Screening for frailty in older adults using a self-reported instrument

Abstract

OBJECTIVE To validate a screening instrument using self-reported assessment of frailty syndrome in older adults.METHODS This cross-sectional study used data from the Saúde, Bem-estar e Envelhecimento study conducted in Sao Paulo, SP, Southeastern Brazil. The sample consisted of 433 older adult individuals (≥ 75 years) assessed in 2009. The self-reported instrument can be applied to older adults or their proxy respondents and consists of dichotomous questions directly related to each component of the frailty phenotype, which is considered the gold standard model: unintentional weight loss, fatigue, low physical activity, decreased physical strength, and decreased walking speed. The same classification proposed in the phenotype was utilized: not frail (no component identified); pre-frail (presence of one or two components), and frail (presence of three or more components). Because this is a screening instrument, “process of frailty” was included as a category (pre-frail and frail). Cronbach’s α was used in psychometric analysis to evaluate the reliability and validity of the criterion, the sensitivity, the specificity, as well as positive and negative predictive values. Factor analysis was used to assess the suitability of the proposed number of components.RESULTS Decreased walking speed and decreased physical strength showed good internal consistency (α = 0.77 and 0.72, respectively); however, low physical activity was less satisfactory (α = 0.63). The sensitivity and specificity for identifying pre-frail individuals were 89.7% and 24.3%, respectively, while those for identifying frail individuals were 63.2% and 71.6%, respectively. In addition, 89.7% of the individuals from both the evaluations were identified in the “process of frailty” category.CONCLUSIONS The self-reported assessment of frailty can identify the syndrome among older adults and can be used as a screening tool. Its advantages include simplicity, rapidity, low cost, and ability to be used by different professionals.

Association of Bone Mineral Density with Frailty, Pre-Frailty, and Osteoporosis in Community-Dwelling Elderly: A Prospective Study

“…It is important to consider the applicability of the research in the context of health service practices, and therefore this research chose subjective frailty measurements due to its easiness of application, low cost, reproducibility, and accuracy [18,33,34]. These qualities are important both in the context of the reality of many health units as the entry door is primary attention to health, where ambulatory patients do not undergo complex exams, and for the development of epidemiological studies.…”

“…Loss to follow-up was reported when the elderly could not be located by phone or home visit. Follow-up included finally 106 elderly, to whom standardized and validated questionnaires were applied regarding frailty [18].…”

“…According to these components, the elderly were classified in not frail (no component identified), pre-frail (presence of one or two components), and frail (presence of three or more components) [18]. The choice for the subjective evaluation of the fragility was due to the specialized equipment and specific training required for the objective assessment, generating greater difficulty of implementation in primary health care.…”

“…The choice for the subjective evaluation of the fragility was due to the specialized equipment and specific training required for the objective assessment, generating greater difficulty of implementation in primary health care. The subjective evaluation is constituted by a validated instrument for this population and is easy to apply [18].…”

Fragility in the elderly participants of coexistence and health promotion groups in the aging

“…The current concept states that this is a complex syndrome which occurs with the reduce of the homeostatic reserve capacity of the organism and decrease of the resistance to the stressors, causing reduction of the physiological systems and leaving the elderly vulnerable, allowing numerous clinical problems. (4) Therefore, the aging triad most associated with frailty permeates sarcopenia, neuroendocrine dysregulation and immune dysfunction (3,(5)(6)(7) Fragility is a syndrome, so it is characterized by its phenotype, and 5 items are conferred for classification, which is unintentional weight loss, self-reported fatigue, reduction of grip strength of dominant hand, reduction of physical activity and reduced gait speed. (2,8,7) In addition, because it is a multidimensional condition, the impact of social participation on the maintenance of capacities and the relationship between these and the risk differentials for frailty, puts in focus the concept of Social Determinants of Health (SDH).…”