Frailty Should be Assessed Using Validated Scales

Abstract

We read with interest the article by Tulner et al. as there are an increasing number of studies investigating frailty, specifically the use of frailty to predict adverse outcomes. Recently it has come to our attention that a number of studies that have used ‘frailty’ in the title of their papers to describe the population being studied have not used a validated frailty scale or justification of the study cohort’s condition beyond advanced age. Furthermore, these papers go on to state that chronological age is the most important factor in determining adverse therapeutic outcomes. A number of validated frailty scales exist to measure frailty in both inpatient and outpatient populations. These scales have been utilized and associated with clinical outcomes in a study not dissimilar to the current paper by Tulner et al. Frailty measures must be incorporated in studies of older populations in order to truly associate the frailty ‘syndrome’ with any outcome data. Furthermore, numerous studies have demonstrated that chronological age is a poor predictor of variability in response to medicines, and indeed associations between increasing age and adverse outcomes are probably confounded by the increasing prevalence of frailty with age. Listing frailty in the title of a paper in order to describe a patient population without incorporating a valid measure of frailty can be misleading for researchers and clinicians. This may hinder the progression of the evolving definition of frailty and its association with medicine use and medicine response, and result in spurious application of the findings of research to practice. Vidya Perera, Sarah N. Hilmer and Andrew J. McLachlan 1 Faculty of Pharmacy, University of Sydney, New South Wales, Australia 2 Centre for Research and Education on Ageing, Concord Hospital, New South Wales, Australia 3 Sydney Medical School, University of Sydney, New South Wales, Australia