A Quantified Pre-frailty Prediction Score in Frailty Syndrome

Abstract

Frailty syndrome is currently a novel but emerging concept in geriatrics and leads to disability of older adults and escalation of healthcare costs. Early Pre-frail detection is essential for Frailty prevention. Fried Frailty Criteria contained five clinical physiological items helps to determine whether an elder is in Frailty or Pre-frail stage; however, no quantitative index of Frailty has been developed so far. PURPOSE: To organize common clinical physical performance tests and to form a quantitative score to indicate the degree of Pre-frail severity. METHODS: Thirty-five community-dwelled elders were recruited and screened into Frailty (n=4, 72.5±5.52 y/o), Pre-Frail (n=19, 74.63±5.33 y/o) and Robust groups (n=12, 71.42±5.82 y/o). Only Pre-frail and Robust groups participated and performed six physical performance tests, including Single Leg Stand (SLS), Repeated Chair Rise (RCRT), Timed Up and Go (TUG), Self-selected Walking Speed (SWS), Functional Reach (FR), and Grip Power (GP). Differences between groups were compared using independent t-test and Mann-Whitney U test, and a binary logistic regression model were used to build a Pre-frail index, the “FAT score”. Statistically significant level was set at .05. (α = .05) RESULTS: Five tests were valid to detect Pre-Frail from Robust, i.e. RCRT (20.26 vs 9.25 sec, p = .001), TUG (19.58 vs 10.33 sec, p = .006), SWS (75.19±12.76 vs 111.09±26.1 m/s, p = .000), FR (17.59±2.7 vs 19.53±1.84 %, p = .037), and GP (21.83±6.97 vs 30.27±9.54 kg, p = .008), and a Pre-frail predict equation was formulated: FAT score = 1/(1+e^(Z_Robust)); Z_Robust = -80.857+0.188(CRT)+1.708(TUG)+0.482(SWS)+0.156(FR)+0.559(GP). The average FAT score of Pre-Frail and Robust were 90.73±19.95% and 15.01±25.25% respectively. Coincidentally, one higher FAT Robust elder (46.88%) had suffered a pontine infarction in the 7th month after accomplishing the study. CONCLUSIONS: FAT score gathered by five physical performance tests is a beneficial Pre-Frailty predictor, and the pontine infarcted Robust demonstrated the potential to predict Pre-frailty. It contributes to detect elders who are entering Pre-frail stage and determine intervention strategy before obvious signs arise. Further studies are needed to recruit more elders and organize other effective physical performance tests.