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. 2020;9(2):101-106.
doi: 10.14283/jfa.2019.41.

A Novel Tool for the Early Identification of Frailty in Elderly People: The Application in Primary Care Settings

M Maggio  1 , M Barbolini, Y Longobucco, L Barbieri, C Benedetti, F Bono, I Cacciapuoti, A Donatini, E Iezzi, D Papini, P M Rodelli, S Tagliaferri, M L Moro
Affiliations

A Novel Tool for the Early Identification of Frailty in Elderly People: The Application in Primary Care Settings

M Maggio et al. J Frailty Aging. 2020.

Abstract

Background: Frailty is a pre-disability condition in older persons providing a challenge to Health-Care Systems. Systematic reviews highlight the absence of a gold-standard for its identification. However, an approach based on initial screening by the General Practitioner (GP) seems particularly useful. On these premises, a 9-item Sunfrail Checklist (SC), was developed by a multidisciplinary group, in the context of European Sunfrail Project, and tested in the Community.

Objectives: - to measure the concordance between the judgments of frailty (criterion-validity): the one formulated by the GP, using the SC, and the one subsequently expressed by a Comprehensive Geriatric Assessment Team (CGA-Team); - to determine the construct-validity through the correspondence between some checklist items related to the 3 domains (physical, cognitive and social) and the three tools used by the CGA-Team; - to measure the instrument's performance in terms of positive predictive value (PPV) and negative predictive value (NPV).

Design: Cross-sectional study, with a final sample-size of 95 subjects.

Setting: Two Community-Health Centers of Parma, Italy.

Participants: Subjects aged 75 years old or more, with no disability and living in the community.

Measurements: We compared the screening capacity of the GP using the SC to that one of CGA-Team based on three tests: 4-meter Gait-Speed, Mini-Mental State Examination and Loneliness Scale.

Results: 95 subjects (51 women), with a mean age of 81±4 years were enrolled. According to GPs 34 subjects were frail; the CGA-Team expressed a frailty judgment on 26 subjects. The criterion-validity presented a Cohen's k of 0.353. Construct-validity was also low, with a maximum contingency-coefficient of 0.19. The analysis showed a PPV of 58.1% and a NPV equal to 84.6%.

Conclusions: Our data showed a low agreement between the judgements of GP performed by SC and CGA-Team. However, the good NPV suggests the applicability of SC for screening activities in primary-care.

Keywords: Ageing; frailty; integrated care; multimorbidity; sunfrail.

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Conflict of interest statement

All the authors have nothing to disclose

Figures

Figure 1
Figure 1
Positive and negative answers to single checklist items allowing the final judgement of frailty by GP (N=122)
See this image and copyright information in PMC

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