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. 2025 Jun;16(3):1037-1044.
doi: 10.1007/s41999-025-01182-3. Epub 2025 Mar 14.

Validation of the nurse directed frailty assessment tool, to identify patients at risk of emergency department visits, hospitalisation, and 1-year all-cause mortality

P H Drop  1 , C van Ham  1 , A C M Mulder  1 , P A Veeken-Dijkstra  1 , J O Daal  1 , L A R Zwart  2   3
Affiliations

Validation of the nurse directed frailty assessment tool, to identify patients at risk of emergency department visits, hospitalisation, and 1-year all-cause mortality

P H Drop et al. Eur Geriatr Med. 2025 Jun.

Abstract

Methods: This is a validation study of a new frailty assessment that can be administered by outpatient care nurses. The nurse directed frailty assessment (NDFA) encompasses the medical, psychological, social, and functional domain, based on standard care, and can be performed without any specialised equipment. Performance of the NDFA is compared to a comprehensive geriatric assessment (CGA)-based frailty index (FI), with generalised linear model with reporting of hazard ratios (HR) and 95% confidence intervals (95% CI). The best cutoff value for the NDFA was assessed by Youden index and the area under the receiver operator curve (ROC).

Results: Within 1 year, 15 patients (5%) died, 57 (18%) had an unplanned hospital admission, and 83 (26%) visited the emergency department (ED). Based on the Youden index and ROC curve, the best cutoff value for the NDFA was 4 points. With a binary logistic regression model, an HR of 3.59 (95% CI 1.16-11.15, p < 0.001) was found for mortality. In the general mixed model with Poisson logistic regression, an HR of 1.78 (95% CI 1.06-2.97, p 0.028) was found for unplanned hospital and an HR of 1.87 (95% CI 1.25-2.78, p 0.002) was found for ED visits. The HR and 95% CI of the FI were similar for all three outcome measures.

Conclusions: The NDFA identifies patients at risk for hospitalisation, emergency department visits, and mortality within 12 months equally well as the FI. Further research is necessary to determine the effectiveness of the NDFA in other settings than the geriatric medicine outpatient population.

Keywords: Frailty; Frailty assessment tool; Frailty index; Older patients.

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Conflict of interest statement

Declarations. Conflict of interest: On behalf of all the authors, the corresponding author states that there is no conflict of interest. Ethical approval: The Dutch GERAF-study conforms to the Declaration of Helsinki, and the protocol was approved by the Medical Ethics Committee Oost Nederland, with reference number 2019-5889. Informed consent: All participating patients gave written informed consent.

Figures

Fig. 1
Fig. 1
Domains and items in the nurse directed frailty assessment
See this image and copyright information in PMC

References

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