Comparison of 3 Frailty Instruments in a Geriatric Acute Care Setting in a Low-Middle Income Country.

Comparison of frailty instruments in low-middle income countries, where the prevalence of frailty may be higher, is scarce. In addition, less complex diagnostic tools for frailty are important in these settings, especially in acutely ill patients, because of limited time and economic resources. We aimed to compare the performance of 3 frailty instruments for predicting adverse outcomes after 1 year of follow-up in older adults with an acute event or a chronic decompensated disease. Prospective cohort study. Geriatric day hospital (GDH) specializing in acute care. A total of 534 patients (mean age 79.6 ± 8.4 years, 63% female, 64% white) admitted to the GDH. Frailty was assessed using the Cardiovascular Health Study (CHS) criteria, the Study of Osteoporotic Fracture (SOF) criteria, and the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) questionnaire. Monthly phone contacts were performed over the course of the first year to detect the following outcomes: incident disability, hospitalization, fall, and death. Multivariable Cox proportional hazard regression models were performed to evaluate the association of the outcomes with frailty as defined by the 3 instruments. In addition, we compared the accuracy of these instruments for predicting the outcomes. Prevalence of frailty ranged from 37% (using FRAIL) to 51% (using CHS). After 1 year of follow-up, disability occurred in 33% of the sample, hospitalization in 40%, fall in 44%, and death in 16%. Frailty, as defined by the 3 instruments was associated with all outcomes, whereas prefrailty was associated with disability, using the SOF and FRAIL instruments, and with hospitalization using the CHS and SOF instruments. The accuracy of frailty to predict different outcomes was poor to moderate with area under the curve varying from 0.57 (for fall, with frailty defined by SOF and FRAIL) to 0.69 (for disability, with frailty defined by CHS). In acutely ill patients from a low-middle income country GDH acute care unit, the CHS, SOF, and FRAIL instruments showed similar performance in predicting adverse outcomes.

Lin SM ，Aliberti MJR ，Fortes-Filho SQ ，Melo JA ，Aprahamian I ，Suemoto CK ，Jacob Filho W ... -  《-》

Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women.

Ensrud KE ，Ewing SK ，Taylor BC ，Fink HA ，Cawthon PM ，Stone KL ，Hillier TA ，Cauley JA ，Hochberg MC ，Rodondi N ，Tracy JK ，Cummings SR ... -  《ARCHIVES OF INTERNAL MEDICINE》

A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men.

Ensrud KE ，Ewing SK ，Cawthon PM ，Fink HA ，Taylor BC ，Cauley JA ，Dam TT ，Marshall LM ，Orwoll ES ，Cummings SR ，Osteoporotic Fractures in Men Research Group ... -  《-》

Frailty and Risk of Adverse Outcomes in Hospitalized Older Adults: A Comparison of Different Frailty Measures.

There is a paucity of data for the assessment of frailty in acutely ill hospitalized older adults. We aim to (1) compare the performance of frailty measures [5-item scale of fatigue, resistance, ambulation, illnesses, and loss of weight) (FRAIL), Tilburg Frailty Indicator (TFI), and Clinical Frailty Scale (CFS)] in identifying frailty, using the widely adopted Frailty Index (FI) as "gold standard," and (2) compare their ability to predict negative outcomes among hospitalized older adults. Prospective cohort study. Acute inpatient care. A total of 210 patients (mean age 89.4 ± 4.6 years, 69.5% female) admitted to the Department of Geriatric Medicine. Premorbid frailty status was assessed by FI, FRAIL, TFI, and CFS. We collected data on comorbidities, severity of illness, functional status, and cognitive status. We compared area under receiver operator characteristic curves for FRAIL, TFI, and CFS against the reference FI. Multiple logistic regression was performed to examine the association between frailty and the primary outcome of in-hospital mortality. Frailty prevalence estimates were 87.1% (FI), 50% (FRAIL), 80% (TFI), and 81% (CFS). Area under receiver operator characteristics against FI ranged from 0.81 [95% confidence interval (CI) 0.72-0.90: FRAIL] to 0.91 (95% CI 0.87-0.95: CFS), with no significant difference on receiver operating characteristic curve contrast. Frailty, as defined by FRAIL score ≥3, was associated with higher in-hospital mortality (6.7% vs 1.0%, P = .031) and length of hospitalization [10 days (6.0-17.5) vs 8 days (5.0-14.0), P = .043]. FI [odds ratio (OR) = 1.15, 95% CI 1.00-1.33, P = .05], FRAIL (OR = 3.31, 95% CI 1.43-7.67, P = .005), and CFS (OR = 2.57, 95% CI 1.14-5.83, P = .023) independently predicted in-hospital mortality adjusted for age, sex, and severity of illness. FRAIL and CFS are simple frailty measures that may identify older adults at highest risk of adverse outcomes of hospitalization. FRAIL performed better in predicting in-hospital mortality.

Chong E ，Ho E ，Baldevarona-Llego J ，Chan M ，Wu L ，Tay L ... -  《-》

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.

Checa-López M ，Oviedo-Briones M ，Pardo-Gómez A ，Gonzales-Turín J ，Guevara-Guevara T ，Carnicero JA ，Alamo-Ascencio S ，Landi F ，Cesari M ，Grodzicki T ，Rodriguez-Mañas L ，FRAILTOOLS consortium ... -  《BMC Geriatrics》