Dataset Information

Discrepancy in Frailty Identification: Move Beyond Predictive Validity.

ABSTRACT:

Background

To evaluate the discordance in frailty classification between the frailty index (FI) and the physical frailty phenotype (PFP) and identify factors discriminating those with discordant frailty classification from each other and from those for whom the assessments agree.

Methods

A prospective observational study of older adults aged 65 and older selected from Medicare eligibility lists in four U.S. communities (n = 5,362). The PFP was measured by the Cardiovascular Health Study PFP. Participants meeting three or more of the five criteria were deemed frail. The FI was calculated as the proportion of deficits in an a priori selected set of 48 measures, and participants were classified as frail if FI is greater than 0.35.

Results

The prevalence of frailty was 7.0% by the PFP and 8.3% by the FI. Of the 730 deemed frail by either instrument, only 12% were in agreement, whereas 39% were classified as frail by the PFP, but not the FI, and 48% were classified as frail by the FI, but not the PFP. Participants aged 65-72 years or with greater disease burden were most likely to be characterized as being FI-frail, but not PFP-frail. The associations of frailty with age and mortality were stronger when frailty was measured by the PFP rather than the FI.

Conclusions

Despite comparable frailty prevalence between the PFP and the FI, there was substantial discordance in individual-level classification, with highest agreement existing only in the most vulnerable subset. These findings suggest that there are clinically important contexts in which the PFP and the FI cannot be used interchangeably.

SUBMITTER: Xue QL

PROVIDER: S-EPMC7176056 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

Discrepancy in Frailty Identification: Move Beyond Predictive Validity.

Xue Qian-Li QL Tian Jing J Walston Jeremy D JD Chaves Paulo H M PHM Newman Anne B AB Bandeen-Roche Karen K

The journals of gerontology. Series A, Biological sciences and medical sciences 20200101 2

<h4>Background</h4>To evaluate the discordance in frailty classification between the frailty index (FI) and the physical frailty phenotype (PFP) and identify factors discriminating those with discordant frailty classification from each other and from those for whom the assessments agree.<h4>Methods</h4>A prospective observational study of older adults aged 65 and older selected from Medicare eligibility lists in four U.S. communities (n = 5,362). The PFP was measured by the Cardiovascular Health ...[more]

PMID: 30789645

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Project description:RationaleIdentifying frailty by the presence of a critical number of frailty markers has been difficult to operationalize in the intensive care unit (ICU), where patients often cannot complete performance measures or answer complex questions.ObjectivesTo assess the construct and predictive validity of a questionnaire-based approach to identifying frailty in adult ICU patients.MethodsWe conducted an observational cohort study of adults admitted to a medical or surgical ICU at one of two hospitals in New York. We asked patients or surrogates about demographic information, frailty markers, and prehospital disability status. ICU physicians completed the Clinical Frailty Scale (CFS), a judgment-based frailty assessment tool. We examined the relationship between individual frailty markers, CFS, and demographic correlates of frailty such as age, prehospital living arrangement, and prehospital disability. We assessed the predictive validity of possible frailty phenotypes, using hospital and 6-month outcomes.ResultsAmong 95 study participants (mean age [SD], 57.1 [17.5] yr), 80% reported one or more of seven frailty markers (median [interquartile range], 3 [1-4]). The most common frailty markers were impaired mobility (60%), impaired physical activity (60%), and decreased strength (44.2%). Patients with more frailty markers were older (mean age [SD] of those with at least three frailty markers: 62.3 [17.7] vs. 51.6 [15.8] yr; P?<?0.001) compared with those with fewer than three markers, and were more likely to be judged frail by CFS (57.0 vs. 19.6%; P?=?0.001), although of the 49 patients with three or more frailty markers, CFS identified 36.7% as not frail. Malnutrition and fatigue or low energy were not significantly associated with other frailty correlates. Survivors with more frailty markers were more likely to die or report increased disability at follow-up. In multivariate models, a frailty phenotype defined as at least three of the seven frailty markers performed similarly to CFS in predicting death or increased disability at 6 months (adjusted odds ratio [95% confidence interval], 3.3 [1.2-9.0] vs. 3.8 [1.2-11.7]) for CFS.ConclusionsAsking patients or surrogates about frailty markers may be a valid approach to identifying critically ill adults with a frailty phenotype associated with increased risk of adverse outcomes. Larger studies measuring frailty markers may provide insight into factors that impact short- and long-term outcomes after ICU admission.

Dataset Information

Discrepancy in Frailty Identification: Move Beyond Predictive Validity.

Background

Methods

Results

Conclusions

Publications

Discrepancy in Frailty Identification: Move Beyond Predictive Validity.

Similar Datasets

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