CARE frailty e-health scale: Association with incident adverse health outcomes and comparison with the Cardiovascular Health Study frailty scale in the NuAge cohort

Background: This study examines and compares CARE and Cardiovascular Health Study (CHS) frailty states (i.e., robust, prefrail and frail) for their association with incident adverse health outcomes, including falls, depression, cognitive and functional decline, major neurocognitive disorders, hospitalization and mortality in community-dwelling older adults living in the province of Quebec (Canada). Methods: A subset of individuals (n = 1098) who participated in "Nutrition as a determinant of successful aging: The Quebec longitudinal study" (NuAge), which is an elderly population-based observational cohort study with 3 years of follow-up, were selected. CARE and CHS frailty states were determined using the NuAge baseline assessment. Incident falls (i.e., >= 1, >= 2 and severe falls), depression (i.e., 30-item Geriatric Depression Scale score > 10/30), decline in cognition (i.e., Modified Mini Mental State (3MS) score < 79/100) and functionality (i.e., Activity Daily Living (ADL) score <= 3/4 and an Instrumental Activity Daily Living (IADL) score <= 6/8), major neurocognitive disorders (i.e., 3MS score < 79/100 and IADL score < 6/8), hospitalization and mortality were annually recorded over a 3-year follow-up period. Results: 66.8% and 23.6% of participants were classified as pre-frail and frail with CARE respectively, whereas this distribution of frailty states differed with CHS (47.9% and 8.4%). There were significant associations of CARE pre-frail and frail states with all incident adverse health outcomes, the lowest odds ratio (OR) being reported with falls and the highest with cognitive decline (OR ranging from 1.63 to 12.85 with P <= 0.032). All ORs of the CARE frailty states were greater than those of the CHS, except for frail participants with IADL decline (OR = 4.92 for CARE versus OR = 9.62 for CHS). Conclusions: CARE frail states were associated with incident adverse health outcomes and these associations were greater than with CHS, suggesting that the CARE scale is of clinical interest when screening for frailty and related adverse health outcomes in the elderly population.