CONSTRUCT VALIDITY OF FOUR FRAILTY MEASURES IN AN OLDER AUSTRALIAN POPULATION: A RASCH ANALYSIS

Individuals identified as frail have been shown to be at an increased risk of adverse health outcomes. However, there is no gold standard frailty measure and frailty status can vary depending on the measure used, suggesting the measures perform differently. Construct validity can be used to assess a measure’s performance. This study aimed to examine the construct validity of four frailty measures in an Australian older population using Rasch analysis. Frailty status among the 2087 participants aged 65 years and above from the Australian Longitudinal Study of Ageing (ALSA) was assessed using: frailty phenotype - FP, simplified frailty phenotype - SFP, frailty index - FI, and prognostic frailty score – PFS. Rasch analysis was used to assess the unidimensionality of the measures, which is the extent to which the underlying characteristic of frailty is assessed. The criteria for unidimensionality from principal component analysis of the residuals was when 50% or more of the raw variance was explained by the measures, and less than 5% was unexplained variance. Only FI meet the unidimensionality criteria with 74% of explained variance and 2.1% of unexplained variance. SFP did not show a unidimensional construct with 13.3% of explained variance and 47.1% of unexplained variance. FP and PFS had 39.6%, 18.1% and 46.5%, 8.7% of explained and unexplained variance, respectively. Our findings showed that FI has better construct validity than the other three measures in assessing frailty among the Australian older population.

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Frailty Status and All-Cause Mortality in the Community-Dwelling Older People: An Umbrella Review

Innovation in Aging ◽

10.1093/geroni/igaa057.1580 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 488-489

Author(s):

A R M Saifuddin Ekram ◽

Joanne Ryan ◽

Carlene Britt ◽

Sara Espinoza ◽

Robyn Woods

Keyword(s):

Older People ◽

Systematic Reviews ◽

Community Dwelling ◽

Umbrella Review ◽

Frailty Phenotype ◽

Frailty Status ◽

Increased Risk ◽

All Cause Mortality ◽

Community Dwelling Older People ◽

Meta Analyses

Abstract Frailty is increasingly recognised for its association with adverse health outcomes including mortality. However, various measures are used to assess frailty, and the strength of association could vary depending on the specific definition used. This umbrella review aimed to map which frailty scale could best predict the relationship between frailty and all-cause mortality among community-dwelling older people. According to the PRISMA guidelines, Medline, Embase, EBSCOhost and Web of Science databases were searched to identify eligible systematic reviews and meta-analyses which examined the association between frailty and all-cause mortality in the community-dwelling older people. Relevant data were extracted and summarised qualitatively. Methodological quality was assessed by AMSTAR-2 checklist. Five moderate-quality systematic reviews with a total of 374,529 participants were identified. Of these, two examined the frailty phenotype and its derivatives, two examined the cumulative deficit models and the other predominantly included studies assessing frailty with the FRAIL scale. All of the reviews found a significant association between frailty status and all-cause mortality. The magnitude of association varied between individual studies, with no consistent pattern related to the frailty measures that were used. In conclusion, regardless of the measure used to assess frailty status, it is associated with an increased risk of all-cause mortality.

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20 Comparison of Six Frailty Screening Tools in Patients Aged 65+ with An Arm Fragility Fracture

Age and Ageing ◽

10.1093/ageing/afab028.20 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i1-i6

Author(s):

K Ibrahim ◽

T Lim ◽

M A Mullee ◽

G L Yao ◽

S Zhu ◽

...

Keyword(s):

