Identification and management of frailty in the primary care setting

Marjan Abbasi; Darryl Rolfson; Amandeep S. Khera; Julia Dabravolskaj; Elsa Dent; Linda Xia

doi:10.1503/cmaj.171509

Article Figures & Tables

Tables

View popup

Table 1:

Selected frailty measures for the primary care setting

Tool	Type	Components examined	Frailty scoring system	Psychometric properties	Time to complete, min	Tool administered by
Clinical Frailty Scale	Judgment based	Visual chart of nine pictures covering the frailty spectrum, with corresponding explanation text.	Nine grades of frailty from 1 (very fit) to 9 (terminally ill). A score of 5 or more indicates frailty.	Predictive validity and reliability36	< 5	Physicians or practice nurses
Gait Speed	Performance based	Patient is asked to walk from one place to another at usual speed. Distance considered ranges from 2.4 to 6 m.	A walking speed of < 0.8 m/s identifies patients at high risk of frailty.	Diagnostic test accuracy34	< 5	Physicians or practice nurses
Timed-up-and-go test	Performance based	The test measures the time taken to stand up from a chair, walk a distance of 3 m, turn, walk back and sit down.	A time of > 10 s identifies patients at risk of frailty.	Diagnostic test accuracy37	< 5	Physicians or practice nurses
FRAIL	Questionnaire	Five items with yes/no answers: Fatigue Resistance (ability to climb up one flight of stairs) Ambulation (ability to walk one block) Illness (> 5 comorbidities) Loss of weight (> 5%)	Frailty: three or more components present Prefrailty: one to two components present Robust: zero components present	Convergent and predictive validity38	< 5	Physicians, practice nurses, or patients or their family members
Groningen Frailty Indicator	Questionnaire	Fifteen-item clinician-administered questionnaire concerning four domains: physical, social, psychological and cognitive.	Frailty: scores > 4	Construct validity39	15	Physicians or practice nurses
PRISMA-7	Questionnaire	Seven-item self-completed questionnaire with yes or no answers that covers ADL limitations, age (> 85 yr) and sex	Frailty: three or more components present	Diagnostic test accuracy34	< 5	Self-administered
Tilburg Frailty Indicator	Questionnaire	Contains two parts: 10 questions on determinants of frailty and diseases (Part A) and 15 questions on components of frailty in three domains (i.e., physical, psychologic and social frailty) (Part B)	A score of 5 or more indicates frailty.	Reliability, construct, predictive and concurrent types of validity40	< 15	Self-administered
Frailty phenotype	Mixed (questionnaire and performance based)	Five items with yes or no answers: Weight loss over the past year (≥4.5 kg unintentionally) Slow walking speed Low grip strength Exhaustion (two self-reported questions) Low physical activity	Frailty: three or more components present Prefrailty: one or two components present Robust: no components present	Concurrent and predictive validity10	15–20	Physicians or practice nurses
SHARE Frailty Instrument (SHARE-FI)	Mixed (questionnaire and performance based)	Includes five variables: exhaustion, weight loss, weakness (as assessed by handgrip strength using a dynamometer), slowness and low activity	Web-based calculator distinguishes three categories: nonfrail, prefrail and frail	Construct and predictive validity41	< 10	Nonphysicians (e.g., nurses, allied health professionals)
Study of Osteoporotic Fractures	Mixed (Questionnaire and performance based)	Three items with yes or no answers: Weight loss (> 5% intentional/unintentional) Exhaustion (Do you feel full of energy?) Inability to rise from a chair five times without using arms	Frailty: one or more components present Prefrailty: one component present Robust: No components present	Predictive validity42	< 5	Physicians or practice nurses
Electronic Frailty Index	Data set	As per the Frailty Index below, with variables obtained from primary care electronic medical records	Severe frailty: a score of > 0.36 Frailty: a score of 0.24–0.36 Mild frailty: a score of 0.12–0.24 Fit: a score of ≤ 0.12	Predictive validity43	< 5 (if automated)	Automatically computed from the electronic medical records^*
Frailty Index	Data set	Any 30 or more health deficits (variables) that increase in prevalence with age but do not plateau with age. Variables should be multidimensional, including ADLs/IADLs, comorbidities, mood, cognition and nutritional status.	Frailty is measured on a continuum, although > 0.25 is often selected to define frailty.44	Criterion and construct validity45	20–30	Mostly administered by researchers; further use in clinical practice needs to be explored
Edmonton Frail Scale	Multidimensional	Nine items: cognition, health (two items), admission to hospital, social support, nutrition, mood, function and continence	Frailty: score > 7	Construct validity and reliability46	< 10	Physicians or practice nurses

Note: ADL = activities of daily living, IADL = instrumental activities of daily living, PRISMA-7 = Program of Research to Integrate the Services for the Maintenance of Autonomy, SHARE = Survey of Health, Aging and Retirement in Europe.
↵* The Electronic Frailty Index is easy to use once it is automated in the electronic medical records; however, if done manually, it requires time and training.