Instruments for the detection of frailty syndrome in older adults: A systematic review

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Abstract

Frailty is a dynamic process in which there is a reduction in the physical, psychological and/or social function associated with aging. The aim of this study was to identify instruments for the detection of frailty in older adults, characterizing their components, application scenarios, ability to identify pre-frailty and clinimetric properties evaluated. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), under registration number CRD42017039318. A total of 14 electronic sources were searched to identify studies that investigated instruments for the detection of frailty or that presented the construction and/or clinimetric evaluation of the instrument, according to criteria established by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 96 studies were included in the qualitative synthesis: 51 instruments for the detection of frailty were identified, with predominantly physical domains; 40 were constructed and/or validated for use in the older adult community population, 28 only highlighted the distinction between frail and non-frail individuals and 23 presented three or more levels of frailty. The FRAGIRE, FRAIL Scale, Edmonton Frail Scale and IVCF-20 instruments were the most frequently analyzed in relation to clinimetric properties. It was concluded that: (I) there is a large number of instruments for measuring the same construct, which makes it difficult for researchers and clinicians to choose the most appropriate; (II) the FRAGIRE and CFAI stand out due to their multidimensional aspects, including an environmental assessment; however, (III) the need for standardization of the scales was identified, since the use of different instruments in clinical trials may prevent the comparability of the results in systematic reviews and; (IV) considering the different instruments identified in this review, the choice of researchers/clinicians should be guided by the issues related to the translation and validation for their location and the suitability for their context.

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Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments.

Brian J Buta, Jeremy Walston, Job G Godino … (2016)

The medical syndrome of frailty is widely recognized, yet debate remains over how best to measure it in clinical and research settings. This study reviewed the frailty-related research literature by (a) comprehensively cataloging the wide array of instruments that have been utilized to measure frailty, and (b) systematically categorizing the different purposes and contexts of use for frailty instruments frequently cited in the research literature. We identified 67 frailty instruments total; of these, nine were highly-cited (≥ 200 citations). We randomly sampled and reviewed 545 English-language articles citing at least one highly-cited instrument. We estimated the total number of uses, and classified use into eight categories: risk assessment for adverse health outcomes (31% of all uses); etiological studies of frailty (22%); methodology studies (14%); biomarker studies (12%); inclusion/exclusion criteria (10%); estimating prevalence as primary goal (5%); clinical decision-making (2%); and interventional targeting (2%). The most common assessment context was observational studies of older community-dwelling adults. Physical Frailty Phenotype was the most used frailty instrument in the research literature, followed by the Deficit Accumulation Index and the Vulnerable Elders Survey. This study provides an empirical evaluation of the current uses of frailty instruments, which may be important to consider when selecting instruments for clinical or research purposes. We recommend careful consideration in the selection of a frailty instrument based on the intended purpose, domains captured, and how the instrument has been used in the past. Continued efforts are needed to study the validity and feasibility of these instruments.

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The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument

Lidwine Mokkink, Cecilia Prinsen, Lex Bouter … (2016)

Background: COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) is an initiative of an international multidisciplinary team of researchers who aim to improve the selection of outcome measurement instruments both in research and in clinical practice by developing tools for selecting the most appropriate available instrument. Method: In this paper these tools are described, i.e. the COSMIN taxonomy and definition of measurement properties; the COSMIN checklist to evaluate the methodological quality of studies on measurement properties; a search filter for finding studies on measurement properties; a protocol for systematic reviews of outcome measurement instruments; a database of systematic reviews of outcome measurement instruments; and a guideline for selecting outcome measurement instruments for Core Outcome Sets in clinical trials. Currently, we are updating the COSMIN checklist, particularly the standards for content validity studies. Also new standards for studies using Item Response Theory methods will be developed. Additionally, in the future we want to develop standards for studies on the quality of non-patient reported outcome measures, such as clinician-reported outcomes and performance-based outcomes. Conclusions: In summary, we plea for more standardization in the use of outcome measurement instruments, for conducting high quality systematic reviews on measurement instruments in which the best available outcome measurement instrument is recommended, and for stopping the use of poor outcome measurement instruments.

