Heterogeneity amongst different diagnostic tools in frailty screening
DOI:
https://doi.org/10.23938/ASSN.0642Keywords:
Primary health care, frailty, mass screening, frail elderlyAbstract
Background. Frailty means a state of vulnerability with a predisposition to adverse health outcomes, closely related to age and a consequent loss of functional capability. Early detection is important for initiating measures to slow its progression. Primary Health Care (PHC) occupies a privileged place in this. However, we do not possess a gold standard tool for its detection. Our aim is to analyse the prevalence of frailty in PHC and define the most useful diagnostic tool for this area.
Methods. Cross-sectional study with 225 people were selected from a population of 4,252 people aged over 75 years-old, from three different basic health zones of Navarre. Four different diagnostic tests for frailty were conducted: the Fried phenotype, the Short Physical Performance Battery (SPPB), the Timed Up-to-Go test (TUG) and the Gait Speed test (GS). Patients who were unable to finish any of the tests weren’t included in the subsequent analysis.
Results. Fifty-one percent of participants were men, with mean age 80.5 years-old, 80% were taking more than five daily drugs, 8.4% had cognitive impairment, and 31.1 and 41.3% were independent for basic and instrumental activities, respectively, of daily living. The frailty prevalence was 8.3% for Fried phenotype, 13.7% for SPPB, 46.2% for TUG and 52.2% for Gait Speed.
Conclusion. Great heterogeneity in the prevalence of frailty was shown depending on the tool employed. As a reliable, fast and simple tool for early detection of frailty is needed in PHC, based on our results and the particularities of PHC, we propose TUG or GS as good early predictors of this decline.
Keywords. Primary health care. Frailty. Mass screening. Frail elderly.
Downloads
References
CLEGG A, YOUNG J, ILIFFE S, RICKKERT MO, ROCKWOOD K. Frailty in elderly people. Lancet 2013; 381: 752. https://doi.org/10.1016/S0140-6736(12)62167-9
RODRÍGUEZ-MAÑAS L, FÉART C, MANN G, VIÑA J, CHATTERJI S, CHODZKO-ZAYKO W et al. Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci 2013; 68: 62. https://doi.org/10.1093/gerona/gls119
STERNBERG SA, WERSHOF SCHWARTZ A, KARUNANANTHAN S, BERGMAN H, CLARFIELD AM. The identification of frailty: a systematic literature review. J Am Geriatr Soc 2011; 59: 2129. https://doi.org/10.1111/j.1532-5415.2011.03597.x
FRIED LP, TANGEN CM, WALSTON J, NEWMAN AB, HIRSCH C, GOTTDIENER J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146. https://doi.org/10.1093/gerona/56.3.M146
ROCKWOOD K, SONG X, MACKNIGHT C, BERGMAN H, HOGAN DB, MCDOWELL I et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489. https://doi.org/10.1503/cmaj.050051
ABIZANDA P, LÓPEZ-TORRES JH, HIDALGO J, ROMERO L, LÓPEZ M, SÁNCHEZ PM et al. Fragilidad y dependencia en Albacete (estudio FRADEA): razonamiento, diseño y metodología. Rev Esp Geriatr Gerontol 2011; 46: 81-88. https://doi.org/10.1016/j.regg.2010.10.004
AUYEUNG TW, LEE JS, LEUNG J, KWOK T, WOO J. The selection of a screening test for frailty identification in community-dwelling older adults .J Nutr Health Aging 2014; 18: 199-203. https://doi.org/10.1007/s12603-013-0365-4
AGUAYO GA, DONNEAU AF, VAILLANT MT, SCHRITZ A, FRANCO O, STRANGER S et al. Agreement between 35 Published frailty scores in the general population. Am J Epidemiol 2017; 186: 420; https://doi.org/10.1093/aje/kwx061
CASTELL MV, MELGAR AB, JULIÁN R, CANTO DE HOYOS M. Consideraciones sobre los estudios de prevalencia de fragilidad en el mayor en España. Aten Primaria 2012; 44: 295-296; https://doi.org/10.1016/j.aprim.2011.06.008
DIEZ-RUIZ A, BUENO-ERRANDONEA A, NUÑEZ-BARRIO J, SANCHEZ-MARTÍN I, VROTSOU K, VERGARA I. Factors associated with frailty in primary care: a prospective cohort study. BMC Geriatrics 2016; 16: 91. https://doi.org/10.1186/s12877-016-0263-9
TURNER G, CLEGG A. Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing 2014; 43: 744. https://doi.org/10.1093/ageing/afu138
LEE L, PATEL T, COSTA A, BRYCE E, HILLIER LM, SLONIM K. Screening for frailty in primary care: accuracy of gait speed and hand-grip strength. Can Fam Physician 2017; 63: e51-e57.
GILARDI F, CAPANNA A, FERRARO M, SCARCELLA P, MARAZZI MC, PALOMBI L et al. Frailty screening and assessment tools: a review of characteristics and use in Public Health. Ann Ig 2018; 30: 128-139.
