Commonly Used Screening Instruments to Identify Frailty Among Community-Dwelling Older People in a General Practice (Primary Care) Setting: A Study of Diagnostic Test Accuracy

Abstract Background Rapid frailty screening remains problematic in primary care. The diagnostic test accuracy (DTA) of several screening instruments has not been sufficiently established. We evaluated the DTA of several screening instruments against two reference standards: Fried’s Frailty Phenotype [FP] and the Adelaide Frailty Index [AFI]), a self-reported questionnaire. Methods DTA study within three general practices in South Australia. We randomly recruited 243 general practice patients aged 75+ years. Eligible participants were 75+ years, proficient in English and community-dwelling. We excluded those who were receiving palliative care, hospitalized or living in a residential care facility. We calculated sensitivity, specificity, predictive values, likelihood ratios, Youden Index and area under the curve (AUC) for: Edmonton Frail Scale [EFS], FRAIL Scale Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC], Polypharmacy [POLY], PRISMA-7 [P7], Reported Edmonton Frail Scale [REFS], Self-Rated Health [SRH] and Timed Up and Go [TUG]) against FP [3+ criteria] and AFI [>0.21]. Results We obtained valid data for 228 participants, with missing scores for index tests multiply imputed. Frailty prevalence was 17.5% frail, 56.6% prefrail [FP], and 48.7% frail, 29.0% prefrail [AFI]. Of the index tests KC (Se: 85.0% [70.2–94.3]; Sp: 73.4% [66.5–79.6]) and REFS (Se: 87.5% [73.2–95.8]; Sp: 75.5% [68.8–81.5]), both against FP, showed sufficient diagnostic accuracy according to our prespecified criteria. Conclusions Two screening instruments—the KC and REFS, show the most promise for wider implementation within general practice, enabling a personalized approach to care for older people with frailty.

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Diagnostic test accuracy of self-reported frailty screening instruments in identifying community-dwelling older people at risk of frailty and pre-frailty

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/jbisrir-2017-003363 ◽

2017 ◽

Vol 15 (10) ◽

pp. 2464-2468 ◽

Cited By ~ 6

Author(s):

Rachel C. Ambagtsheer ◽

Mark Q. Thompson ◽

Mandy M. Archibald ◽

Mavourneen G. Casey ◽

Timothy J. Schultz

Keyword(s):

At Risk ◽

Older People ◽

Diagnostic Test ◽

Community Dwelling ◽

Diagnostic Test Accuracy ◽

Test Accuracy ◽

Screening Instruments ◽

Community Dwelling Older People

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Diagnostic test accuracy of self‐reported screening instruments in identifying frailty in community‐dwelling older people: A systematic review

Geriatrics and Gerontology International ◽

10.1111/ggi.13810 ◽

2019 ◽

Vol 20 (1) ◽

pp. 14-24

Author(s):

Rachel C Ambagtsheer ◽

Mark Q Thompson ◽

Mandy M Archibald ◽

Mavourneen G Casey ◽

Timothy J Schultz

Keyword(s):

Systematic Review ◽

Older People ◽

Diagnostic Test ◽

Community Dwelling ◽

Diagnostic Test Accuracy ◽

Test Accuracy ◽

Screening Instruments ◽

Community Dwelling Older People

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Feasibility, acceptability and diagnostic test accuracy of frailty screening instruments in community-dwelling older people within the Australian general practice setting: a study protocol for a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2017-016663 ◽

2017 ◽

Vol 7 (8) ◽

pp. e016663 ◽

Cited By ~ 10

Author(s):

Rachel Ambagtsheer ◽

Renuka Visvanathan ◽

Matteo Cesari ◽

Solomon Yu ◽

Mandy Archibald ◽

...