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Operationalizing a frailty index from a standardized comprehensive geriatric assessment.

David M. Jones, Xiaowei Song, Kenneth Rockwood (2004)

To construct and validate a frailty index (FI) that is clinically sensible and practical for geriatricians by basing it on a routinely used comprehensive geriatric assessment (CGA) instrument. Secondary analysis of a 3-month randomized, controlled trial of a specialized mobile geriatric assessment team. Rural Nova Scotia. Participants were seen in their homes. Frail older adults, of whom 92 were in the intervention group and 77 in the control group. A standard CGA form that accounts for impairment, disability, and comorbidity burden was scored and summed as a frailty index (FI-CGA). The FI-GCA was stratified to describe three levels of frailty. Patients were followed for up to 12 months to determine how well the index predicted adverse outcomes (institutionalization or mortality, whichever came first). The three levels of frailty were mild (FI-CGA 0-7), moderate (FI-CGA 7-13), and severe (FI-CGA>13). Demographic and social traits were similar across groups, but greater frailty was associated with worse function (r=0.55) and mental status (r=0.33). Those with moderate and severe frailty had a greater risk of adverse outcomes than those with mild frailty (unadjusted hazard ratio=1.9 and 5.5, respectively). There was no difference between frailty groups in mean 3-month goal-attainment scaling scores. Intrarater reliability was 0.95. The FI-CGA is a valid, reliable, and sensible clinical measure of frailty that permits risk stratification of future adverse outcomes.

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Author and article information

Contributors

Jossiana Wilke Faller:

ORCID: http://orcid.org/0000-0002-1216-8180

Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

David do Nascimento Pereira: Role: InvestigationRole: Writing – review & editing

Suzana de Souza: Role: InvestigationRole: Writing – review & editing

Fernando Kenji Nampo: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Fabiana de Souza Orlandi: Role: Writing – original draftRole: Writing – review & editing

Silvia Matumoto:

ORCID: http://orcid.org/0000-0002-8590-5276

Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Antony Bayer: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 29 April 2019

Publication date Collection: 2019

Volume: 14

Issue: 4

Electronic Location Identifier: e0216166

Affiliations

[1 ] Department of Maternal and Child Health and Public Health, University of São Paulo, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto School of Nursing, Ribeirão Preto, Brazil

[2 ] Program in Health Promotion and Care in Hospital Care of the Medical School of the University of São Paulo, São Paulo, Brazil

[3 ] Latin-American Institute of Life and Natural Sciences, Federal University of Latin-American Integration, Foz do Iguassu, Paraná, Brazil

[4 ] Department of Gerontology of the Federal University of São Carlos, São Carlos, São Paulo, Brazil

Cardiff University, UNITED KINGDOM

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: jofaller@ 123456hotmail.com

Author information

Jossiana Wilke Faller http://orcid.org/0000-0002-1216-8180

Silvia Matumoto http://orcid.org/0000-0002-8590-5276

Article

Publisher ID: PONE-D-19-00792

DOI: 10.1371/journal.pone.0216166

PMC ID: 6488093

PubMed ID: 31034516

SO-VID: 456f9ee9-b74b-4ab8-b90c-dbc036daf351

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 10 January 2019

Date accepted : 15 April 2019

Page count

Figures: 1, Tables: 3, Pages: 23

Funding

The authors thank the Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES). JWF received support and funding from ITAIPU Binacional and the Araucária Foundation (FA), in addition to the PROEX grant: Aid N. 0524/2018, Case N. 23038.003643 / 2018-11. The funders had no additional role in the design of the study, data collection and analysis, decision to publish or preparation of the manuscript.

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Instruments for the detection of frailty syndrome in older adults: A systematic review

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REPO4EU WP2 Systematic Reviews

Most cited references 97

Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments.

The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument

Operationalizing a frailty index from a standardized comprehensive geriatric assessment.

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