The ability of four frailty screening instruments to predict mortality, hospitalization and dependency in (instrumental) activities of daily living

Linda P M Op Het Veld,Henrica C W De Vet,Gertrudis I J M Kempen,Sander M J Van Kuijk,Erik Van Rossum,Klaasjan Hajema,Anna J H M Beurskens

doi:10.1007/s10433-019-00502-4

Abstract

The aim of this study was to assess the predictive ability of the frailty phenotype (FP), Groningen Frailty Indicator (GFI), Tilburg Frailty Indicator (TFI) and frailty index (FI) for the outcomes mortality, hospitalization and increase in dependency in (instrumental) activities of daily living ((I)ADL) among older persons. This prospective cohort study with 2-year follow-up included 2420 Dutch community-dwelling older people (65+, mean age 76.3 ± 6.6 years, 39.5% male) who were pre-frail or frail according to the FP. Mortality data were obtained from Statistics Netherlands. All other data were self-reported. Area under the receiver operating characteristic curves (AUC) was calculated for each frailty instrument and outcome measure. The prevalence of frailty, sensitivity and specificity were calculated using cutoff values proposed by the developers and cutoff values one above and one below the proposed ones (0.05 for FI). All frailty instruments poorly predicted mortality, hospitalization and (I)ADL dependency (AUCs between 0.62–0.65, 0.59–0.63 and 0.60–0.64, respectively). Prevalence estimates of frailty in this population varied between 22.2% (FP) and 64.8% (TFI). The FP and FI showed higher levels of specificity, whereas sensitivity was higher for the GFI and TFI. Using a different cutoff point considerably changed the prevalence, sensitivity and specificity. In conclusion, the predictive ability of the FP, GFI, TFI and FI was poor for all outcomes in a population of pre-frail and frail community-dwelling older people. The FP and the FI showed higher values of specificity, whereas sensitivity was higher for the GFI and TFI.

Highlights

Over the past decades, many instruments have been developed to identify frail older people (Pialoux et al 2012)
Based on the cutoff value proposed by the developers, the prevalence of frail participants was calculated for each frailty instrument, as well as the associated sensitivity and specificity for each outcome measure (Table 3)
The aim of this study was to investigate the ability of four frailty instruments to predict mortality, hospitalization and an increase in (I)ADL dependency over a 2-year time period among pre-frail and frail community-dwelling older people

Summary

Introduction

Many instruments have been developed to identify frail older people (Pialoux et al 2012). Since consensus on a frailty definition is still lacking, these instruments are based on different concepts. Fried and colleagues proposed an instrument based on (five) solely physical measures, the Frailty Phenotype (FP) (Fried et al 2001). Others prefer a broader concept and include other, predefined domains, such as social or psychological domains, in their frailty instrument. An example of the latter is the Tilburg Frailty Indicator (TFI), developed by Gobbens et al (2010). The common factor of all of these instruments, irrespective of the frailty definition used, is that when a person is classified as frail, there is an increased risk of adverse outcomes, such as mortality, disability, institutionalization and hospitalization (Sternberg et al 2011)

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