Abstract
BackgroundFrailty and sarcopenia are common amongst hospitalised older people and associated with poor healthcare outcomes. Widely recognised tools for their identification are the Fried Frailty Phenotype, its self-report version the FRAIL Scale, and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. We studied the feasibility of using these tools in a hospital setting of acute wards for older people.MethodsPatients aged 70+ years admitted to acute wards at one English hospital were prospectively recruited. The Fried Frailty Phenotype was assessed through measured grip strength, gait speed and questions on unintentional weight loss, exhaustion and physical activity. The 5-item self-reported FRAIL scale questionnaire covering the same domains was completed. Agreement between the two tools was reported using the Cohen kappa statistic. The EWGSOP criteria (gait speed, grip strength and muscle mass) were assessed by additional bedside measurement of muscle mass with bioelectrical impedance.ResultsTwo hundred thirty three participants (median age 80 years, 60% men) were recruited. Most (221, 95%) had their grip strength measured: 4 (2%) were unable and data were missing for 8 (3%). Only 70 (30%) completed the gait speed assessment: 153 (66%) were unable with missing data on 10 (4%). 113 (49%) participants had the bioelectrical impedance assessment. Muscle mass measurement was not possible for 84 (36%) participants: 25 patients declined, 21 patients were unavailable, 22 results were technically invalid, and 16 had clinical contra-indications. Data on 36 (15%) were missing.Considering inability to complete grip strength or gait speed assessments as low values, data for the Fried Frailty Phenotype was available for 218 (94%) of participants; frailty was identified in 105 (48%). 230 (99%) patients completed the FRAIL scale; frailty was identified among 77 (34%). There was moderate agreement between the two frailty tools (Kappa value of 0.46, 95%CI: 0.34 to 0.58). Complete data for the EWGOSP criteria were only available for 124 (53%) patients of whom 40 (32%) had sarcopenia.ConclusionIt was feasible to measure grip strength and complete the FRAIL scale among older inpatients in hospital. Measuring gait speed and muscle mass to identify sarcopenia was challenging in the acute setting.Trial registrationISRCTN registry (ID ISRCTN16391145) on 30.12.14.
Highlights
Frailty and sarcopenia are common amongst hospitalised older people and associated with poor healthcare outcomes
Frailty and sarcopenia are both associated with adverse health outcomes and admission to hospital [1, 2]
Sarcopenia has been recently recognized in the International Classification of Diseases (ICD-10) as a condition that should be diagnosed in older populations [3]
Summary
Frailty and sarcopenia are common amongst hospitalised older people and associated with poor healthcare outcomes. There is increasing recognition of the importance of identifying frailty, but identifying these common conditions is neither routine nor standardised in the in-patient hospital setting [4, 5]. This is an important area to address in view of the prevalence, reversibility, and prognostic value of these two conditions [6]. A recent survey of 388 clinicians from 44 countries reported that the Fried Frailty Phenotype (27%), gait speed assessment (44%), and the Clinical Frailty Scale (34%) are among the most widely used frailty tools [8]. The five item self-report frailty tool “FRAIL scale” developed from the Fried Frailty Phenotype does not require physical measurements of grip strength or gait speed [9] and is recommended by the International Academy on Nutrition and Aging for use in daily clinical practice [10, 11]
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