Fragility Fracture ◽

Frailty Index ◽

Screening Tools ◽

Frailty Phenotype ◽

Fracture Clinic ◽

Increased Risk ◽

Sensitivity Range ◽

Practical Tool ◽

Acute Trust ◽

Medication Changes

Abstract Introduction Frailty is associated with an increased risk of falling and fracture, but not routinely assessed in fracture clinic. Early identification and management of frailty among older people with arm fragility fracture could help avoid further falls and fractures, especially of the hip. We evaluated the feasibility of assessing frailty in a busy fracture clinic. Methods People aged 65+ years with an arm fracture in one acute trust were recruited. Frailty was assessed in fracture clinics using six tools: Fried Frailty Phenotype (FFP), FRAIL scale, PRISMA-7, electronic Frailty Index (e-FI), Clinical Frailty Score (CFS), and Study of Osteoporotic Fracture (SOF). The sensitivity and specificity of each tool was compared against FFP as a reference. Participants identified as frail by 2+ tools were referred for Comprehensive Geriatric Assessment (CGA). Results 100 patients (mean age 75 years±7.2; 20 men) were recruited. Frailty prevalence was 9% (FRAIL scale), 13% (SOF), 14% (CFS > 6), 15% (FFP; e-FI > 0.25), and 25% (PRISMA-7). Men were more likely to be frail than women. Data were complete for all assessments and completion time ranged from one minute (PRISMA-7; CFS) to six minutes for the FFP which required most equipment. Comparing with FFP, the most accurate instrument for stratifying frail from non-frail was the PRISMA-7 (sensitivity = 93%, specificity = 87%) while the remaining tools had good specificity (range 93%–100%) but average sensitivity (range 40%–60%). Twenty patients were eligible for CGA. Five had recently had CGA and 11/15 referred were assessed. CGA led to 3–6 interventions per participant including medication changes, life-style advice, investigations, and onward referrals. Conclusion It was feasible to assess frailty in fracture clinic and to identify patients who benefitted from CGA. Frailty prevalence was 9%—25% depending on the tool used and was higher among men. PRISMA-7 could be a practical tool for routine use in fracture clinics.

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444Frailty status and all-cause mortality in the community-dwelling individuals: An umbrella review

International Journal of Epidemiology ◽

10.1093/ije/dyab168.190 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

A R M Saifuddin Ekram ◽

Joanne Ryan ◽

Carlene Britt ◽

Sara Espinoza ◽

Robyn Woods

Keyword(s):

Systematic Reviews ◽

Critical Appraisal ◽

Frailty Index ◽

Community Dwelling ◽

Umbrella Review ◽

Deficit Accumulation ◽

Frailty Phenotype ◽

Essential Information ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Frailty is increasingly recognised for its association with adverse health outcomes, including mortality. However, various measures are used to assess frailty, and the strength of association could vary depending on the specific definition used. This umbrella review aims to map which frailty scale can best predict the relationship between frailty and all-cause mortality among community-dwelling older people. Methods A protocol was registered at PROSPERO, and it was conducted following the PRISMA statement. MEDLINE, Embase, PubMed, Cochrane Database of Systematic Reviews, Joanna Briggs Institute (JBI) EBP database, and Web of Science database was searched. Methodological quality was assessed using the JBI critical appraisal checklist and online AMSTAR-2 critical appraisal checklist. For eligible studies, essential information was extracted and synthesized qualitatively. Results Five systematic reviews were included, with a total of 434,115 participants. Three systematic reviews focused on single frailty scales; one evaluated Fried's physical frailty phenotype and its modifications; another focused on the deficit accumulation frailty index. The third evaluated the FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale. The two other systematic reviews determined the association between frailty and mortality using different frailty scales. All of the systematic reviews found that frailty was significantly associated with all-cause mortality. Conclusion This umbrella review demonstrates that frailty is a significant predictor of all-cause mortality, irrespective of the specific frailty scale. Key messages Frailty is associated with an increased risk of all-cause mortality in community-dwelling individuals signifying the importance of assessment in the primary healthcare setting.

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Frailty and Mortality in a Community-Dwelling Relatively Healthy Older Population

Innovation in Aging ◽

10.1093/geroni/igab046.2187 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 573-573

Author(s):

A R M Saifuddin Ekram ◽

Joanne Ryan ◽

Sara Espinoza ◽

Michael Ernst ◽

Anne Murray ◽

...

Keyword(s):

Older Adults ◽

Cox Regression ◽

Multinomial Logistic Regression ◽

Frailty Index ◽

Community Dwelling ◽

Deficit Accumulation ◽

Healthy Older Adults ◽

Frailty Status ◽

Increased Risk ◽

Related Mortality

Abstract This study examined factors associated with frailty and studied the association between frailty status and mortality in healthy community-dwelling older persons. Participants included 19,114 individuals from the “ASPirin in Reducing Events in the Elderly” (ASPREE) trial. Frailty was defined using modified Fried phenotype comprising exhaustion, body mass index, grip strength, gait speed and physical activity. A deficit accumulation frailty index (FI) using 66 items was also developed. Correlates of frailty were examined using multinomial logistic regression. The association between frailty status at baseline and mortality was analyzed using Cox regression. At baseline, 39.0% (95% CI: 38.3, 39.7) of participants were prefrail, and 2.2% (95% CI: 2.0, 2.4) were frail according to Fried phenotype, while 40.6% (95% CI: 40.0, 41.3) of participants were pre-frail and 8.1% (95% CI: 7.7, 8.5) were frail according to FI. Older age, female sex, lower education, African-American and Hispanic ethno-racial status, smoking, alcohol use, comorbidities, and polypharmacy were associated with frailty status. Pre-frailty increased risk of all-cause mortality significantly (Fried HR: 1.48; 95% CI: 1.28, 1.71; FI HR: 1.54; 95% CI: 1.31, 1.81); and the risk was even higher for frailty (Fried HR: 2.24; 95% CI: 1.67, 3.00; FI HR: 2.34; 95% CI: 1.83, 2.99) after adjustment for covariates. Cardiovascular disease (CVD) and non-CVD-related mortality showed similar trends. These results highlight a considerable burden of pre-frailty among a large group of community-dwelling, initially healthy older adults. Both Fried phenotype and deficit accumulation FI similarly predicted all-cause, CVD and non-CVD-related mortality in relatively healthy older adults.

