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Evaluating frailty scores to predict mortality in older adults using data from population based electronic health records: case control study.

Lookup NU author(s): Dr Daniel StowORCiD, Professor Fiona MatthewsORCiD, Professor Dame Louise Robinson, Professor Barbara Hanratty



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Background: Recognising that a patient is nearing the end of life is essential, to enable professional carers to discuss prognosis and preferences for end of life care. Objective: Investigate whether an electronic frailty index (eFI) generated from routinely collected data, can be used to predict mortality at an individual level. Design: Historical prospective case control study Setting: UK primary care electronic health records Subjects: 13,149 individuals age 75 and over who died between 01/01/2015 and 01/01/2016, 1:1 matched by age and sex to individuals with no record of death in the same time period Methods: Two subsamples were randomly selected to enable development and validation of the association between eFI three months prior to death and mortality. Receiver operator characteristic (ROC) analyses were used to examine diagnostic accuracy of eFI at three months prior to death. Results: An eFI>0·19 predicted mortality in the development sample at 75% sensitivity and 69% area under received operating curve (AUC). In the validation dataset this cut point gave 76% sensitivity, 53% specificity. Conclusions: The eFI measured at a single time point has low predictive value for individual risk of death, even three months prior to death. Although the eFI is a strong predictor or mortality at a population level, its use for individuals is far less clear

Publication metadata

Author(s): Stow D, Matthews FE, Barclay S, Iliffe S, Clegg A, De Biase S, Robinson L, Hanratty B

Publication type: Article

Publication status: Published

Journal: Age and Ageing

Year: 2018

Volume: 47

Issue: 4

Pages: 564-569

Print publication date: 01/07/2018

Online publication date: 13/03/2018

Acceptance date: 05/01/2018

Date deposited: 17/03/2018

ISSN (print): 0002-0729

ISSN (electronic): 1468-2834

Publisher: Oxford University Press


DOI: 10.1093/ageing/afy022

PubMed id: 29546362


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Funder referenceFunder name
National Institute for Health Research (NIHR) School for Primary Care Research (SPCR, 2016DS to D.S.)
National Institute for Health Research (NIHR) under its ‘NIHR Research Professorship’ scheme (Reference Number NIHR-RP-011-043 to L.R.)
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Yorkshire & Humber (NIHR CLAHRC to B.H. and A.C.)
Medical Research Council (MC_U105292687 to F.E.M.)