The ability of eight frailty instruments to identify adverse outcomes across different settings: the FRAILTOOLS project

Abstract

Background To compare the performance of eight frailty instruments to identify relevant adverse outcomes for older people across different settings over a 12 month follow-up. Methods Observational longitudinal prospective study of people aged 75 + years enrolled in different settings (acute geriatric wards, geriatric clinic, primary care clinics, and nursing homes) across five European cities. Frailty was assessed using the following: Frailty Phenotype, SHARE-FI, 5-item Frailty Trait Scale (FTS-5), 3-item FTS (FTS-3), FRAIL scale, 35-item Frailty Index (FI-35), Gérontopôle Frailty Screening Tool, and Clinical Frailty Scale. Adverse outcomes ascertained at follow-up were as follows: falls, hospitalization, increase in limitation in basic (BADL) and instrumental activities of daily living (IADL), and mortality. Sensitivity, specificity, and capacity to predict adverse outcomes in logistic regressions by each instrument above age, gender, and multimorbidity were calculated. Results A total of 996 individuals were followed (mean age 82.2 SD 5.5 years, 61.3% female). In geriatric wards, the FI-35 (69.1%) and the FTS-5 (67.9%) showed good sensitivity to predict death and good specificity to predict BADL worsening (70.3% and 69.8%, respectively). The FI-35 also showed good sensitivity to predict BADL worsening (74.6%). In nursing homes, the FI-35 and the FTSs predicted mortality and BADL worsening with a sensitivity > 73.9%. In geriatric clinic, the FI-35, the FTS-5, and the FRAIL scale obtained specificities > 85% to predict BADL worsening. No instrument achieved high enough sensitivity nor specificity in primary care. All the instruments predict the risk for all the outcomes in the whole sample after adjusting for age, gender, and multimorbidity. The associations of these instruments that remained significant by setting were for BADL worsening in geriatric wards [

Development and validation of retrospective electronic frailty index using operational data of aged care homes

“…The average reFI of the dataset was 0.21 which shows that this cohort is overall frail (mild frail 0.13 < reFI≤0.26), whereas other studies have also reported that RAC (nursing) home residents are known to be frail [ 8 ]. It should be noted that a 6-month history was selected based on the literature [ 33 , 34 , 37 – 40 ], but the history timeline could be reduced as per the needs and requirements of RACs for tracking purposes. This should be done with caution as a few frailty deficits are evaluated for their persistence over time such as polypharmacy (require a history of more than 2 weeks to avoid erroneous inclusion of antibiotics in polypharmacy), chronic pain (requires pain issues for consecutive 3 months [ 46 , 47 ]) and weight loss (weight loss within 6 months [ 33 , 48 ]).…”

“…In the final reFI, eleven domains were identified that consisted of 32 frailty deficits or syndromes (Table 2 , further details are reported in Additional file 1 ). It should be noted that “ housebound ” and “ requirement for care ” deficits from Clegg’s list applied to all the residents at RACs i.e., residents in RACs are generally housebound and may require assistance for their daily routine work [ 33 , 34 ]. So “ requirement for care ” in terms of assistance was reflected in the selected frailty deficits for RACs, whose details are found in Additional file 1 .…”

“…Deficits that could be addressed by intervention, in order to reverse the health deterioration e.g., pain, polypharmacy, weight loss, etc. were associated with a 6 months history [33,34,[37][38][39][40]. A five-year medical history was considered for the deficits that can permanently impact the health of the residents, e.g., cardiac disease, cancer, thyroid, etc.…”

“…This limit was enforced as at least 6 months history was required for computing reFI [39,40]; the remainder of the duration was used to track changes in the frailty index for the residents. It should be noted that the 6 month timeline was selected as it was the shortest time window found in the literature for calculating frailty [33,34,[37][38][39][40]. Moreover, residents with missing data sources, e.g., assessments and observational charts, etc.…”

The Impact of Glucose-Lowering Strategy on the Risk of Increasing Frailty Severity among 49,519 Patients with Diabetes Mellitus: A Longitudinal Cohort Study

“…FRAIL scale was coined since 2012 as an easy-to-administer instrument for identifying frail adults, and its results exhibited excellent correlation with those using the Fried's criteria [16] and other instruments [17]. Individuals with FRAIL-detected frailty (≥3 positive components) had an increased risk of mortality, disability, fall, institutionalization, and other geriatric syndrome development compared to robust ones [18][19][20]. FRAIL scale has been validated for its applicability in younger populations, including those with morbidities such as CKD or DM [21].…”