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Frailty in Older Adults With Multiple Myeloma: A Study of US Veterans

JCO Clinical Cancer Informatics ◽

10.1200/cci.19.00094 ◽

2020 ◽

pp. 117-127

Author(s):

Bindiya G. Patel ◽

Suhong Luo ◽

Tanya M. Wildes ◽

Kristen M. Sanfilippo

Keyword(s):

Multiple Myeloma ◽

Administrative Data ◽

Proportional Hazards ◽

Frailty Index ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Frailty Status ◽

Patients With Cancer ◽

Hazard Ratios ◽

Increased Risk

PURPOSE Age-associated cumulative decline across physiologic systems results in a diminished resistance to stressors, including cancer and its treatment, creating a vulnerable state known as frailty. Frailty is associated with increased risk of adverse outcomes in patients with cancer. Identification of frailty in administrative data can allow for assessment of prognosis and facilitate control for confounding variables. The purpose of this study was to assess frailty from claims-based data using the accumulation of deficits approach in veterans with multiple myeloma (MM). METHODS From the Veterans Administration Central Cancer Registry, we identified patients who were diagnosed with MM between 1999 and 2014. Using the accumulation of deficits approach, we calculated a Frailty Index (FI) using 31 health-associated deficits and categorized scores into five groups: nonfrail (FI, 0 to 0.1), prefrail (FI, 0.11 to 0.20), mild frailty (FI, 0.21 to 0.30), moderate frailty (FI, 0.31 to 0.40), and severe frailty (FI, > 0.4). We used Cox proportional hazards regression analysis to assess association between FI score and mortality while adjusting for potential confounders. RESULTS We calculated an FI for 3,807 veterans age 65 years or older. Among the cohort, 28.7% were classified as nonfrail, 41.3% prefrail, 21.6% mildly frail, 6.6% moderately frail, and 1.7% severely frail. Frailty was strongly associated with mortality independent of age, race, MM treatment, body mass index, or statin use. Higher FI score was associated with higher mortality with hazard ratios of 1.33 (95% CI, 1.21 to 1.47), 1.97 (95% CI, 1.70 to 2.20), 2.86 (95% CI, 2.45 to 3.34), and 3.22 (95% CI, 2.46 to 4.22) for prefrail, mildly frail, moderately frail, and severely frail, respectively. CONCLUSION Frailty status is a significant predictor of mortality in older veterans with MM. Assessment of frailty status using the readily available electronic medical records data in administrative data allows for assessment of prognosis.

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5-Item Modified Frailty Index Predicts Outcomes After Below-Knee Amputation in the Vascular Quality Initiative Amputation Registry

The American Surgeon ◽

10.1177/0003134820964190 ◽

2020 ◽

Vol 86 (10) ◽

pp. 1225-1229

Author(s):

James C. Andersen ◽

Joshua A. Gabel ◽

Kristyn A. Mannoia ◽

Sharon C. Kiang ◽

Sheela T. Patel ◽

...

Keyword(s):

Frailty Index ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Frailty Status ◽

Knee Amputation ◽

Point Increase ◽

Increased Risk ◽

History Of ◽

Modified Frailty Index

Patient frailty indices are increasingly being utilized to anticipate post-operative complications. This study explores whether a 5-factor modified frailty index (mFI-5) is associated with outcomes following below-knee amputation (BKA). All BKAs in the vascular quality initiative (VQI) amputation registry from 2012-2017 were reviewed. Preoperative frailty status was determined with the mFI-5 which assigns one point each for history of diabetes, chronic obstructive pulmonary disease or active pneumonia, congestive heart failure, hypertension, and nonindependent functional status. Outcomes included 30-day mortality, unplanned return to odds ratio (OR), post-op myocardial infarction (MI), post-op SSI, all-cause complication, revision to higher level amputation, disposition status, and prosthetic use. 2040 BKAs were performed. Logistic regression showed an increasing mFI-5 score that was associated with higher risk of combined complications (OR 1.22, confidence interval [CI] 1.07-1.38, P < .05), 30-day mortality (OR 1.60, CI 1.19-2.16, P < .05), post-op MI (OR 1.79, CI 1.30-2.45, P < .05), and failure of long-term prosthetic use (OR 1.17, CI 1.03-1.32, P < .05). In the VQI, every one-point increase in mFI-5 is associated with an increased risk of 22% for combined complications, 60% for 30-day mortality, nearly 80% for post-op MI, and 17% for failure of prosthetic use in BKA patients. The mFI-5 frailty index should be incorporated into preoperative planning and risk stratification.

