Concordância entre instrumentos de avaliação da fragilidade em idosos na atenção primária à saúde

Abstract

RESUMO Objetivo: Avaliar o nível de concordância entre a Avaliação Subjetiva da Fragilidade (SFA) e o Índice de Vulnerabilidade Clínico-Funcional (IVCF-20) para rastreio da fragilidade em idosos. Métodos: Estudo descritivo, comparativo e transversal realizado em 2018/2019 com 492 idosos, em 09 Estratégias Saúde da Família no município de Três Lagoas-MS. A Fragilidade foi avaliada utilizando a SFA e IVCF-20 e entrevista estruturada. Para comparações, utilizou testes de Wilcoxon e qui-quadrado de Pearson. Resultados: Concordância foi de 35,4%, com coeficiente Kappa de 0,11. Dicotomizando em idosos frágeis e não-frágeis, a concordância foi de 70,1%, com coeficiente Kappa foi 0,41 e o alfa de Cronbach para IVCF-20 foi 0.61 e SFA 0.74. A prevalência da fragilidade foi menor do IVCF - 20 (17,1%) e maior na SFA (59,8%). Conclusão: A concordância entre os dois instrumentos variou de baixa a moderada, destacando a necessidade de padronizar o instrumento para aferir a fragilidade em idosos comunitários.

Comparison of instruments for screening frailty in community-dwelling older adults

“…Interscale agreement for the diagnosis of frailty occurred in 70.1% of the individuals, with a Kappa coefficient of 0.41 (95% CI: 0.32 to 0.48; p < 0.001), indicating a moderate level of agreement (Melo et al, 2022). Thus, although the EFS and IVCF-20 instruments present similar characteristics in relation to dimensions, as well as moderate agreement and strong positive correlation, the prevalence of frailty pointed out was discrepant, being higher when EFE was used (Carneiro et al, 2020;Ribeiro et al, 2022).…”

“…In the study that analyzed the agreement between the Subjective Assessment of Frailty (SFA) and the Functional Clinical Vulnerability Index (IVCF-20), the results indicated weak agreement in the classification of frailty between the Subjective Assessment of Frailty and the CFVI-20, however, moderate agreement was found when the outcome was dichotomized into "frail" and "not frail" (Melo et al, 2022).…”

“…as it considers the five components of Fried's phenotype, which is a more sensitive indicator. Thus, despite evaluating similar concepts, the two instruments are complementary and one cannot replace the other (Melo et al, 2022).…”

“…The literature offers several instruments for assessing frailty and, although some studies have used these instruments in the same target population, none of them have investigated their interscale agreement. This assessment is relevant because the lack of agreement between the assessment instruments and the inconsistency in the measurement of frailty can be a significant source of bias when reporting frailty outcomes (Melo et al, 2022).…”

“…al, 2018;Maia et al, 2020). Therefore, identifying frail older adults at risk of frailty is of fundamental importance, being a public health priority at all levels of health care, making it possible to guide interventions aimed at coping with the severity of the syndrome and minimizing adverse outcomes (Melo et. al, 2022).…”