Discordance in Frailty Measures in Old Community Dwelling People with Multimorbidity – A Cross-Sectional Study

Abstract

Purpose Assessment of frailty is a key method to identify older people in need of holistic care. However, agreement between different frailty instrument varies. Thus, groups classified as frail by different instruments are not completely overlapping. This study evaluated differences in sociodemographic factors, cognition, functional status, and quality of life between older persons with multimorbidity who were discordantly classified by five different frailty instruments, with focus on the Clinical Frailty Scale (CFS) and Fried’s Frailty Phenotype (FP). Participants and Methods This was a cross-sectional study in a community-dwelling setting. Inclusion criteria were as follows: ≥75 years old, ≥3 visits to the emergency department the past 18 months, and ≥3 diagnoses according to ICD-10. 450 participants were included. Frailty was assessed by CFS, FP, Short Physical Performance Battery (SPPB), Grip Strength and Walking Speed. Results 385 participants had data on all frailty instruments. Prevalence of frailty ranged from 34% (CFS) to 75% (SPPB). Nine percent of participants were non-frail by all instruments, 20% were frail by all instruments and 71% had discordant frailty classifications. Those who were frail according to CFS but not by the other instruments had lower cognition and functional status. Those who were frail according to FP but not CFS were, to a larger extent, women, lived alone, had higher cognitive ability and functional status. Conclusion The CFS might not identify physically frail women in older community-dwelling people with multimorbidity. They could thus be at risk of not be given the attention their frail condition need.

Assessing frailty amongst older people admitted to hospital in a low-income setting: a multicentre study in northern Tanzania

“…A range of tools exist for its measurement, two of the most widely utilised being Rockwood’s Clinical Frailty Scale and Fried’s Frailty Phenotype [ 6 , 9 , 10 ]. Different conceptions of frailty underpin these instruments, and consequently they (and the myriad of other available tools) produce differing estimates of prevalence [ 11 ]. Irrespective of which tool is used, in studies from High-Income Countries (HICs), older adults living with frailty who are admitted to hospital experience longer admissions, greater functional decline and higher mortality [ 12 ].…”