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Toward Using a Smartwatch to Monitor Frailty in a Hospital Setting: Using a Single Wrist-Wearable Sensor to Assess Frailty in Bedbound Inpatients

Gerontology ◽

10.1159/000484241 ◽

2017 ◽

Vol 64 (4) ◽

pp. 389-400 ◽

Cited By ~ 8

Author(s):

Hyoki Lee ◽

Bellal Joseph ◽

Ana Enriquez ◽

Bijan Najafi

Keyword(s):

Frailty Index ◽

Hospital Setting ◽

Area Under The Curve ◽

Screening Tools ◽

Recursive Feature Elimination ◽

Physical Frailty ◽

Frailty Phenotype ◽

Frailty Status ◽

Flexion Extension ◽

Sensor Configuration

Background: While various objective tools have been validated for assessing physical frailty in the geriatric population, these are often unsuitable for busy clinics and mobility-impaired patients. Recently, we have developed a frailty meter (FM) using two wearable sensors, which allows capturing key frailty phenotypes (weakness, slowness, and exhaustion), by testing 20-s rapid elbow flexion-extension test. Objective: In this study, we proposed an enhanced automated algorithm to identify frailty using a single wrist-worn sensor. Methods: The data collected from 100 geriatric inpatients (age: 78.9 ± 9.1 years, 49% frail) were reanalyzed to validate the new algorithm. The frailty status of the participants was determined using a validated modified frailty index. Different FM phenotypes (31 features) including velocity of elbow rotation, decline in velocity of elbow rotation over 20 s, range of motion, etc. were extracted. A regression model, bootstrap with 2,000 iterations, and recursive feature elimination technique were used for optimizing the FM parameters and identifying frailty using a single wrist-worn sensor. Results: A strong agreement was observed between two-sensor and wrist-worn sensor configuration (r = 0.87, p < 0.001). Results suggest that the wrist-worn FM with no demographic information still yields a high accuracy of 80.0% (95% CI: 79.7-80.3%) and an area under the curve of 87.7% (95% CI: 87.4-87.9%) to identify frailty status. Results are comparable with two-sensor configuration, where the observed accuracy and area under the curve were 80.6% (95% CI: 80.4-80.9%) and 87.4% (95% CI: 87.1-87.6%), respectively. Conclusion: The simplicity of FM may open new avenues to integrate wearable technology and mobile health to capture frailty status in a busy hospital setting. Furthermore, the reduction of needed sensors to a single wrist-worn sensor allows deployment of the proposed algorithm in the form of a smartwatch application. From the application standpoint, the proposed FM is superior to traditional physical frailty-screening tools in which the walking test is a key frailty phenotype, and thus they cannot be used for bedbound patients or in busy clinics where administration of gait test as a part of routine assessment is impractical.

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Letter to the Editor: Exploring Associations Between Oral Health and Frailty in Community-Dwelling Older People

Journal of Frailty & Aging ◽

10.14283/jfa.2021.10 ◽

2021 ◽

pp. 1-1

Author(s):

R.C. Castrejón-Pérez

Keyword(s):

Oral Health ◽

Older People ◽

Medical Record ◽

Frailty Index ◽

Community Dwelling ◽

Frailty Phenotype ◽

Cross Sectional ◽

Frailty Status ◽

Community Dwelling Older People ◽

Oral Conditions

The studies exploring the association between oral conditions and Frailty status are increasing in number, and many manuscripts have been published during the last couple of years. Even when Everaars et al. (1) manuscript is cross-sectional, it contributes to the knowledge by confirming the association between oral conditions and Frailty despite the selected strategy for measuring Frailty since authors added the interview Groningen Frailty Index and the Frailty Index (computed with data extracted from the Electronic Medical Record) to the most frequently used Frailty Phenotype and Kihon checklist (2).

