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》

The ability of eight frailty instruments to identify adverse outcomes across different settings: the FRAILTOOLS project.

To compare the performance of eight frailty instruments to identify relevant adverse outcomes for older people across different settings over a 12 month follow-up. Observational longitudinal prospective study of people aged 75 + years enrolled in different settings (acute geriatric wards, geriatric clinic, primary care clinics, and nursing homes) across five European cities. Frailty was assessed using the following: Frailty Phenotype, SHARE-FI, 5-item Frailty Trait Scale (FTS-5), 3-item FTS (FTS-3), FRAIL scale, 35-item Frailty Index (FI-35), Gérontopôle Frailty Screening Tool, and Clinical Frailty Scale. Adverse outcomes ascertained at follow-up were as follows: falls, hospitalization, increase in limitation in basic (BADL) and instrumental activities of daily living (IADL), and mortality. Sensitivity, specificity, and capacity to predict adverse outcomes in logistic regressions by each instrument above age, gender, and multimorbidity were calculated. A total of 996 individuals were followed (mean age 82.2 SD 5.5 years, 61.3% female). In geriatric wards, the FI-35 (69.1%) and the FTS-5 (67.9%) showed good sensitivity to predict death and good specificity to predict BADL worsening (70.3% and 69.8%, respectively). The FI-35 also showed good sensitivity to predict BADL worsening (74.6%). In nursing homes, the FI-35 and the FTSs predicted mortality and BADL worsening with a sensitivity > 73.9%. In geriatric clinic, the FI-35, the FTS-5, and the FRAIL scale obtained specificities > 85% to predict BADL worsening. No instrument achieved high enough sensitivity nor specificity in primary care. All the instruments predict the risk for all the outcomes in the whole sample after adjusting for age, gender, and multimorbidity. The associations of these instruments that remained significant by setting were for BADL worsening in geriatric wards [FI-35 OR = 5.94 (2.69-13.14), FTS-3 = 3.87 (1.76-8.48)], nursing homes [FI-35 = 4.88 (1.54-15.44), FTS-5 = 3.20 (1.61-6.38), FTS-3 = 2.31 (1.27-4.21), FRAIL scale = 1.91 (1.05-3.48)], and geriatric clinic [FRAIL scale = 4.48 (1.73-11.58), FI-35 = 3.30 (1.55-7.00)]; for IADL worsening in primary care [FTS-5 = 3.99 (1.14-13.89)] and geriatric clinic [FI-35 = 3.42 (1.56-7.49), FRAIL scale = 3.27 (1.21-8.86)]; for hospitalizations in primary care [FI-35 = 3.04 (1.25-7.39)]; and for falls in geriatric clinic [FI-35 = 2.21 (1.01-4.84)]. No single assessment instrument performs the best for all settings and outcomes. While in inpatients several commonly used frailty instruments showed good sensitivities (mainly for mortality and BADL worsening) but usually poor specificities, the contrary happened in geriatric clinic. None of the instruments showed a good performance in primary care. The FI-35 and the FTS-5 showed the best profile among the instruments assessed.

Oviedo-Briones M ，Rodríguez-Laso Á ，Carnicero JA ，Gryglewska B ，Sinclair AJ ，Landi F ，Vellas B ，Rodríguez Artalejo F ，Checa-López M ，Rodriguez-Mañas L ... -  《-》

Assumptions of the European FRAILTOOLS project and description of the recruitment process for this study in Poland.

Kańtoch A ，Gryglewska B ，Wizner B ，Parnicka A ，Grodzicki T ... -  《-》

A Comparison of Frailty Assessment Instruments in Different Clinical and Social Care Settings: The Frailtools Project.

To determine which of 8 commonly employed frailty assessment tools demonstrate the most appropriate characteristics to be employed in different clinical and social settings. Cross-sectional multicenter European-based study. 1440 patients aged ≥75 years evaluated in geriatric inpatient wards, geriatric outpatient clinics, primary care clinics, and nursing homes. The frailty instruments used were Frailty Phenotype, SHARE-FI, 3-item Frailty Trait Scale (FTS-3), 5-item Frailty Trait Scale (FTS-5), FRAIL, 35-item Frailty Index (FI-35), Gérontopôle Frailty Screening Tool (GFST), and Clinical Frailty Scale (CFS). The settings were geriatrics wards, outpatient clinics, primary care, and nursing homes. Suitability was evaluated by considering the feasibility (patients with the test fully completed), administration time (time spent for administering the test), and interscale agreement (Cohen kappa index among instruments to detect frailty). The prevalence of frailty varied across settings and adopted tests. The scales with the mean highest feasibility were the FRAIL scale (99.4%), SHARE-FI (98.3%), and GFST (95.0%). The mean shortest administration times were obtained with CFS (24 seconds), GFST (72 seconds), and FRAIL scale (90 seconds). The interscale agreement between most of the tests was fair. CFS followed by FTS-5 agreed at least moderately with a greater number of scales overall and in almost all settings. Based on feasibility, time to undertake the tool, and agreement with other scales, different scales would be recommended according to the setting considered. Our findings suggest that most of the tools evaluated are actually assessing different frailty constructs.

Oviedo-Briones M ，Laso ÁR ，Carnicero JA ，Cesari M ，Grodzicki T ，Gryglewska B ，Sinclair A ，Landi F ，Vellas B ，Checa-López M ，Rodriguez-Mañas L ... -  《-》

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 ... -  《-》