Introduction:
Objective screening for frailty is seldom performed because existing tools are time consuming and usually applied post-hoc. Implementation of efficient and feasible frailty screening approaches within clinic is needed.
Purpose and hypothesis:
We implemented grip strength measurement as a frailty screening tool in a cardiovascular clinic setting and compared this to existing frailty assessment tools, including the modified frailty index-5 (mFI-5) and -11 (mFI-11). We hypothesized that grip strength would be comparable to the mFI-5 and -11, associated with common adverse events including urinary incontinence (UI) and falls, and increased diagnosis of frailty would occur as a result implementation.
Methods:
Grip strength measurement was integrated into clinic intake to screen for weakness, a frailty component. Measurements were performed routinely for cardiovascular clinic visits and entered into the EMR data field. Categorical frailty was assessed based on 20
th
percentile for grip strength (kg) adjusted for gender and BMI. A “dotphrase” statement was built to streamline clinical documentation, and quarterly newsletters were used to disseminate coding and other related information. Categorical tests were used to evaluate associations between grip, weakness, and other measures of frailty.
Results:
A total of 4,447 unique patients had grip strength measured. Mean age was 63.3±15.6, BMI 29.6±7.0, 47.6% (n=2,115) were female, and 86.5% were Caucasian/White. Based on grip strength, 34.6% (n=1,538) were weak, and 22.0% (n=980) and 16.9% (n=754) were frail based on mFI-5 and mFI-11, respectively. Less than 10% (n=408, 9.25%) had a history of falls and 39 (0.88%) had UI. Falls were associated with weakness (P<0.001) but UI was not. Only 45 (1.01%) had a coded frailty diagnosis in the EMR. Among those with a frailty diagnosis, 35 (77.8%) were considered frail by grip. The negative predictive value (NPV) of the grip strength when mFI-5 is used as the gold standard is 0.84.
Conclusions:
Grip strength is both feasible and practical for frailty screening in clinical environments. Mismatch between screening-based and coding-based frailty prevalence suggests an opportunity to improve risk screening through routine grip strength assessment.
Stimulated grip strength measurement: Validation of a novel method for functional assessment
