FRAILTOOLS study protocol: a comprehensive validation of frailty assessment tools to screen and diagnose frailty in different clinical and social settings and to provide instruments for integrated care in older adults

Abstract

BackgroundDozens of scales and questionnaires have been used in the detection of frailty; however, a generalized method for its screening and diagnosis is still lacking in clinical settings. FRAILTOOLS´ main objective is to evaluate the usefulness of frailty scales in the detection of frailty in different clinical and social settings, and its integration in management algorithms for the frail older patient.MethodsFRAILTOOLS is an observational, longitudinal and prospective study with a follow-up of 6, 12 and 18 months. People older than 75 years old will be recruited from three separate clinical settings (acute geriatric wards, geriatric outpatient clinics and primary care) and one social setting (nursing homes). Exclusion criteria include Mini-mental State Examination < 20 points, and a Barthel index < 90 points, except in nursing home residents (< 40 points). The participants will be recruited in Spain, Italy, France, United Kingdom and Poland. The total sample size will be of 1.940 subjects, 97 subjects in each clinical setting by center. A personal interview with each participant will take place to register data on comorbidity (Charlson Index), functional (SPPB, Barthel and Lawton indexes), cognitive (MMSE) and frailty status (Fried Phenotype, Frailty Trait Scale – short version, SHARE-FI, 35-Items Rockwood Frailty Index, Clinical Frailty Scale, FRAIL scale and Gérontopôle Frailty Screening Tool) in the baseline visit, month 12 and month 18 visit of follow up. At 6 month a phone call will be made to assess whether there have been falls and to check the vital status.DiscussionCurrently, the usefulness of certain assessment tools in social and clinical settings have not been properly assessed, including their ability to predict the individual risk for different adverse outcomes, which is the main interest in daily practice.The FRAILTOOLS project concentrates on providing screening and diagnostic tools for frailty in those settings where its prevalence is the highest and where efforts in prevention could make a significant change in the trend towards disability.Trial registrationComprehensive validation of frailty assessment tools in older adults in different clinical and social settings (FRAILTOOLS), NCT02637518 (date of registration: 12/18/2015).

The importance of different frailty domains in a population based sample in England

“…Finally, a continuous frailty scale might be more sensitive, but measures which capture the frequency of problems over a longer time period are more predictive than isolated measures of performance [37]. A disadvantage of the Strawbridge assessment of frailty is that it is not widely used, but it remains one of the few instruments that can be collected by postal questionnaire [4,38] and it is one of the instruments without items on comorbidity or disability [4]. Although there are numerous frailty scales currently in use, research is needed on their reliability, validity and usefulness in both community and clinical settings [4,38].…”

Protein Intake and Frailty: A Matter of Quantity, Quality, and Timing

“…The main limitation is that the relationship between protein intake and frailty is not unanimous among studies [ 74 , 79 , 80 ], and some authors [ 79 ] have suggested that protein distribution over the day and/or protein quality, an index of the amount of EAAs that is provided by a given quantity of protein [ 81 ], may be more relevant to muscle anabolism than overall protein intake. Moreover, these studies used different instruments for assessing frailty, which might indicate that they captured different frailty domains [ 82 ].…”

“…Notably, a recent systematic review and meta-analysis indicated that different instruments had been used for assessing frailty [ 82 ]. This topic deserves attention, given that negative health-related events (e.g., disability and hospitalization) are differentially predicted by various frailty instruments.…”

Exercise interventions for older people at risk for frailty

“…The main outcomes in this study are the scores of the following frailty indices referenced in the literature: Fried Frailty Phenotype Criteria [ 19 ] ; Frailty Trait Scale–short version [ 20 ] ; SHARE Frailty Instrument [ 21 ] ; the FRAIL scale [ 22 ] ; the Gérontopôle Frailty Screening Tool [ 31 ] ; the Clinical Frailty Scale [ 25 ] ; the Rockwood and Mitnitsky Frailty Index [ 22 ] ; the Edmonton Frailty Scale [ 23 ] ; the Fatigue, Resistance, Ambulation, Illness and Loss of weight Index [ 24 ] ; the Multidimensional Prognostic Index [ 26 ] ; the Tilburg Frailty Indicator [ 27 ] ; PRISMA-7 [ 28 ] ; the Groningen Frailty Indicator [ 29 ] ; the Sherbrooke Postal Questionnaire [ 30 ] ; and the Kihon Checklist. [ 32 ]…”