Instrumentos para medir la capacidad funcional intrínseca y la fragilidad de personas mayores en la Atención Primaria en Chile

Abstract

Instruments to assess functional capacity and the presence of frailty in older peopleBackground: The evaluation of functional capacity and the presence of frailty is an essential prognostic indicator in older people. Aim: To explore the instruments used to characterize the intrinsic functional capacity (CFI) and frailty in elderly people cared at Primary Health Care Centers (PHC) in Chile. Material and Methods: A narrative review of national and international scientific literature was carried out, including observational studies published in Pubmed (since 2015) and Scielo (since 2010) about tools to assess CFI or frailty. Studies in English or Spanish carried out in Chilean beneficiaries of PHC aged 60 years and over, were included. Results: After the first search, 110 articles were selected in Pubmed and 86 in Scielo. According to the relevance of the title and abstract, 36 articles were preliminarily screened, of which 25 were selected for full reading, 12 of which were finally included in this review. In Chile, the main instrument used to assess CFI is the Functional Examination of the Elderly (EFAM). There are few national studies to assess frailty and the instruments used are mainly based on the Fried criteria and the FTI (Frailty Tilburg Indicator). The reviewed studies suggest improving the coverage and reconsidering the predictive capacity of the measurements used for the assessment of CFI and frailty in older people, suggesting the incorporation of handgrip strength as a predictor of frailty. Conclusions: The main instruments to assess CFI and frailty in older people cared in PHC in Chile are the EFAM, and the Fried and FTI criteria, respectively.

Factors Associated with Frailty in Older Adults in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis

“…Regarding the Frail scale, its frailty assessment is predominantly conducted within community populations; the Clinical Frailty Scale and the EFS assessments are primarily conducted in hospital or clinical settings, which diverges from the findings of this study. In contrast, the KCL, FSS, GFI, and TFI are applicable in both community and clinical settings [6,7,10,64]. However, it is noteworthy that in the nursing home environment, the studies included in this research did not use the FRAIL-NH tool, which is specifically tailored for assessing frailty in nursing-home populations [65,66].…”

“…However, a globally standardized assessment tool remains to be established [6,7]. Assessment instruments for frailty are commonly categorized into two distinct groups: the unidimensional, which primarily addresses physical and physiological dimensions, exemplified by the Fried frailty criteria underpinning the Cardiovascular Health Study Index (CHS), or the Physical Frailty Phenotype (PFP); and the multidimensional, encompassing the intricate interplay of physical, psychological, and social dimensions, as seen in tools like the Deficit Accumulation Index (DAI) and the Edmonton Frail Scale (EFS) [6,[8][9][10]. Additionally, it is worth noting that not only do these dimensions of frailty reflect the health status of older adults, but physical, psychological, and social frailty have also been found to be predictive of heart failure, underscoring the multifaceted impact of frailty on overall health outcomes [11].…”