SIELIWONCZYK E, PERKISAS S, VANDEWOUDE M. Frailty indexes, screening instruments and their application in Belgian primary care. Acta ClinBelg 2014; 69: 233-239. https://doi.org/10.1179/2295333714Y.0000000027
LOBO A, EZQUERRA J, GÓMEZ FB, SALA JM, SEVA A. El mini examen cognoscitivo. Un test sencillo y práctico para detectar alteraciones intelectuales en pacientes médicos. Actas Luso-Esp Neurol Psiquiatr 1979; 7: 189e202;
MAHONEY FI, BARTHEL DW. Functional evaluation: The Barthel Index. Md State Med J 1965; 14: 61e65. https://doi.org/10.1037/t02366-000
LAWTON MP, BRODY EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9: 179-186. https://doi.org/10.1093/geront/9.3_Part_1.179
CABRERO-GARCÍA J, MUÑOZ-MENDOZA CL, CABAÑERO-MARTÍNEZ MJ, GONZÁLEZ-LLOPÍS L, RAMOS-PICHARDO JD, REIG-FERRER A. Valores de referencia de la Short Physical Performance Battery para pacientes de 70 y más años en atención primaria de salud. Aten Primaria 2012; 44: 540-548. https://doi.org/10.1016/j.aprim.2012.02.007
IBRAHIM A, SINGH DKA, SHAHAR S. 'Timed Up and Go' test: age, gender and cognitive impairment stratified normative values of older adults. PLoS One. 2017; 12: e0185641. https://doi.org/10.1371/journal.pone.0185641
STUDENSKI S, PERERA S, PATEL K, ROSANO C, FAULKNER K, INZITARI M et al. Gait Speed and Survival in Older Adults. JAMA 2011; 305: 50-58; doi:10.1001/jama.2010.1923. https://doi.org/10.1001/jama.2010.1923
ENSRUD KE, EWING SK, CAWTHON PM, FINK HA, TAYLOR BC, CAULEY JA et al. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc 2009; 57: 492. https://doi.org/10.1111/j.1532-5415.2009.02137.x
MARTÍNEZ-VELILLA N, HERCE PA, HERRERO ÁC, GUTIÉRREZ-VALENCIA M, SÁEZ DE ASTEASU ML, MATEOS AS. Heterogeneity of different tools for detecting the prevalence of frailty in nursing homes: feasibility and meaning of different approaches. J Am Med Dir Assoc 2017; 18: 898.e1-898.e8. https://doi.org/10.1016/j.jamda.2017.06.016
PAHOR M, GURALNIK JM, AMBROSIUS WT, BLAIR S, BONDS DE, CHURCH TS et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 2014; 311: 2387. https://doi.org/10.1001/jama.2014.5616
METZELTHIN SF, VAN ROSSUM E, DE WITTE LP, AMBERGEN AW, HOBMA SO, SIPERS W et al. Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial. BMJ 2013; 347: f5264. https://doi.org/10.1136/bmj.f5264
ROCKWOOD K. Grading frailty in long-term care. J Am Med Dir Assoc 2015; 16: 544e545. https://doi.org/10.1016/j.jamda.2015.03.006
KORENVAIN C, FAMIYEH IM, DUNN S, WHITEHEAD CR, ROCHON PA, MCCARTHY LM. Identifying frailty in primary care: a qualitative description of family physicians' gestalt impressions of their older adult patients. BMC Family Practice 2018; 19: 61. https://doi.org/10.1186/s12875-018-0743-4
Documento de consenso sobre prevención de fragilidad y caídas en la persona mayor. Estrategia de Promoción de la Salud y Prevención en el SNS 2014. Ministerio de sanidad, servicios sociales e igualdad. Recuperado a partir de: https://bit.ly/2HIrTI4, el 17/10/18.
MORLEY JE, MALMSTROM TK, MILLER DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012; 16: 601-608. https://doi.org/10.1007/s12603-012-0084-2
VELLAS B, BALARDY L, GILLETTE-GUYONNET S, ABELLAN VAN KAN G, GHISOLFI-MARQUE A, SUBRA J et al. Looking for frailty in community-dwelling older persons: the Gérontopôle Frailty Screening Tool (GFST). J Nutr Health Aging 2013; 17: 629-631. https://doi.org/10.1007/s12603-013-0363-6
IZQUIERDO M, CASAS-HERRERO A, ZAMBOM-FERRARESI F, MARTÍNEZ-VELILLA N, ALONSO-BOUZÓN C, RODRÍGUEZ-MAÑAS L. A practical guide for prescribing a multi-component physical training program to prevent weakness and falls in people over 70. Multi-Component Physical Exercise Program VIVIFRAIL. ISBN: 978-84-617-9780-6. Publisher: VIVIFRAIL (Erasmus+ 556988-EPP-1-2014-1-ES-SPO-SCP).
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Anales del Sistema Sanitario de Navarra
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
