News Release

Frailty Index based on common laboratory tests for patients starting
home-based medical care
Key Points• There are several methods for evaluating frailty, including a standard Frailty
Index (FI) based on assessments of functional abilities such as activities ofdaily living, and a Frailty Index calculated from common blood test results(Frailty Index-laboratory: FI-lab).
• FI-lab was found to predict mortality at least as well as standard FI in patients
receiving home-based medical care.
• FI-lab may be calculated automatically using results of common laboratory
tests performed in daily clinical practice, without additional invasion. AndFI-lab is anticipated for assessing the risk of prognosis in a variety of clinicalsettings, including home-based medical care.
Summary
A research group led by Hirotaka Nakashima, Associate Professor, and Hiroyuki
Umegaki, Professor, of the Department of Geriatrics, Nagoya University Hospital,
has reported that a Frailty Index calculated from blood test results (Frailty
Index-laboratory: FI-lab) in older patients receiving home-based medical carepredicts mortality at least as well as a standard Frailty Index based on physicalfunction and other parameters (Frailty Index: FI).
Frailty is a clinical state of vulnerability with inherent increased risk foradverse outcomes, including functional decline and mortality. Frail older
patients are more prone to falls and other health problems, and are at increased
risk for death. Many older patients who receive home-based medical care arefrail, and assessment of frailty is important for appropriate medical care andcare planning.
One of the most widely known indicators for evaluating frailty is FI. In recentyears, FI-lab that use blood test results and other laboratory data have also
been attracting attention. Because it is often difficult to use specialized
medical equipment in home-based medical care, it is necessary to makeeffective use of test results that can be used anywhere, such as blood tests.
The study group analyzed data from a study enrolling patients who begin
receiving home-based medical cares (the Observational study of Nagoya Elderlywith HOme MEdical care study: the ONEHOME study) and found that FI-lab at1 / 3enrollment predicted mortality within 1 and 2 years, independently of standard
FI. Furthermore, the predictive ability of FI-lab was shown to be equal to or
better than standard FI.
FI-lab can be calculated without additional invasion using test results fromroutine medical care, and can be automatically displayed in electronic medical
records. Although FI-lab evaluates only laboratory test abnormalities andcannot substitute for an assessment of the patient's overall medical condition
or functional status, it can help with a more accurate risk assessment and maytrigger an early discussion about the goals of care.
Research Background
Frailty is a clinical state of vulnerability with inherent increased risk foradverse outcomes, including functional decline and mortality. Frail older
patients are more prone to health problems such as falls, fractures, andhospitalization, and have an increased risk of death. With the global aging ofsociety, home-based medical care has become an important part of thehealthcare system. Many older patients receiving home-based medical care arefrail, and assessment of frailty is important for appropriate medical care andcare planning.
One of the most widely known methods of assessing frailty is Frailty Index (FI).
Standard FI demands to evaluate a number of items across a variety of areas,
including disease, symptoms, and physical function, and is calculated by
dividing the number of abnormalities by the number of items evaluated.
Standard FI ranges from 0 to 1. Another relatively new method is FI-lab, whichcalculates the degree of frailty based on laboratory tests such as blood tests.
FI-lab was calculated by dividing the number of abnormal laboratory results by
the number of laboratory tests performed. FI-lab score also ranges from 0 to 1,
and a higher score indicates more severe frailty.
Previous studies have shown that standard FI is associated with prognosis in avariety of clinical settings, including home-based medical care; for FI-lab,associations with prognosis has been reported for hospitalized older patientsand community-dwelling older adults, but not for older patients receiving
home-based medical care. Because it is difficult to use specialized medical
equipment in home-based medical care, FI-lab, which utilize blood test results,
may be particularly useful in this setting. Therefore, the research group
investigated the relationship between FI-lab and prognosis using data from astudy that enrolls patients who start receiving home-based medical care (theONEHOME study).

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Research Results
188 patients were included in the analyses, with standard FI calculated using
42 items and FI-lab using 25 blood test results.
The analyses showed that a higher FI-lab at enrollment was associated with ahigher subsequent mortality rate (Figure). FI-lab was also associated withmortality within 1 and 2 years, independent of standard FI (per 0.1 points ofFI-lab, odds ratio for 1-year mortality 1.53, 95% confidence interval 1.25-1.88;
odds ratio for 2-year mortality 1.49, 95% confidence interval 1.25-1.77).
Furthermore, the predictive ability of FI-lab was shown to be at least as good asthat of standard FI.
Research Summary and Future Perspective
FI-lab may represent the degree of accumulation of acute and/or chronic
disease as reflected in blood tests. FI-lab can be calculated without additional
invasion using test results from routine medical care, and can be automaticallydisplayed in electronic medical records. Although FI-lab evaluates only
laboratory test abnormalities and cannot substitute for an assessment of thepatient's overall medical condition or functional status, it can help with a moreaccurate risk assessment and may trigger an early discussion about the goals ofcare.
This study was supported by a Health Labour Sciences Research Grant(#H24YA003) from the Ministry of Health, Labour and Welfare, Japan.
Publication
Journal：Journal of the American Medical Directors Association
Title ： Frailty Index based on common laboratory tests for patients starting
home-based medical care
Author and Affiliation： Hirotaka Nakashima,1 Kazuhisa Watanabe,1Hitoshi Komiya,1 Chisato Fujisawa,1 Yosuke Yamada,1 Tomomichi Sakai,1Tomihiko Tajima,1 and Hiroyuki Umegaki1,2
1
Department of Geriatrics, Nagoya University Hospital, Nagoya, Aichi, Japan
2
Institute of Innovation for Future Society, Nagoya University, Nagoya, Aichi,
Japan
DOI: 10.1016/j.jamda.2024.105114
Japanese ver.
https://www.med.nagoya-u.ac.jp/medical_J/research/pdf/Jou_240717.pdf

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