Original Study| Volume 18, ISSUE 7, P583-587, July 01, 2017

Download started.


Screening for Frailty and Sarcopenia Among Older Persons in Medical Outpatient Clinics and its Associations With Healthcare Burden

Published:February 24, 2017DOI:



      With an aging population and increase in multimorbidity, the importance of screening for frailty and sarcopenia has become a public health priority. Several tools to do so exist. This study aimed to examine whether the SARC-F and Edmonton frail screening tools are useful in clinical practice to identify at-risk patients for negative health outcomes who would benefit from intervention.


      This is a cross-sectional study of patients attending medical specialist outpatient clinics at the National University Hospital, Singapore from May 2015 to February 2016.


      Frailty and sarcopenia were identified using the Edmonton Frail Scale and SARC-F questionnaires, respectively. Other clinically relevant data including basic demographics, presence of caregiver, number of follow-ups, medications and hospital readmissions in the past 1 year, Charlson comorbidity index, and modified Barthel index were collected from chart review.


      A total of 115 patients 65 years old and older were screened. Of the sample, 44.3% (n = 51) of patients were sarcopenic, whereas 27.0% (n = 31) were classified as frail; 23.5% (n = 27) were both frail and sarcopenic; and 87.1% of frail patients were sarcopenic, whereas 47.1% of sarcopenic patients were frail. Sarcopenia and frailty were associated with a higher Charlson comorbidity index, higher likelihood of requiring a caregiver, more medical specialty follow-ups, polypharmacy, more than 2 hospital admissions within a year, a higher number of falls and falls with serious consequences. This affected their perceived health status with 50.0% of robust patients rating their health excellent compared with 19.6% of sarcopenic patients (P < .001), 9.7% of frail patients (P < .001) and sarcopenic and frail patients scoring the lowest with 3.7% (P < .001).


      The prevalence of frailty and sarcopenia among older adults attending medical outpatient clinic is high. Both syndromes are predictors of recurrent hospital admissions, polypharmacy, multiple medical clinic appointments, higher rate of falls, and falls with serious consequences. Early identification of older adults at risk of adverse health outcomes would aid in instituting timely intervention to reduce healthcare burden and improve quality of life.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cesari M.
        • Prince M.
        • Thiyagarajan J.A.
        • et al.
        Frailty: An emerging public health priority.
        J Am Med Dir Assoc. 2016; 17: 188-192
        • Clegg A.
        • Young J.
        • Lliffe S.
        • et al.
        Frailty in elderly people.
        Lancet. 2013; 381: 752-762
        • Cesari M.
        • Landi F.
        • Vellas B.
        • et al.
        Sarcopenia and physical frailty: Two sides of the same coin.
        Front Aging Neurosci. 2014; 6: 192
        • Morley J.E.
        • Abbatecola A.M.
        • Argiles J.M.
        • et al.
        Sarcopenia with limited mobility: An international consensus.
        J Am Med Dir Assoc. 2011; 12: 403-409
        • Shamliyan T.
        • Talley K.M.
        • Ramakrishnan R.
        • Kane R.L.
        Association of frailty with survival: A systematic literature review.
        Ageing Res Rev. 2013; 12: 719-736
        • Morley J.E.
        Frailty: Diagnosis and management.
        J Nutr Health Aging. 2011; 15: 667-670
        • Rolland Y.
        • Czerwinski S.
        • Abellan Van Kan G.
        • et al.
        Sarcopenia: Its assessment, etiology, pathogenesis, consequences and future perspectives.
        J Nutr Health Aging. 2008; 12: 433-450
        • Rubenstein L.Z.
        • Josephson K.R.
        • Wieland G.D.
        • et al.
        Effectiveness of a geriatric evaluation unit. A randomized clinical trial.
        N Engl J Med. 1984; 311: 1664-1670
        • Van Craen K.
        • Braes T.
        • Wellens N.
        • et al.
        The effectiveness of inpatient geriatric evaluation and management units: A systematic review and meta-analysis.
        J Am Geriatr Soc. 2010; 58: 83-92
        • Stuck A.E.
        • Siu A.L.
        • Wieland G.D.
        • et al.
        Comprehensive geriatric assessment: A meta-analysis of controlled trials.
        Lancet. 1993; 342: 1032-1036
        • Morley J.E.
        • Vellas B.
        • van Kan G.A.
        • et al.
        Frailty consensus: A call to action.
        J Am Med Dir Assoc. 2013; 14: 392-397
        • Rockwood K.
        • Xiaowei S.
        • MacKnight C.
        • et al.
        A global clinical measure of fitness and frailty in elderly people.
        Can Med Assoc J. 2005; 173: 489-495
        • Sewo Sampaio P.Y.
        • Sampaio R.A.
        • Yamada M.
        • Arai H.
        Systematic review of the Kihon Checklist: Is it a reliable assessment of frailty?.
        Geriatr Gerontol Int. 2016; 16: 893-902
        • Vellas B.
        Implementing frailty screening, assessment, and sustained intervention: The experience of the Gérontopôle.
        J Nutr Health Aging. 2015; 19: 673-680
        • Morley John E.
        • Adams Erin V.
        Rapid geriatric assessment.
        J Am Med Dir Assoc. 2015; 16: 808-812
        • Woo J.
        • Leung J.
        • Morley J.E.
        Validating the SARC-F: A suitable community screening tool for sarcopenia?.
        J Am Med Dir Assoc. 2014; 15: 630-634
        • Malmstrom T.K.
        • Miller D.K.
        • Simonsick E.M.
        • et al.
        SARC-F: A symptom score to predict persons with sarcopenia at risk for poor functional outcomes.
        J Cachexia Sarcopenia Muscle. 2016; 7: 28-36
        • Malmstrom T.K.
        • Morley J.E.
        SARC-F: A simple questionnaire to rapidly diagnose sarcopenia.
        J Am Med Dir Assoc. 2013; 14: 531-532
        • Rolfson D.B.
        • Majumdar S.R.
        • Tsuyuki R.T.
        • et al.
        Validity and reliability of the Edmonton Frail Scale.
        Age Ageing. 2006; 35: 526-529
        • Morley J.E.
        • Malmstrom T.K.
        • Miller D.K.
        A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans.
        J Nutr Health Aging. 2012; 16: 601-608
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: Evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • Mijnarends D.M.
        • Schols J.M.
        • Meijers J.M.
        • et al.
        Instruments to assess sarcopenia and physical frailty in older people living in a community (care) setting: Similarities and discrepancies.
        J Am Med Dir Assoc. 2015; 16: 301-308
        • Ida S.
        • Murata K.
        • Nakadachi D.
        • et al.
        Development of a Japanese version of the SARC-F for diabetic patients: An examination of reliability and validity.
        Aging Clin Exp Res. Epub November 10, 2016;
        • Liccini A.
        • Malmstrom T.K.
        Frailty and sarcopenia as predictors of adverse health outcomes in persons with diabetes mellitus.
        J Am Med Dir Assoc. 2016; 17: 846-851
        • Satake S.
        • Senda K.
        • Hong Y.J.
        • et al.
        Validity of the Kihon checklist for assessing frailty status.
        Geriatr Gerontol Int. 2016; 16: 709-715
        • Philip K.E.
        • Alizad V.
        • Oates A.
        • et al.
        Development of EASY-Care, for brief standardized assessment of the health and care needs of older people: With latest information about cross-national acceptability.
        J Am Med Dir Assoc. 2014; 15: 42-46