Underweight mobility-type pre-frailty/frailty was associated with complex care needs of long-term care facilities residents: Results using MDS RAP triggers

Background/Purpose: To evaluate the association of body mass index (BMI) and complex care needs among oldest old male with and without mobilitytype pre-frailty/frailty. Methods: This cross-sectional study recruited subjects aged 80 years and over from two veterans homes in Taiwan. Complexity of care was evaluated by the Resident Assessment Protocol (RAP) triggers derived from Minimum Data Set (MDS). High complexity of care needs was defined as ≥4 RAP triggers. Mobility-type pre-frailty/frailty was defined as low handgrip or slow gait speed (cutoff point defined by Asian Working Group for Sarcopenia). Results: Overall, 344 participants (mean age 84.6±3.9 years, all male) were enrolled for study and 79.4% of them were classified with mobility-type prefrailty/ frailty. Lower BMI is significantly associated with higher mean of MDSbased triggers (residents with BMI <18.5: 5.4±2.4; with 18.5: BMI <25.0: 4.8±2.3; with 25.0: 4.1±2.1; P=0.022). Multivariate logistic regression analysis showed that after adjusting the covariates for age, education and Charlson comorbidity index (CCI), among residents with mobility-type pre-frailty/ frailty, the groups classified as BMI <18.5 and 18.5-24.9 levels were strongly associated with higher complexity of care needs compared with the group with BMI ≥25 [adjusted odds ratio (aOR) 4.182, 95% confidence interval (CI) 1.291-13.543, p=0.017 and aOR 1.793, 95%CI 1.041-3.091, p=0.035, respectively]. But however, the difference was not found among residents without mobility-type pre-frailty/frailty. Conclusion: Low BMI was associated with high complex care needs among oldest old long-term care facilities male residents with mobility-type prefrailty/ frailty. Further intervention study is needed to reverse the low BMI and mobility-type pre-frailty/frailty.