Fracture Risk Assessment in Long Term Care (FRAiL)
The Fracture Risk Assessment in Long term care (FRAiL) model was developed by investigators at Hebrew SeniorLife and Brown University to evaluate the risk of hip fracture in nursing home residents. It was developed among all long-stay nursing home residents in the United States enrolled in Medicare fee-for-service plans in the years 2007-2010.
The model considers 15 characteristics that are routinely collected on nursing home residents as part of the Minimum Data Set (MDS). The model was developed using information from MDS version 2.0, but it has been validated using MDS version 3.0.
The FRAiL risk score provides the absolute two year probability of a long-stay nursing home resident experiencing a hip fracture.
Evaluation Form
Assess Online ~ The algorithm may be evaluated using our online Web form.
Characteristics in the FRAiL model
Algorithm Parameters
| Variable | Description |
|---|---|
| Age | The model was developed on residents between the ages of 65 – 113 years. If the age is below 65 years, the model will use the age 65 |
| Body Mass Index (BMI) | The model was developed using BMI between 15.5-46.8 kg/m2. If BMI is lower or greater than this range, the model will use a BMI of 15.5 or 46.8kg/m2 respectively |
| Cognitive Performance Score | Model developed in residents with a score of 0-5. 0=intact, 1=borderline intact, 2=mild impairment, 3=moderate impairment, 4=moderate-sever impairment, 5=severe impairment, and 6=very severe impairment. Residents with a score of 6 were excluded in model development. The model will use a score of 5, but the resident may have lower risk than estimated. |
| Activities of Daily Living (ADL) Hierarchy | Model used the hierarchial scale, a combination of eating, hygiene, locomotion, and toileting, with a score of 0-6. Independent or mild dependence (0-2), extensive assistance in personal hygiene or toilet use, and less than extensive in both eating and locomotion (3), extensive assistance, but not total dependence, in eating or locomotion (4), dependent (5), totally dependent (6) |
| Sex | Male or female |
| Race | Only one race identified for model: White, Black, Hispanic, Asian, Native American, or Other race |
| Easily Distracted | Any symptoms in the last 7 days, yes versus no |
| Wandering | Any symptoms in the last 7 days, yes versus no |
| Transfer Performance | Independent or supervision, limited assistance, extensive assistance, totally dependent |
| Walking in Room (locomotion) | Independent or supervision, limited assistance, extensive assistance, fully dependent |
| Bladder Continence | Continent or mostly continent, frequent incontinence, total incontinence |
| Diabetes Diagnosis | Model did not specify severity or whether on treatment. Any medical diagnosis of diabetes, yes versus no |
| Osteoarthritis | Model did not specify site or severity. Any medical diagnosis of osteoarthritis, yes versus no |
| History of Previous Falls | Fall in the last 180 days, yes or no |
| Pressure Ulcer | Any stage 2-4 pressure ulcer in the prior 7 days |