Keyword(s):

General Practice ◽

Diagnostic Test ◽

Frailty Index ◽

Community Dwelling ◽

Diagnostic Test Accuracy ◽

Test Accuracy ◽

Screening Instruments ◽

Frailty Phenotype ◽

Predictive Values ◽

Increased Risk

IntroductionFrailty is one of the most challenging aspects of population ageing due to its association with increased risk of poor health outcomes and quality of life. General practice provides an ideal setting for the prevention and management of frailty via the implementation of preventive measures such as early identification through screening.Methods and analysisOur study will evaluate the feasibility, acceptability and diagnostic test accuracy of several screening instruments in diagnosing frailty among community-dwelling Australians aged 75+ years who have recently made an appointment to see their general practitioner (GP). We will recruit 240 participants across 2 general practice sites within South Australia. We will invite eligible patients to participate and consent to the study via mail. Consenting participants will attend a screening appointment to undertake the index tests: 2 self-reported (Reported Edmonton Frail Scale and Kihon Checklist) and 5 (Frail Scale, Groningen Frailty Index, Program on Research for Integrating Services for the Maintenance of Autonomy (PRISMA-7), Edmonton Frail Scale and Gait Speed Test) administered by a practice nurse (a Registered Nurse working in general practice). We will randomise test order to reduce bias. Psychosocial measures will also be collected via questionnaire at the appointment. A blinded researcher will then administer two reference standards (the Frailty Phenotype and Adelaide Frailty Index). We will determine frailty by a cut-point of 3 of 5 criteria for the Phenotype and 9 of 42 items for the AFI. We will determine accuracy by analysis of sensitivity, specificity, predictive values and likelihood ratios. We will assess feasibility and acceptability by: 1) collecting data about the instruments prior to collection; 2) interviewing screeners after data collection; 3) conducting a pilot survey with a 10% sample of participants.Ethics and disseminationThe Torrens University Higher Research Ethics Committee has approved this study. We will disseminate findings via publication in peer-reviewed journals and presentation at relevant conferences.

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A systematic review of brief screeners for suicidal behaviour in primary care

10.21203/rs.2.14068/v2 ◽

2019 ◽

Author(s):

Karoline Lukaschek ◽

Milena Frank ◽

Kathrin Halfter ◽

Antonius Schneider ◽

Jochen Gensichen

Keyword(s):

Primary Care ◽

Suicidal Ideation ◽

Diagnostic Accuracy ◽

Diagnostic Test ◽

Suicidal Behaviour ◽

Risk Of Bias ◽

Diagnostic Test Accuracy ◽

Cochrane Library ◽

Test Accuracy ◽

Index Tests

Abstract Background: As primary contacts, general practitioners can play a pivotal role in identifying suicidal behaviour in their patients. A brief instrument could help in identifying vulnerable patients. We summarized the available studies reporting diagnostic accuracy of short screening instruments for suicidal behaviour in primary care or the general population in a narrative synthesis. Methods: The databases MEDLINE, EMBASE, PsychINFO, PSYNDEX, and Cochrane Library were searched in January 2019 without any time constraints. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. The certainty of evidence was rated via GRADEpro. The authors followed the PRISMA extensions for Diagnostic Test Accuracy Studies. Results: We identified a total of 9 969 studies with our search strategy. After the selection process, six relevant studies fulfilled all criteria and were included. They used the following index tests: Kessler Psychological Distress Scale, Suicidal Ideation Screening Questionnaire, Suicidal Ideation Attributes Scale, Gate question suicide attempt, Gate question suicidal ideation, Feeling suicidal, Wishing you were dead, Thoughts of death and Patient-Health-Questionaire-9 - item 9. The diagnostic accuracy measurements sensitivity and specificity had a wide range (sensitivity: 26% - 100%, specificity: 64% - 99%). Risk of bias was rated moderate and concerns regarding applicability acceptable. A required sensitivity of at least 80% and specificity of 50% with a moderate to high GRADE rating was achieved by six of nine index tests. Conclusions: The identified studies were heterogeneous regarding sample size, index test and reference standard. Even though screening of suicidal behaviour in primary care is already recommended by several guidelines, there are only few screeners in primary care that have been examined regarding their diagnostic accuracy. Although they can assist GPs in their judgement of suicidal behaviour of patients at risk, the final assessment is always based on the clinical judgement of the attending physician. Further diagnostic test accuracy studies of promising short questionnaires are needed. Registration: The study protocol was registered at PROSPERO (ID: CRD42019122173).

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