Dataset Information

The predictive properties of frailty-rating scales in the acute medical unit.

ABSTRACT:

Background

older people are at an increased risk of adverse outcomes following attendance at acute hospitals. Screening tools may help identify those most at risk. The objective of this study was to compare the predictive properties of five frailty-rating scales.

Method

this was a secondary analysis of a cohort study involving participants aged 70 years and above attending two acute medical units in the East Midlands, UK. Participants were classified at baseline as frail or non-frail using five different frailty-rating scales. The ability of each scale to predict outcomes at 90 days (mortality, readmissions, institutionalisation, functional decline and a composite adverse outcome) was assessed using area under a receiver-operating characteristic curve (AUC).

Results

six hundred and sixty-seven participants were studied. Frail participants according to all scales were associated with a significant increased risk of mortality [relative risk (RR) range 1.6-3.1], readmission (RR range 1.1-1.6), functional decline (RR range 1.2-2.1) and the composite adverse outcome (RR range 1.2-1.6). However, the predictive properties of the frailty-rating scales were poor, at best, for all outcomes assessed (AUC ranging from 0.44 to 0.69).

Conclusion

frailty-rating scales alone are of limited use in risk stratifying older people being discharged from acute medical units.

SUBMITTER: Wou F

PROVIDER: S-EPMC3809719 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Publications

The predictive properties of frailty-rating scales in the acute medical unit.

Wou Franklin F Gladman John R F JR Bradshaw Lucy L Franklin Matthew M Edmans Judi J Conroy Simon Paul SP

Age and ageing 20130510 6

<h4>Background</h4>older people are at an increased risk of adverse outcomes following attendance at acute hospitals. Screening tools may help identify those most at risk. The objective of this study was to compare the predictive properties of five frailty-rating scales.<h4>Method</h4>this was a secondary analysis of a cohort study involving participants aged 70 years and above attending two acute medical units in the East Midlands, UK. Participants were classified at baseline as frail or non-fr ...[more]

PMID: 23666406

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Project description:Rating scales are popular methods for generating quantitative data directly by persons rather than automated technologies. But scholars increasingly challenge their foundations. This article contributes epistemological and methodological analyses of the processes involved in person-generated quantification. They are crucial for measurement because data analyses can reveal information about study phenomena only if relevant properties were encoded systematically in the data. The Transdisciplinary Philosophy-of-Science Paradigm for Research on Individuals (TPS-Paradigm) is applied to explore psychological and social-science concepts of measurement and quantification, including representational measurement theory, psychometric theories and their precursors in psychophysics. These are compared to theories from metrology specifying object-dependence of measurement processes and subject-independence of outcomes as key criteria, which allow tracing data to the instances measured and the ways they were quantified. Separate histories notwithstanding, the article's basic premise is that general principles of scientific measurement and quantification should apply to all sciences. It elaborates principles by which these metrological criteria can be implemented also in psychology and social sciences, while considering their research objects' peculiarities. Application of these principles is illustrated by quantifications of individual-specific behaviors ('personality'). The demands rating methods impose on data-generating persons are deconstructed and compared with the demands involved in other quantitative methods (e.g., ethological observations). These analyses highlight problematic requirements for raters. Rating methods sufficiently specify neither the empirical study phenomena nor the symbolic systems used as data nor rules of assignment between them. Instead, pronounced individual differences in raters' interpretation and use of items and scales indicate considerable subjectivity in data generation. Together with recoding scale categories into numbers, this introduces a twofold break in the traceability of rating data, compromising interpretability of findings. These insights question common reliability and validity concepts for ratings and provide novel explanations for replicability problems. Specifically, rating methods standardize only data formats but not the actual data generation. Measurement requires data generation processes to be adapted to the study phenomena's properties and the measurement-executing persons' abilities and interpretations, rather than to numerical outcome formats facilitating statistical analyses. Researchers must finally investigate how people actually generate ratings to specify the representational systems underlying rating data.

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Dataset Information

The predictive properties of frailty-rating scales in the acute medical unit.

Background

Method

Results

Conclusion

Publications

The predictive properties of frailty-rating scales in the acute medical unit.

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