Abstract
BackgroundFrailty is highly prevalent in elderly people. While significant progress has been made to understand its pathogenesis process, few validated questionnaire exist to assess the multidimensional concept of frailty and to detect people frail or at risk to become frail. The objectives of this study were to construct and validate a new frailty-screening instrument named Frailty Groupe Iso-Ressource Evaluation (FRAGIRE) that accurately predicts the risk for frailty in older adults.MethodsA prospective multicenter recruitment of the elderly patients was undertaken in France. The subjects were classified into financially-helped group (FH, with financial assistance) and non-financially helped group (NFH, without any financial assistance), considering FH subjects are more frail than the NFH group and thus representing an acceptable surrogate population for frailty. Psychometric properties of the FRAGIRE grid were assessed including discrimination between the FH and NFH groups. Items reduction was made according to statistical analyses and experts’ point of view. The association between items response and tests with “help requested status” was assessed in univariate and multivariate unconditional logistic regression analyses and a prognostic score to become frail was finally proposed for each subject.ResultsBetween May 2013 and July 2013, 385 subjects were included: 338 (88%) in the FH group and 47 (12%) in the NFH group. The initial FRAGIRE grid included 65 items. After conducting the item selection, the final grid of the FRAGIRE was reduced to 19 items. The final grid showed fair discrimination ability to predict frailty (area under the curve (AUC) = 0.85) and good calibration (Hosmer-Lemeshow P-value = 0.580), reflecting a good agreement between the prediction by the final model and actual observation. The Cronbach's alpha for the developed tool scored as high as 0.69 (95% Confidence Interval: 0.64 to 0.74). The final prognostic score was excellent, with an AUC of 0.756. Moreover, it facilitated significant separation of patients into individuals requesting for help from others (P-value < 0.0001), with sensitivity of 81%, specificity of 61%, positive predictive value of 93%, negative predictive value of 34%, and a global predictive value of 78%.ConclusionsThe FRAGIRE seems to have considerable potential as a reliable and effective tool for identifying frail elderly individuals by a public health social worker without medical training.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0360-9) contains supplementary material, which is available to authorized users.
Highlights
Frailty is highly prevalent in elderly people
Patients selection was based on a hypothesis that the elderly in Groupe Iso-Ressource (GIR) 5 and 6 populations who claim the Pension additional plan (PAP), contrary to those who do not, are probably more at risk to become frail and represent an acceptable surrogate population for frailty prediction.in GIR 5 and 6 population who are not yet frail
The Frailty Groupe Iso-Ressource Evaluation (FRAGIRE) pre-grid For the phase 1, 65 items (Q1–Q65) describing 10 dimensions were identified: overall health status (4 items), emotional dimension (15 items), cognitive impairment (2 items plus 5 tests), environmental (9 items), cultural (2 items), sexual (4 items), burden of help (3 items), nutritional (8 items), neurosensory (6 items), mobility (9 items with 1 test), and proxy assessment of frailty by the social worker (3 items). This step resulted in a 65-item and 3-test grid that administration lasted approximately 45 min
Summary
Frailty is highly prevalent in elderly people. While significant progress has been made to understand its pathogenesis process, few validated questionnaire exist to assess the multidimensional concept of frailty and to detect people frail or at risk to become frail. A core geriatric concept, is considered highly prevalent and heterogeneous in its level of expression [1]. Most people aged 65 years or over lead independent live. As people age, progressively they are more likely to live with frailty. Twenty-five to 50% of elderly subjects older than 85 years old could be considered frail in the North American [1, 2] and European [3] countries. In the Survey of Health, Aging and Retirement in Europe (SHARE), the prevalence of frailty is estimated at 17% in Europe and 15% in France for people older than 65 years. Frailty represents an important clinical and public health problem
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