased risk of mortality or unplanned hospitalisation. We developed and validated a new frailty index that is easy to apply in elderly people in rural India and has predictive accuracy for all-cause mortality at 6 and 12 months. Methods. 1000 participants aged >60 years who were admitted to a geriatric unit of a rural hospital for screening or treatment of any illness were recruited for development and validation of the Frailty Index in Rural Elderly - Mental status, Activities of daily living, Depression, and Events (FIRE-MADE), which combines the Cumulative Deficits Model and the Comprehensive Geriatric Assessment Model and takes into account of four domains: physical, cognitive, psychosocial, and functional. Results. The FIRE-MADE score increased with age and was higher in men than in women. Higher FIRE-MADE score was associated with higher rates of mortality and unplanned hospitalisation. In multivariable analysis, predictors for mortality were Mini-Mental State Examination, activities of daily living, ischaemic heart disease, history of stroke, and polypharmacy. In Kaplan-Meier survival analysis, 4.9%, 7.1%, and 16.7% of participants with mild (FIRE-MADE score, 0.3-0.4), moderate (0.5-0.6), and severe (>0.7) frailty died at the end of 1 year. The cut-off values for mortality and unplanned hospitalisation were 0.32 and 0.27, respectively, with the area under the receiver operating characteristic curve for the severity being 0.883 and 0.794, respectively. Compared with the Longitudinal Aging Study Amsterdam frailty index score in predicting mortality and unplanned hospitalisation, the FIRE-MADE score had positive predictive values of 88.89% and 88.89%, respectively, and negative predictive values of 65.93% and 41.10%, respectively. Association between the two indices was strong. Conclusions. FIRE-MADE is easy to apply in clinical practice as a screening tool to detect frailty in elderly people in rural India.