30 THE DIAGNOSTIC AND PREDICTIVE ACCURACY OF THE EDMONTON FRAIL SCALE FOR SCREENING FRAILTY IN OLDER ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Abstract Background Frailty is a dynamic, multidimensional syndrome that is highly prevalent in older adults (65 years or older), which increases one’s dependency and vulnerability to adverse health outcomes, including mortality. The Edmonton Frail Scale (EFS) is a commonly used screening tool for identifying frailty in older adults. The purpose of this systematic review and meta-analysis is to determine the diagnostic test accuracy of the EFS to identify frailty in older adults, as well as the predictive accuracy of the EFS for adverse outcomes associated with frailty. Methods A literature search was performed across PubMed, EMBASE, CINAHL, MEDLINE and the Cochrane Library to identify all studies that validated the EFS across clinical settings. The methodological quality of the included studies was assessed using the QUADAS-2 tool. A bivariate random effects model generated pooled estimates of sensitivity and specificity. Results Eleven studies were included in the systematic review and six studies were included in meta-analysis. The diagnostic test accuracy of the EFS could not be proven from the included studies. The EFS was found to be more useful at ruling in rather than ruling out increased risk of mortality in individuals classified as frail, with a higher pooled specificity (0.75, 95% CI 0.64-0.84) than sensitivity (0.49, 95% CI 0.42-0.56). Conclusion The Edmonton Frail scale has limited ability as a frailty screening tool and should not be used in isolation to screen for frailty in older adults in clinical settings.