Construct and Criterion-Related Validity of the Clinical Frailty Scale in Persons With HIV

McMillan, Jacqueline; Gill, M John; Power, Christopher; Fujiwara, Esther; Hogan, David B.; Rubin, Leah H.

doi:10.1097/qai.0000000000002736

Cited by 6 publications

(5 citation statements)

References 40 publications

(110 reference statements)

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“…The clinical challenges of the FFP have been described, and a universally applicable HIV-specific Frailty Index is not available, though adaptations of an Italian Frailty Index for people living with HIV could be used [36]. A Canadian study ( n = 143, 88% men, mean age 57 years) examined the concordance of the Clinical Frailty Scale (CFS), a 9-point judgement-based tool that evaluates specific domains including comorbidity, function and cognition, and a Frailty Index to the FFP, which showed a prevalence of 15% (CFS 14%; Frailty Index 26%), recommending the CFS because of its ease of use and lack of need for additional measurements, though it is only validated in those over 65 years [11,37 ▪▪ ]. A second Canadian study ( n = 101, 80% male, median age 56 years) utilized the Rotterdam Healthy Ageing Score (HAS) with only 39% of participants considered to be ageing healthily [38,39].…”

Section: Diagnostic Toolsmentioning

confidence: 99%

Frailty in people living with HIV: an update

Jones

Levett

Barber

2021

Current Opinion in Infectious Diseases

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Purpose of reviewThe HIV population is ageing with rising rates of frailty though strategies of how best to manage it remain ill-defined. It also remains unclear what the prevalence of frailty is within this cohort, how best to diagnose it and what factors are associated. Recent findingsThe prevalence of frailty remains unclear because of heterogenous results. Routine screening in those 50þ is recommended and whilst the Fried Frailty Phenotype is currently preferred the Clinical Frailty Scale could be considered. No biomarkers are currently recommended. Looking at associated factors, HIV neurocognitive impairment and long-term alcohol usage has been shown to be associated with developing frailty whilst those who are frail have been shown to be less active and more likely to fall. NAFLD with fibrosis has been shown to be an indicator of metabolic age and the Pooled Cohort Equations has been shown to be more effective in diagnosing cardiovascular risk in frail people living with HIV.

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Section: Diagnostic Toolsmentioning

confidence: 99%

Frailty in people living with HIV: an update

Jones

Levett

Barber

2021

Current Opinion in Infectious Diseases

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“…phenotype validity but is an important feature of the measure (Kim et al, 2020;McMillan et al, 2021;Van der Elst et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…This consistency is important to confirm because future studies may focus on specific population subgroups for certain research questions. This is also a new approach that has not been done in other studies evaluating phenotype validity but is an important feature of the measure (Kim et al, 2020; McMillan et al, 2021; Van der Elst et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…As a result, several modified versions of the FFP have proposed substitutions replacing objectively assessed measures with self-report (Op Het Veld et al, 2018; Theou et al, 2015) or excluding the objectively assessed measures (Desquilbet et al, 2007; Theou et al, 2015). There is limited validation work among clinical care cohorts specifically evaluating modifications to FFP (Akgun et al, 2014; Bouillon et al, 2013; McMillan et al, 2021), especially among PWH (Aprahamian et al, 2017; Jung et al, 2021; Kim et al, 2020; Van der Elst et al, 2020), which is important to understand measurement properties within particular settings of use.…”

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confidence: 99%

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Validity Properties of a Self-reported Modified Frailty Phenotype Among People With HIV in Clinical Care in the United States

Ruderman¹,

Webel²,

Willig³

et al. 2023

J Assoc Nurses AIDS Care

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Modifications to Fried's frailty phenotype (FFP) are common. We evaluated a self-reported modified frailty phenotype (Mod-FP) used among people with HIV (PWH). Among 522 PWH engaged in two longitudinal studies, we assessed validity of the four-item Mod-FP compared with the five-item FFP. We compared the phenotypes via receiver operator characteristic curves, agreement in classifying frailty, and criterion validity via association with having experienced falls. Mod-FP classified 8% of PWH as frail, whereas FFP classified 9%. The area under the receiver operator characteristic curve for Mod-FP classifying frailty was 0.93 (95% CI = 0.91–0.96). We observed kappa ranging from 0.64 (unweighted) to 0.75 (weighted) for categorizing frailty status. Both definitions found frailty associated with a greater odds of experiencing a fall; FFP estimated a slightly greater magnitude (i.e., OR) for the association than Mod-FP. The Mod-FP has good performance in measuring frailty among PWH and is reasonable to use when the gold standards of observed assessments (i.e., weakness and slowness) are not feasible.

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“…These models were adjusted for demographic characteristics, ART use, and time-updated CD4 cell count. We stratified these models into 4 groups defined by sex and baseline age (dichotomized at 50 years, as is common in frailty studies among PWH 19,51 ) to evaluate sex-specific and age-specific associations and understand whether differences observed in studies among the general population persist among PWH. 28,29 We conducted multiple sensitivity analyses, including assessing for interactions with smoking by age and sex (see Methods S1 in Appendix, Supplemental Digital Content, http:// links.lww.com/QAI/C80) and adjusting for baseline alcohol and drug use.…”

Section: Discussionmentioning

confidence: 99%

Tobacco Smoking and Pack-Years Are Associated With Frailty Among People With HIV

Ruderman

Odden

Webel

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Tobacco smoking increases frailty risk among the general population and is common among people with HIV (PWH) who experience higher rates of frailty at younger ages than the general population. Methods: We identified 8608 PWH across 6 Centers for AIDS Research Network of Integrated Clinical Systems sites who completed ≥2 patient-reported outcome assessments, including a frailty phenotype measuring unintentional weight loss, poor mobility, fatigue, and inactivity, and scored 0–4. Smoking was measured as baseline pack-years and time-updated never, former, or current use with cigarettes/day. We used Cox models to associate smoking with risk of incident frailty (score ≥3) and deterioration (frailty score increase by ≥2 points), adjusted for demographics, antiretroviral medication, and time-updated CD4 count. Results: The mean follow-up of PWH was 5.3 years (median: 5.0), the mean age at baseline was 45 years, 15% were female, and 52% were non-White. At baseline, 60% reported current or former smoking. Current (HR: 1.79; 95% confidence interval: 1.54 to 2.08) and former (HR: 1.31; 95% confidence interval: 1.12 to 1.53) smoking were associated with higher incident frailty risk, as were higher pack-years. Current smoking (among younger PWH) and pack-years, but not former smoking, were associated with higher risk of deterioration. Conclusions: Among PWH, smoking status and duration are associated with incident and worsening frailty.

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Construct and Criterion-Related Validity of the Clinical Frailty Scale in Persons With HIV

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 6 publications

References 40 publications

Frailty in people living with HIV: an update

Frailty in people living with HIV: an update

Validity Properties of a Self-reported Modified Frailty Phenotype Among People With HIV in Clinical Care in the United States

Tobacco Smoking and Pack-Years Are Associated With Frailty Among People With HIV

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