140 The Use of the Variable Indicative of Placement risk (VIP) as a Frailty Identification Tool

Abstract

Abstract Background The Variable Indicative of Placement risk (VIP) was developed in order to identify, at the time of hospital admission, those who need liaison geriatrics and those who do not (Vandewoude et al, 2008). It was derived from physical and cognitive measures of known risk factors for frailty. This supports its face and content validity as an indicator of frailty. The Clinical Frailty Score (CFS) is a validated measure of frailty (Rockwood et al, 2005), recommended as part of a patient’s Comprehensive Geriatric Assessment (CGA). Construct validity and inter-rater reliability of the VIP, as a frailty identification tool, have not been evaluated. Methods A prospective analysis was undertaken of 232 consecutive people, 70 years and older, presenting to an acute hospital. The VIP is administered by a triage nurse in the Emergency Department. A VIP-positive patient (2 or more “Yes” answers) triggers a CGA by a member of the Integrated Inter-Disciplinary team. The VIP screen is undertaken again by the team member, prior to commencing CGA. The VIP and CFS of each patient was entered onto an Excel spreadsheet. Inter-rater agreement was evaluated by looking at percentage agreement between raters. Validity was explored by looking at the relationship between VIP and CFS. Results Inter-rater agreement of the VIP was 90%; 78% of VIP positive people were mild, moderate or severely pre-frail, as measured by the CFS. A further 18% of people were categorised as vulnerable. Conclusion The VIP is a quick, easy to use tool that doesn’t require training. It shows agreement between raters. It predominantly identifies people who are mildly to severely frail. It may not be valid in identifying those who are pre-frail. Further evaluation of the validity and reliability of the VIP, as a frailty identification tool, is required.