Frailty: Identification and Markers (original) (raw)
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Screening for Frailty With the FRAIL Scale: A Comparison With the Phenotype Criteria
Journal of the American Medical Directors Association, 2017
Background: Reliable and valid frailty screening instruments are lacking. The aim of the present study was to compare the diagnostic properties of the FRAIL-BR with Fried's frailty phenotype (CHS), which has not been done. Methods: Cross-sectional observational study of 124 older adults aged 60 or older from 2 universitybased geriatric outpatient units in the state of São Paulo, Brazil. In ROC analyses, we evaluated different cutoff points and AUC areas of the FRAIL-BR compared with the CHS criteria. Also, components of both diagnostic strategies had head-to-head comparisons whenever possible. Results: The sample was composed mostly of overweight (mean BMI ¼ 29.5 kg/m 2) women (83%) with mean age of 78.6 (AE7.1) years. Prevalence of frailty varied according to the FRAIL-BR (23.3%) and the CHS criteria (14.5%) (P ¼ .04). A cutoff of 3 points in the FRAIL-BR presented a sensitivity of 28% and specificity of 90% (P ¼ .049). A cutoff of 2 points resulted in a sensitivity of 54% and specificity of 73% (P ¼ .01). Comparisons of 4 FRAIL-BR items (ie, weight loss, aerobic capacity, fatigue, and physical resistance) to the respective CHS components showed an independent diagnostic property of all measures, with the exception for weight loss. Conclusion: The FRAIL scale can be used as a screening instrument for frailty (time and cost-effective).
Assessment of frailty: a survey of quantitative and clinical methods
BMC Biomedical Engineering
Background: Frailty assessment is a critical approach in assessing the health status of older people. The clinical tools deployed by geriatricians to assess frailty can be grouped into two categories; using a questionnaire-based method or analyzing the physical performance of the subject. In performance analysis, the time taken by a subject to complete a physical task such as walking over a specific distance, typically three meters, is measured. The questionnaire-based method is subjective, and the time-based performance analysis does not necessarily identify the kinematic characteristics of motion and their root causes. However, kinematic characteristics are crucial in measuring the degree of frailty. Results: The studies reviewed in this paper indicate that the quantitative analysis of activity of daily living, balance and gait are significant methods for assessing frailty in older people. Kinematic parameters (such as gait speed) and sensor-derived parameters are also strong markers of frailty. Seventeen gait parameters are found to be sensitive for discriminating various frailty levels. Gait velocity is the most significant parameter. Short term monitoring of daily activities is a more significant method for frailty assessment than is long term monitoring and can be implemented easily using clinical tests such as sit to stand or stand to sit. The risk of fall can be considered an outcome of frailty. Conclusion: Frailty is a multi-dimensional phenomenon that is defined by various domains; physical, social, psychological and environmental. The physical domain has proven to be essential in the objective determination of the degree of frailty in older people. The deployment of inertial sensor in clinical tests is an effective method for the objective assessment of frailty.
Detecting and categorizing frailty status in older adults using a self-report screening instrument
Archives of Gerontology and Geriatrics, 2012
Purpose: The purpose of this study was to design and validate a self-reported assessment tool for the identification of frailty. Materials and methods: A thousand community-dwelling older adults (60 years), users of the medical insurance of the French national education system, received (Year 1) a postal questionnaire requesting information about health and socio-demographic characteristics. Among those who responded to the questionnaire (n = 535), 398 individuals were classified as frail, pre-frail, or robust. One year later (Year 2), the same questionnaire was sent to this group and n = 309 were returned. Frailty was operationalized using four criteria: low body mass index (BMI), low level of physical activity, and dissatisfaction with both muscle strength and endurance. Results: Frailty constituted a single entity, different from physical limitation and co-morbidity. Compared with robust individuals, frail persons were older, had more chronic diseases, higher levels of disability and physical function decline. Pre-frail individuals had an intermediate distribution. Those people classified as either frail or pre-frail had higher frequency of hospitalization, and a higher probability of co-morbidity than robust. Frailty was also associated with higher mortality. Conclusions: Our screening tool for frailty was able to evidence important characteristics of this syndrome, i.e., it is a single entity with grades of severity which are associated with health problems. Detecting and categorizing frailty may lead to early therapeutic interventions to combat this condition. ß
Screening for frailty in older adults using a self-reported instrument
Revista de Saúde Pública, 2015
OBJECTIVE To validate a screening instrument using self-reported assessment of frailty syndrome in older adults.METHODS This cross-sectional study used data from the Saúde, Bem-estar e Envelhecimento study conducted in Sao Paulo, SP, Southeastern Brazil. The sample consisted of 433 older adult individuals (≥ 75 years) assessed in 2009. The self-reported instrument can be applied to older adults or their proxy respondents and consists of dichotomous questions directly related to each component of the frailty phenotype, which is considered the gold standard model: unintentional weight loss, fatigue, low physical activity, decreased physical strength, and decreased walking speed. The same classification proposed in the phenotype was utilized: not frail (no component identified); pre-frail (presence of one or two components), and frail (presence of three or more components). Because this is a screening instrument, “process of frailty” was included as a category (pre-frail and frail). Cr...
Frailty in Older Adults: Evidence for a Phenotype
2001
Background. Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established.
Aging and Disease, 2023
The concept frail elderly has been used to highlight the biological, rather than chronological, age. International and national bodies recommend that individuals over age 70 who visit healthcare facilities should be screened for frailty. There are important objections to the concept. Diagnostics: 'Frailty' is used for several completely different types of health problems. There are no useful biomarkers, but more than 60 different published rating methods for frailty, where different methods provide very different prevalence of frailty and also do not identify the same groups of elderly people. There is significant overlap between Clinical Frailty Scalescores and activity of daily living (ADL)-scores. There is no gold standard method against which published frailty rating scales can be validated. It is unclear when, where and how often screening for frailty should occur in healthcare. Treatment: The evidence for treatment of frailty is very weak. A recent systematic overview found that the 21 included randomised, controlled studies (RCTs) were very heterogeneous as regards inclusion/exclusion criteria, how the condition of frailty was defined, what treatment was given and what health outcomes were assessed. In addition, there are often problems with the quality of the studies. The lack of a clear definition and evidence-based treatment of frailty means that it is inappropriate to introduce assessments of frailty in individual elderly patients in health care