Once frail, always frail? Frailty transitions in home care users with intellectual and developmental disabilities
Bibliographic record
Abstract
Aim Frailty is understood as a dynamic non‐linear process, and used to indicate age‐related decline. Recent work has shown that adults with intellectual and developmental disabilities experience higher rates of frailty at much earlier ages than the general population. The present study describes transitions in frailty status (i.e. non‐frail, pre‐frail, frail) over 1 year, and explores the association between baseline frailty status and worsening/death over time. Methods Results are based on secondary analysis of 2893 individuals with intellectual and developmental disabilities receiving community‐based home care services in Ontario (Canada). Frailty status is based on a validated 42‐item frailty index (FI); where FI ≤0.21 indicates non‐frail, 0.21 < FI ≤ 0.3 indicates pre‐frail and FI >0.30 indicates frail. Baseline characteristics of frailty groups at baseline were compared using the χ2‐test/analysis of variance. Relative risk of worsening/dying was calculated using a modified Poisson regression model. Results Initially, 67.0% of participants were non‐frail, 16.2% were pre‐frail and 16.8% were frail. Of those non‐frail at baseline, 84.3% remained non‐frail, 11.8% worsened and 3.9% died. Among those initially pre‐frail, 37.0% remained stable, 35.3% improved, 18.2% worsened and 9.6% died. Although similar proportions of frail individuals improved (37.4%) or remained stable (36.8%), 25.9% had died. After controlling for other factors, being pre‐frail at baseline was associated with an increase in the risk of worsening or death (RR 1.24, 95% CI 1.04–1.49). Conclusions While many experience worsening of frailty status, stability and improvement are viable goals of care. Future research should examine the rate at which non‐frail, pre‐frail and frail individuals accumulate deficits, as well as the impact of home care services on frailty. Geriatr Gerontol Int 2018; 18: 547–553.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".