Measuring daily functioning in older persons using a frailty index: a cohort study based on routine primary care data

BackgroundElectronic health records (EHRs) are increasingly used for research; however, multicomponent outcome measures such as daily functioning cannot yet be readily extracted.AimTo evaluate whether an electronic frailty index based on routine primary care data can be used as a measure for daily functioning in research with community-dwelling older persons (aged ≥75 years).Design and settingCohort study among participants of the Integrated Systemic Care for Older People (ISCOPE) trial (11 476 eligible; 7285 in observational cohort; 3141 in trial; over-representation of frail people).MethodAt baseline (T0) and after 12 months (T12), daily functioning was measured with the Groningen Activities Restriction Scale (GARS, range 18–72). Electronic frailty index scores (range 0–1) at T0 and T12 were computed from the EHRs. The electronic frailty index (electronic Frailty Index — Utrecht) was tested for responsiveness and compared with the GARS as a gold standard for daily functioning.ResultsIn total, 1390 participants with complete EHR and follow-up data were selected (31.4% male; median age = 81 years, interquartile range = 78–85). The electronic frailty index increased with age, was higher for females, and lower for participants living with a partner. It was responsive after an acute major medical event; however, the correlation between the electronic frailty index and GARS at T0 and over time was limited.ConclusionBecause the electronic frailty index does not reflect daily functioning, further research on new methods to measure daily functioning with routine care data (for example, other proxies) is needed before EHRs can be a useful data source for research with older persons.

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Non-random relations in drug use expressed as patterns comprising prescription and over-the-counter drugs in multimorbid elderly patients in primary care: Data of the exploratory analysis of the multicentre, observational cohort study MultiCare

European Journal of General Practice ◽

10.1080/13814788.2021.1933425 ◽

2021 ◽

Vol 27 (1) ◽

pp. 119-129

Author(s):

Caroline Krüger ◽

Ingmar Schäfer ◽

Hendrik van den Bussche ◽

Michael Baehr ◽

Horst Bickel ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Drug Use ◽

Elderly Patients ◽

Observational Cohort Study ◽

Exploratory Analysis ◽

Over The Counter ◽

Primary Care Data ◽

Observational Cohort

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Cancer incidence in patients with a high normal platelet count: a cohort study using primary care data

Family Practice ◽

10.1093/fampra/cmy018 ◽

2018 ◽

Vol 35 (6) ◽

pp. 671-675 ◽

Cited By ~ 9

Author(s):

Emily Ankus ◽

Sarah J Price ◽

Obioha C Ukoumunne ◽

William Hamilton ◽

Sarah E R Bailey

Keyword(s):

Primary Care ◽

Cohort Study ◽

Platelet Count ◽

Cancer Incidence ◽

Normal Platelet Count ◽

Normal Platelet ◽

Primary Care Data

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Assessing and predicting adolescent and early adulthood common mental disorders using electronic primary care data: analysis of a prospective cohort study (ALSPAC) in Southwest England

BMJ Open ◽

10.1136/bmjopen-2021-053624 ◽

2021 ◽

Vol 11 (10) ◽

pp. e053624

Author(s):

Daniel Smith ◽

Kathryn Willan ◽

Stephanie L Prady ◽

Josie Dickerson ◽

Gillian Santorelli ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Mental Disorders ◽

Outcome Measures ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Common Mental Disorders ◽

Free Text ◽

Primary Care Data ◽

Time Point

ObjectivesWe aimed to examine agreement between common mental disorders (CMDs) from primary care records and repeated CMD questionnaire data from ALSPAC (the Avon Longitudinal Study of Parents and Children) over adolescence and young adulthood, explore factors affecting CMD identification in primary care records, and construct models predicting ALSPAC-derived CMDs using only primary care data.Design and settingProspective cohort study (ALSPAC) in Southwest England with linkage to electronic primary care records.ParticipantsPrimary care records were extracted for 11 807 participants (80% of 14 731 eligible). Between 31% (3633; age 15/16) and 11% (1298; age 21/22) of participants had both primary care and ALSPAC CMD data.Outcome measuresALSPAC outcome measures were diagnoses of suspected depression and/or CMDs. Primary care outcome measure were Read codes for diagnosis, symptoms and treatment of depression/CMDs. For each time point, sensitivities and specificities for primary care CMD diagnoses were calculated for predicting ALSPAC-derived measures of CMDs, and the factors associated with identification of primary care-based CMDs in those with suspected ALSPAC-derived CMDs explored. Lasso (least absolute selection and shrinkage operator) models were used at each time point to predict ALSPAC-derived CMDs using only primary care data, with internal validation by randomly splitting data into 60% training and 40% validation samples.ResultsSensitivities for primary care diagnoses were low for CMDs (range: 3.5%–19.1%) and depression (range: 1.6%–34.0%), while specificities were high (nearly all >95%). The strongest predictors of identification in the primary care data for those with ALSPAC-derived CMDs were symptom severity indices. The lasso models had relatively low prediction rates, especially in the validation sample (deviance ratio range: −1.3 to 12.6%), but improved with age.ConclusionsPrimary care data underestimate CMDs compared to population-based studies. Improving general practitioner identification, and using free-text or secondary care data, is needed to improve the accuracy of models using clinical data.

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Relation of Driving Status to Incident Life Space Constriction in Community-Dwelling Older Persons: A Prospective Cohort Study

The Journals of Gerontology Series A ◽

10.1093/gerona/gls133 ◽

2012 ◽

Vol 67 (9) ◽

pp. 984-989 ◽

Cited By ~ 27

Author(s):

R. C. Shah ◽

K. Maitra ◽

L. L. Barnes ◽

B. D. James ◽

S. Leurgans ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Older Persons ◽

Community Dwelling ◽

Life Space

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An observational cohort study to produce and evaluate an improved tool to screen older women with back pain for osteoporotic vertebral fractures (Vfrac): study protocol

Archives of Osteoporosis ◽

10.1007/s11657-019-0558-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

T. K. Khera ◽

A. Burston ◽

S. Davis ◽

S. Drew ◽

R. Gooberman-Hill ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Back Pain ◽

Older Women ◽

Vertebral Fractures ◽

Screening Tool ◽

Observational Cohort Study ◽

Binary Output ◽

Osteoporotic Vertebral Fractures ◽

Observational Cohort

Abstract Summary The aim of this study is to produce an easy to use checklist for general practitioners to complete whenever a woman aged over 65 years with back pain seeks healthcare. This checklist will produce a binary output to determine if the patient should have a radiograph to diagnose vertebral fracture. Purpose People with osteoporotic vertebral fractures are important to be identified as they are at relatively high risk of further fractures. Despite this, less than a third of people with osteoporotic vertebral fractures come to clinical attention due to various reasons including lack of clear triggers to identify who should have diagnostic spinal radiographs. This study aims to produce and evaluate a novel screening tool (Vfrac) for use in older women presenting with back pain in primary care based on clinical triggers and predictors identified previously. This tool will generate a binary output to determine if a radiograph is required. Methods The Vfrac study is a two-site, pragmatic, observational cohort study recruiting 1633 women aged over 65 years with self-reported back pain. Participants will be recruited from primary care in two sites. The Vfrac study will use data from two self-completed questionnaires, a simple physical examination, a lateral thoracic and lateral lumbar radiograph and information contained in medical records. Results The primary objective is to develop an easy-to-use clinical screening tool for identifying older women who are likely to have vertebral fractures. Conclusions This article describes the protocol of the Vfrac study; ISRCTN16550671.

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