The construction of an evaluation index system for the health vulnerability of frail and vulnerable older persons in nursing homes: a Delphi study.

BACKGROUND: Given the physiological decline in late life, coupled with an elevated risk of various diseases and anticipated adverse events, frail and vulnerable older persons in nursing homes are a principal group that is vulnerable to health risks, thereby manifesting a triple vulnerability comprising "physical-mental-economic" aspects. However, standardized assessments of health vulnerability in frail and vulnerable older persons within nursing homes in China are currently lacking, and an evaluation index system has not yet been undeveloped. Therefore, the aim of this study was to construct an index system for comprehensively evaluating the health vulnerability of frail and vulnerable older persons in nursing homes, aiming to offer personalized elderly care services as a reference for predicting health vulnerability risks among this demographic population. METHODS: On the basis of the "sensitivity‒response capacity" vulnerability analysis framework, multidimensional risk indicators for health vulnerability were preliminarily established through policy literature analysis and semistructured interviews. Between April and August 2023, a Delphi study involved 20 expert representatives from four provinces and municipalities, spanning multiple research domains, for participation. Using a five-point Likert scale, they assessed the value of predefined indicators and provided qualitative feedback. Subsequent to each round of expert input, revisions were enacted upon the evaluation index system. RESULTS: After three rounds of expert consultation, a consensus on the evaluation index system was reached; it contains two primary indicators, individual sensitivity and antifragility capacity, with 12 affiliated secondary indicators and 56 tertiary indicators. The expert authority coefficients ranged from 0.934 to 0.935, and Kendall's coefficient of concordance ranged from 0.310 to 0.360. These differences were statistically significant (P < 0.05). CONCLUSION: The evaluation index system for assessing the health vulnerability of frail and vulnerable older persons in nursing homes developed in this study covers a range of health threats and indicators of health coping capacity faced by frail and vulnerable older persons from individual to societal perspectives. This evaluation index system employs the "sensitivity‒responsiveness" vulnerability analysis framework, addressing the limitations of single-dimensional assessment indicators in capturing a comprehensive overview. This study provides a novel research perspective for assessing health vulnerability in frail and vulnerable older persons. This evaluation index system provides a practical tool for nursing home staff to assess health vulnerability, enabling early risk identification and targeted interventions. Policy-makers and administrators can use it to optimize resource allocation and enhance elderly care services. Future research should validate its real-world applicability and integrate it into existing health monitoring and intervention programs to improve older persons' health outcomes.