# Frailty Assessed Using the FRAIL-NH Scale and its Associations with Long-Term Care Needs in Residents of Japanese Nursing Homes: A Multicenter Cross-Sectional Study

## TL;DR

This study shows that most nursing home residents in Japan are frail or most-frail, and their frailty is strongly linked to higher long-term care needs.

## Contribution

The study provides new evidence on the association between FRAIL-NH scale scores and LTC needs in Japanese nursing home residents.

## Key findings

- 20.7% and 69.9% of residents were classified as frail and most-frail, respectively.
- Frailty was strongly associated with higher LTC needs levels 4 and 5.
- Assessing frailty with the FRAIL-NH scale may improve care decision-making.

## Abstract

Frailty is often considered a pre-disability overall health state. However, even among older adults with disability, assessing frailty can be crucial for providing appropriate support and care services that maintain or promote their remaining independent abilities. The FRAIL-NH scale was developed to assess frailty in nursing home residents and has been shown to be useful in predicting their prognosis. We aimed to determine the prevalence and degree of frailty assessed by the FRAIL-NH scale among nursing home residents in Japan and investigate the associations between frailty status and long-term care (LTC) needs.

A cross-sectional study was conducted in four nursing homes in the Tokyo metropolitan area of Japan, 2020. Frailty status was assessed using the 7-item FRAIL-NH scale Japanese version: non-frail (0-1 points), frail (2-5 points), and most-frail (6-14 points). Levels of LTC needs at the latest LTC needs certification were obtained from electronic health records. Age- and sex-adjusted multivariable logistic regression analyses were conducted to evaluate the associations between frailty status and the level of LTC needs.

Among 372 residents, 20.7% and 69.9% were frail and most-frail, respectively. Adjusted odds ratios (95% confidence intervals) for being either frail or most-frail were 3.62 (1.31-10.01) and 3.69 (1.14-11.94) for LTC needs levels 4 and 5, respectively, compared to level 3. Similarly, adjusted odds ratios (95% confidence intervals) for most-frail were 3.09 (1.77-5.38) and 6.38 (3.13-13.03) for LTC needs levels 4 and 5, respectively.

Most nursing home residents were assessed as being frail or most-frail. Frailty was strongly associated with LTC needs, indicating important resource implications for care services. Moreover, assessing frailty with the FRAIL-NH scale may support medical and care-related decision-making.