Abstract
Objective
To determine which of 8 commonly employed frailty assessment tools demonstrate the
most appropriate characteristics to be employed in different clinical and social settings.
Design
Cross-sectional multicenter European-based study.
Setting and Participants
1440 patients aged ≥75 years evaluated in geriatric inpatient wards, geriatric outpatient
clinics, primary care clinics, and nursing homes.
Methods
The frailty instruments used were Frailty Phenotype, SHARE-FI, 3-item Frailty Trait
Scale (FTS-3), 5-item Frailty Trait Scale (FTS-5), FRAIL, 35-item Frailty Index (FI-35),
Gérontopôle Frailty Screening Tool (GFST), and Clinical Frailty Scale (CFS). The settings
were geriatrics wards, outpatient clinics, primary care, and nursing homes. Suitability
was evaluated by considering the feasibility (patients with the test fully completed),
administration time (time spent for administering the test), and interscale agreement
(Cohen kappa index among instruments to detect frailty).
Results
The prevalence of frailty varied across settings and adopted tests. The scales with
the mean highest feasibility were the FRAIL scale (99.4%), SHARE-FI (98.3%), and GFST
(95.0%). The mean shortest administration times were obtained with CFS (24 seconds),
GFST (72 seconds), and FRAIL scale (90 seconds). The interscale agreement between
most of the tests was fair. CFS followed by FTS-5 agreed at least moderately with
a greater number of scales overall and in almost all settings.
Conclusions and Implications
Based on feasibility, time to undertake the tool, and agreement with other scales,
different scales would be recommended according to the setting considered. Our findings
suggest that most of the tools evaluated are actually assessing different frailty
constructs.
Keywords
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 accessOne-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:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Screening for frailty and sarcopenia among older persons in medical outpatient clinics and its associations with healthcare burden.J Am Med Dir Assoc. 2017; 18: 583-587
- Facilitating frailty identification in clinical practice: Comparison of two methods among community-dwelling older adults.J Am Geriatr Soc. 2012; 3: 216-221
- Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality.J Am Geriatr Soc. 2013; 61: 1537-1551
- Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments.Ageing Res Rev. 2016; 26: 53-61
- FRAILTOOLS study protocol: A comprehensive validation of frailty assessment tools to screen and diagnose frailty in different clinical and social settings and to provide instruments for integrated care in older adults.BMC Geriatr. 2019; 19: 86
- Frailty in older adults: Evidence for a phenotype.J Gerontol Biol Sci Med Sci. 2001; 56A: M146-M156
- The Frailty Phenotype and the Frailty Index: Different instruments for different purposes.Age Ageing. 2014; 43: 10-12
- Components of the Frailty Phenotype in relation to the Frailty Index: Results from the Toulouse frailty platform.J Am Med Dir Assoc. 2015; 16: 855-859
- The SHARE frailty instrument for primary care predicts incident disability in a European population-based sample.Qual Prim Care. 2011; 19: 301-309
- A new operational definition of frailty: The Frailty Trait Scale.J Am Med Dir Assoc. 2014; 15: 371.e7-371.e13
- Frailty Trait Scale–Short Form: A frailty instrument for clinical practice.J Am Med Dir Assoc. 2020; 21: 1260-1266
- The I.A.N.A. Task Force on frailty assessment of older people in clinical practice.J Nutr Health Aging. 2008; 12: 29-37
- FRAIL scale as a predictor of complications and mortality in older patients undergoing reconstructive surgery for non-melanoma skin cancer.Oncol Lett. 2019; 17: 263-269
- Frailty measurement in research and clinical practice: A review.Eur J Intern Med. 2016; 31: 3-10
- A standard procedure for creating a Frailty Index.BMC Geriatr. 2008; 8: 24
- Disability and co-morbidity in relation to frailty: How much do they overlap?.Arch Gerontol Geriatr. 2012; 55: e1-e8
- Looking for frailty in community-dwelling older persons: The Gerontopole Frailty Screening Tool (GFST).J Nutr Health Aging. 2013; 17: 629-631
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
- Frailty in relation to the risk of falls, fractures, and mortality in older Chinese adults: Results from the Beijing longitudinal study of aging.J Nutr Health Aging. 2012; 16: 903-907
- Functional evaluation: The Barthel Index.Md State Med J. 1965; 14: 61-65
- Assessment of older people: Self-maintaining and instrumental activities of daily living.Gerontologist. 1969; 3: 179-186
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.J Chronic Dis. 1987; 40: 373-383
- Reliability of physical findings.in: McGee S.R. Evidence-Based Physical Diagnosis. 3rd ed. Elsevier, Philadelphia, PA2012: 29-39
- A language and environment for statistical computing. R Foundation for Statistical Computing. 2018.(Available at:)
- Prevalence of frailty at population level in European ADVANTAGE Joint Action Member States: A systematic review and meta-analysis.Ann Ist Super Sanità. 2018; 54: 226-238
- State of the art report on the prevention and management of frailty. 2018.(Available at:)http://www.advantageja.eu/images/SoAR-AdvantageJA_Full-text.pdfDate accessed: March 22, 2020
- Use of the electronic Frailty Index to identify vulnerable patients: A pilot study in primary care.Br J Gen Pract. 2017; 67: e751-e756
- Frailty screening and interventions: Considerations for clinical practice.Clin Geriatr Med. 2018; 34: 25-38
- Clinical Frailty Scale in an acute medicine unit: A simple tool that predicts length of stay.Can Geriatr J. 2016; 19: 34-39
- Fried Frailty Phenotype assessment components as applied to geriatric inpatients.Clin Interv Aging. 2016; 11: 453-459
- Agreement between 35 published frailty scores in the general population.Am J Epidemiol. 2017; 186: 420-434
- The identification of frail older adults in primary care: Comparing the accuracy of five simple instruments.Age Ageing. 2013; 42: 262-265
- Relationship between sarcopenia and frailty in the Toledo study of healthy aging: A population based cross-sectional study.J Am Med Dir Assoc. 2018; 19: 282-286
- Subtypes of physical frailty and their long-term outcomes: A longitudinal cohort study.J Cachexia Sarcopenia Muscle. 2020 June 18; ([Epub ahead of print])
- Frailty parameters, morbidity and mortality in older adults with cancer: A structural equation modelling approach based on the fried phenotype.J Clin Med. 2020; 9: 1826
- Predicting risk and outcomes for frail older adults: An umbrella review of frailty screening tools.JBI Database Syst Rev Implement Rep. 2017; 15: 1154-1208
- Validity, reliability and feasibility of tools to identify frail older patients in inpatient hospital care: A systematic review.J Nutr Health Aging. 2016; 20: 218-230
- Measuring frailty in clinical practice: A comparison of physical frailty assessment methods in a geriatric out-patient clinic.BMC Geriatr. 2017; 17: 264
- The feasibility of assessing frailty and sarcopenia in hospitalised older people: A comparison of commonly used tools.BMC Geriatr. 2019; 19: 42
- Prevalence of frailty in community-dwelling older persons: A systematic review.J Am Geriatr Soc. 2012; 60: 1482-1492
- Screening tools for frailty in primary health care: A systematic review.Geriatr Gerontol Int. 2012; 12: 189-197
- Frailty in nursing homes: The FRAIL-NH scale.J Am Med Dir Assoc. 2015; 16: 87-89
Article info
Publication history
Published online: November 05, 2020
Footnotes
This study was supported by contract 662887 of the Third Program of DG-SANTE, European Union’s Health programme (2014-2020). The funding body did not have any role in the design, methods, subject recruitment, data collections, analysis, and preparation of the article.
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
