Comparison of geriatric assessment tools for frailty among community elderly

Abstract

Background: Frailty is an important condition in elderly individuals because it increases disability, morbidity, and mortality. The definition frailty from the Cardiovascular Health Study (CHS) criteria is used worldwide and defined as fulfilling 3 out of the 5 phenotypic criteria that indicate compromised energetics: weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss.

Objective: This research aims to study the validity of 5 screening methods, e.g., Clinical Frailty Scale, simple FRAIL questionnaire, PRISMA-7 questionnaire, Time Up and Go Test (TUG), and Gérontopôle frailty screening tool (GFST), and compare those results with the definition of frailty by using the CHS criteria for screening frailty.

Methods: We conducted a cross-sectional study. The sample was 214 elderly individuals, aged ≥60 years, and living in the community. We used 5 screening tests and the Fried phenotype (CHS criteria) as a reference standard. Analysis of the sensitivity, specificity, PPV, NPV, LR+, LR-, and accuracy of each screening was compared with the Fried phenotype (CHS criteria).

Results: The prevalence of frailty of elderly individuals in the community was 11.7% when using the Fried phenotype (CHS criteria). The Clinical Frailty Scale has sensitivity 56%, specificity 98.41%, PPV 82.35%, NPV 94.42%, LR+ 35.28, LR- 0.45, and accuracy 93.46%. The simple FRAIL questionnaire has sensitivity 88%, specificity 85.71%, PPV 44.90%, NPV 98.18%, LR+ 6.61, LR- 0.14, and accuracy 85.98%. The PRISMA-7 questionnaire has sensitivity 76%, specificity 86.24%, PPV 42.22%, NPV 96.45%, LR+ 5.52, LR- 0.28, and accuracy 85.05%. TUG has sensitivity 72%, specificity 82.54%, PPV 35.29%, NPV 95.71%, LR+ 4.12, LR- 0.34, and accuracy 81.31%. The GFST has sensitivity 88%, specificity 83.56%, PPV 41.51%, NPV 98.14%, LR+ 5.37, LR- 0.14, and accuracy 84.11%.

Conclusions: The simple FRAIL questionnaire and GFST have the highest sensitivity compared with the CHS criteria. All screening tests in this study have an accuracy of more than 80% compared with the CHS criteria.

Keywords: Diagnostics; Elderly; Frailty; Geriatric assessment; Health promotion; Internal medicine; Medicine; Public health; Screening tools.