Abstract
Objectives
Subjective health measures are often used to assess frailty, but the validity of self-reported
online tools to identify frailty remains to be established. We aimed to assess concurrent,
known-groups, convergent and predictive validity of the Centre of Excellence on Longevity
Self-AdMinistered (CESAM) questionnaire for frailty assessment of older adults in
an outpatient setting.
Design
Cross-sectional analysis of 120 participants.
Setting and Participants
Participants of age ≥65 were recruited from an outpatient geriatric clinic. Individuals
who had severe neurological, cognitive, or motor deficits were excluded.
Methods
We assessed concurrent validity with area under receiver operating characteristic
curve (AUC) against the Frailty Index (FI) and Clinical Frailty Scale (CFS). We analyzed
known-groups validity between CESAM scores with frailty status (CFS and FI), Modified
Barthel Index (MBI), and modified Chinese Mini-Mental State Examination (mCMMSE) using
1-way analysis of variance. We evaluated convergent validity using correlations with
MBI, the Lawton index, mCMMSE, and Geriatric Depression Scale (GDS). Associations
between CESAM-identified frailty for clinician-diagnosed geriatric syndromes, and
health-related quality of life (HRQoL) was analyzed using regression analysis.
Results
The CESAM questionnaire demonstrated excellent diagnostic performance for frailty
using FI ≥0.25 (AUC = 0.88; 95% CI: 0.82–0.94; P < .001) and CFS ≥4 (AUC = 0.78; 95% CI: 0.68–0.88; P < .001). CESAM scores increased significantly with increasing frailty (both CFS and
FI), lower MBI, and lower mCMMSE scores (all P < .001), indicating concurrent validity. The moderate-good correlation of CESAM scores
with MBI (r = −0.61; P < 0.001), Lawton Index (r = −0.54; P < .001), mCMMSE (r = −0.53; P < .001) and GDS (r = 0.58; P < .001) supports convergent validity. Using a cutoff of ≥8 for frailty identification,
CESAM-identified frailty was associated with cognitive impairment (OR = 3.7; 95% CI:
1.7–8.2; P = .001) depression (OR = 4.0; 95% CI: 1.7–9.6; P = .002), falls (OR = 3.1; 95% CI: 1.2–8.2; P = .021) and poorer HRQoL (β = −0.1; 95% CI: −0.2 to −0.02; P = .017).
Conclusion and Implications
Our results support the validity of an online self-reported tool to identify frailty
and geriatric syndromes in an outpatient setting, an approach that is potentially
applicable for remote screening of frailty.
Keywords
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Article info
Publication history
Published online: August 08, 2022
Accepted:
June 30,
2022
Received in revised form:
June 27,
2022
Received:
March 24,
2022
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