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FRAILTY STATUS, COGNITIVE IMPAIRMENT, AND THE EFFECTS OF INTENSIVE BLOOD PRESSURE CONTROL

Innovation in Aging ◽

10.1093/geroni/igz038.2945 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S800-S800

Author(s):

Kathryn E Callahan ◽

Maryjo Cleveland ◽

Mark Supiano ◽

Jeff Williamson ◽

Nicholas M Pajewski

Keyword(s):

Blood Pressure ◽

Cognitive Impairment ◽

Cox Regression ◽

Frailty Index ◽

Pressure Control ◽

Intensive Treatment ◽

Frailty Status ◽

Increased Risk ◽

Group A ◽

Using Data

Abstract Background: Frailty associates with cognitive decline and incident dementia in older adults. The Systolic Blood Pressure Intervention Trial (SPRINT) has highlighted blood pressure (BP) control as a potentially modifiable risk factor for cognitive impairment. Using data from SPRINT, we explore whether frailty status, based on a frailty index (FI), prospectively associates with mild cognitive impairment (MCI) and dementia, and whether the effect of intensive BP control on these outcomes varies by frailty status. Methods: SPRINT randomized participants to either to an systolic BP goal of <120 mmHg (intensive treatment) or a goal of <140 mmHg (standard treatment). We used Cox regression to model the association of the FI with MCI and dementia, and to conduct subgroup analyses by frailty status for the effect of intensive treatment. Results: We include 9307 participants, with the majority categorized as pre-frail (0.100.21, 38.0%). Adjusting for age, sex, race/ethnicity, education, and treatment group, a 0.1 increase in the FI was associated with increased risk for MCI (Hazard Ratio (HR) = 1.42, 95% CI: 1.29, 1.58) and dementia (HR = 1.80, 95% CI: 1.56, 2.08). There was weak evidence of an interaction between frailty status and intensive treatment for the composite outcome of MCI and dementia (p=0.03), with a beneficial effect of intensive treatment in pre-frail participants (HR=0.71 95% CI: 0.58, 0.89), and a largely null effect in frail participants (HR=0.98, 95% CI: 0.82, 1.18). Conclusions: Frailty status may modify the effect of intensive BP control on MCI and dementia.

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Reproducibility and responsiveness of the Frailty Index and Frailty Phenotype in older hospitalized patients

BMC Geriatrics ◽

10.1186/s12877-021-02444-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marlies Feenstra ◽

Frederike M.M. Oud ◽

Carolien J. Jansen ◽

Nynke Smidt ◽

Barbara C. van Munster ◽

...

Keyword(s):

Characteristic Curve ◽

Frailty Index ◽

Correlation Coefficients ◽

Medical Patients ◽

Frailty Phenotype ◽

Intra Class Correlation ◽

Frailty Status ◽

Smallest Detectable Change ◽

Standard Error Of Measurement

Abstract Background There is growing interest for interventions aiming at preventing frailty progression or even to reverse frailty in older people, yet it is still unclear which frailty instrument is most appropriate for measuring change scores over time to determine the effectiveness of interventions. The aim of this prospective cohort study was to determine reproducibility and responsiveness properties of the Frailty Index (FI) and Frailty Phenotype (FP) in acutely hospitalized medical patients aged 70 years and older. Methods Reproducibility was assessed by Intra-Class Correlation Coefficients (ICC), standard error of measurement (SEM) and smallest detectable change (SDC); Responsiveness was assessed by the standardized response mean (SRM), and area under the receiver operating characteristic curve (AUC). Results At baseline, 243 patients were included with a median age of 76 years (range 70–98). The analytic samples included 192 and 187 patients in the three and twelve months follow-up analyses, respectively. ICC of the FI were 0.85 (95 % confidence interval [CI]: 0.76; 0.91) and 0.84 (95% CI: 0.77; 0.90), and 0.65 (95% CI: 0.49; 0.77) and 0.77 (95% CI: 0.65; 0.84) for the FP. SEM ranged from 5 to 13 %; SDC from 13 to 37 %. SRMs were good in patients with unchanged frailty status (< 0.50), and doubtful to good for deteriorated and improved patients (0.43–1.00). AUC’s over three months were 0.77 (95% CI: 0.69; 0.86) and 0.71 (95% CI: 0.62; 0.79) for the FI, and 0.68 (95% CI: 0.58; 0.77) and 0.65 (95% CI: 0.55; 0.74) for the FP. Over twelve months, AUCs were 0.78 (95% CI: 0.69; 0.87) and 0.82 (95% CI: 0.73; 0.90) for the FI, and 0.78 (95% CI: 0.69; 0.87) and 0.75 (95% CI: 0.67; 0.84) for the FP. Conclusions The Frailty Index showed better reproducibility and responsiveness properties compared to the Frailty Phenotype among acutely hospitalized older patients.

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