Clinical-Functional Vulnerability Index-20 (IVCF-20): rapid recognition of frail older adults

Abstract

OBJECTIVE:To evaluate the adequacy of the Clinical-Functional Vulnerability Index-20, a rapid triage instrument to test vulnerability in Brazilian older adults, for the use in primary health care. METHODS:The study included convenience sample of 397 patients aged older than or equal to 60 years attended at Centro de Referência para o Idoso (Reference Center for Older Adults) and of 52 older adults the same age attended at the community. The results of the questionnaire, consisting of 20 questions, were compared with those of the Comprehensive Geriatric Assessment, considered a reference for identifying frail older adults. Spearman' s correlation was evaluated in the Clinical-Functional Vulnerability Index-20 with the Comprehensive Geriatric Assessment; the validity was verified by the area under the ROC curve; reliability was estimated by the percentage of agreement among evaluators and by the kappa coefficient, both with quadratic weighted. The cut-off point was obtained based on the higher accuracy criterion. Cronbach' s alpha, a measure of internal consistency, was estimated. RESULTS:The Spearman' s correlation coefficient was high and positive for both groups (0.792 for older adults attended at the Reference Center and 0.305 for older adults from the community [p < 0.001]). The area under the ROC curve for older adults attended at the Reference Center was substantial (0.903). The cut-off point obtained was six, and older adults with scores in Clinical-Functional Vulnerability Index-20 above that value had strong possibility of being frail. For older adults from the community, the quadratic weighted agreement among evaluators was 99.5%, and the global quadratic weighted kappa coefficient was 0.94. Cronbach' s alpha was high for older adults attended at the Reference Center (0.861) and those attended at the community (0.740). CONCLUSIONS:The Clinical-Functional Vulnerability Index-20 questionnaire, in the sample examined, turned out to be positively correlated with the Comprehensive Geriatric Assessment, in addition to the results indicating a high degree of validity and reliability. Thus, the Clinical-Functional Vulnerability Index-20 proves to be viable as a triage instrument in the primary health care that identifies frail older adults (older adults at risk of weakening and frail older adults).

Quality of care for the elderly: pressure injury risk as a marking condition

“…Then, the second stage of the research was started, consisting in the implementation of the following instruments and methods: 1) script of observations during the home visits by the multidisciplinary team including the identification of the patient, reason of the visit, members of the multidisciplinary team present in the visit, procedures and guidelines provided in the form of a checklist which allowed registering the conformities and non-conformities of the actions in relation to the standards and guidelines of quality and safety in the care for elderly patients at risk of pressure injury, their possible causes and consequences; 2) form for collection of data from notes in electronic records, with respect to consultations held on the Basic Health Unit, home care consultations, and guidelines given by the team, in the form of a checklist which allowed to note the compliance and non-compliance of actions carried out/registered in relation to the standards and guidelines of quality and safety in the management of pressure injury risk, their possible causes and consequences (1)(2)(3)9) ; 3) application of the Clinical-Functional Vulnerability Index-20 (IVCF-20) for the multidimensional assessment (11) , which is a standardized instrument on line guide to the health of elderly people in the state of Paraná, Brazil, who are previously classified as frail or at risk of frailty according to the VES-13, and the result allows the evaluation of the major determinants of health of older persons through eight dimensions considered predictive of functional decline.…”

Dependence on others for oral hygiene and its association with hand deformities and functional impairment in elders with a history of leprosy

“…Each section has a specific scoring method, and the overall score sums 40 points. Participants were considered frail if they had a score equal to or >7 on the IVCF, the cut‐off defined by a Brazilian study for showing high sensitivity and positive predictive value . All other participants were classified as robust.…”

“…Frailty was assessed using the Clinical-Functional Vulnerability Index (Índice de Vulnerabilidade Clínico-Funcional-IVCF). 15 The IVCF covers aspects of elderly participants' health using 20 questions divided into 8 sections: age, self-perception of health, functional disabilities, cognition, mood, mobility, communication and multiple comorbidities. It is a multidimensional instrument developed and validated in Brazil to be used by primary care physicians for screening frailty.…”

“…14 Physical impairments, which are common among individuals with leprosy sequelae, when combined with other impairments due to ageing, put this elderly group at a higher risk of frailty and disabilities, as senescence alone is linked to frailty. 15 Frailty is one of the most significant public health problems 16 and is defined as a clinical syndrome characterised by decreased energy, strength and performance resulting in a cumulative decline in multiple physiological facets and increased vulnerability. 17 Functional dependence is measured by assessing difficulties or the need for help in performing basic activities of daily living (BADL) and using basic tools of daily life.…”

Identificação da fragilidade em idosos em região de tríplice fronteira: estratégia para a promoção do envelhecimento ativo

“…Tabela 6.1 -Descrição dos instrumentos identificados na revisão e suas características: número de itens, domínios, cenário de aplicação, idioma, local do estudo, tipo de mensuração da escala, verificação da pré-fragilidade e predição de mortalidade. (continua) CAPACIDADE DO INSTRUMENTO DE IDENTIFICAR A PRÉ-FRAGILIDADE Vinte e três instrumentos apresentaram níveis de fragilidade que variaram de três a seis9,32,48,78,[81][82][83]86,88,93,94,99,110,115,122,125,127,150,153,155,160,165,166 . Esses níveis classificaram os participantes da seguinte forma: idoso robusto ou não frágil, préfrágil ou aparentemente vulnerável, fragilidade leve, moderada ou severa, com base em uma pontuação numérica (Tabela 6.1).…”