A self-reported screening tool for detecting community-dwelling older persons with frailty syndrome in the absence of mobility disability: the FiND questionnaire

Matteo Cesari, Laurent Demougeot, Henri Boccalon, Sophie Guyonnet, Gabor Abellan Van Kan, Bruno Vellas, Sandrine Andrieu, Matteo Cesari, Laurent Demougeot, Henri Boccalon, Sophie Guyonnet, Gabor Abellan Van Kan, Bruno Vellas, Sandrine Andrieu

Abstract

Background: The "frailty syndrome" (a geriatric multidimensional condition characterized by decreased reserve and diminished resistance to stressors) represents a promising target of preventive interventions against disability in elders. Available screening tools for the identification of frailty in the absence of disability present major limitations. In particular, they have to be administered by a trained assessor, require special equipment, and/or do not discriminate between frail and disabled individuals. Aim of this study is to verify the agreement of a novel self-reported questionnaire (the "Frail Non-Disabled" [FiND] instrument) designed for detecting non-mobility disabled frail older persons with results from reference tools.

Methodology/principal findings: Data are from 45 community-dwelling individuals aged ≥60 years. Participants were asked to complete the FiND questionnaire separately exploring the frailty and disability domains. Then, a blinded assessor objectively measured the frailty status (using the phenotype proposed by Fried and colleagues) and mobility disability (using the 400-meter walk test). Cohen's kappa coefficients were calculated to determine the agreement between the FiND questionnaire with the reference instruments. Mean age of participants (women 62.2%) was 72.5 (standard deviation 8.2) years. Seven (15.6%) participants presented mobility disability as being unable to complete the 400-meter walk test. According to the frailty phenotype criteria, 25 (55.6%) participants were pre-frail or frail, and 13 (28.9%) were robust. Overall, a substantial agreement of the instrument with the reference tools (kappa = 0.748, quadratic weighted kappa = 0.836, both p values<0.001) was reported with only 7 (15.6%) participants incorrectly categorized. The agreement between results of the FiND disability domain and the 400-meter walk test was excellent (kappa = 0.920, p<0.001).

Conclusions/significance: The FiND questionnaire presents a very good capacity to correctly identify frail older persons without mobility disability living in the community. This screening tool may represent an opportunity for diffusing awareness about frailty and disability and supporting specific preventive campaigns.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Morley JE, Vellas B, Abellan van Kan G, Anker SD, Bauer JM, et al. (2013) Frailty consensus: a call to action. J Am Med Dir Assoc 14: 392–397.
    1. Vellas B, Cestac P, Morley JE (2012) Implementing frailty into clinical practice: we cannot wait. J Nutr Health Aging 16: 599–600.
    1. Subra J, Gillette-Guyonnet S, Cesari M, Oustric S, Vellas B (2012) The integration of frailty into clinical practice: preliminary results from the gérontopôle. J Nutr Health Aging 16: 714–720.
    1. Rodríguez-Mañas L, Féart C, Mann G, Viña J, Chatterji S, et al. (2012) 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 68: 62–67.
    1. Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, et al. (2004) Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 52: 625–634.
    1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381: 752–762.
    1. Hebert R, Raiche M, Dubois MF, Gueye NR, Dubuc N, et al. (2010) Impact of PRISMA, a coordination-type integrated service delivery system for frail older people in Quebec (Canada): A quasi-experimental study. J Gerontol B Psychol Sci Soc Sci 65B: 107–118.
    1. Hoogendijk EO, van der Horst HE, Deeg DJ, Frijters DH, Prins BA, et al. (2013) The identification of frail older adults in primary care: comparing the accuracy of five simple instruments. Age Ageing 42: 262–265.
    1. Hebert R, Bravo G, Korner-Bitensky N, Voyer L (1996) Predictive validity of a postal questionnaire for screening community-dwelling elderly individuals at risk of functional decline. Age Ageing 25: 159–167.
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, et al. (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56: M146–M156.
    1. Taylor HL, Jacobs DRJ, Schucker B, Knudsen J, Leon AS, et al. (1978) A questionnaire for the assessment of leisure time physical activities. J Chronic Dis 31: 741–755.
    1. Ensrud K, Ewing SK, Taylor BC, Fink HA, Cawthon P, et al. (2008) Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 168: 382–389.
    1. Vellas B, Balardy L, Gillette-Guyonnet S, Abellan Van Kan G, Ghisolfi-Marque A, et al. (2013) Looking for Frailty in Community-Dwelling Older Persons: The Gerontopole Frailty Screening Tool (GFST). J Nutr Health Aging 17: 629–631.
    1. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, et al. (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173: 489–495.
    1. Morley JE, Malmstrom TK, Miller DK (2012) A Simple Frailty Questionnaire (FRAIL) Predicts Outcomes in Middle Aged African Americans. J Nutr Health Aging 16: 601–608.
    1. Fielding RA, Rejeski WJ, Blair S, Church T, Espeland MA, et al. (2011) The Lifestyle Interventions and Independence for Elders Study: Design and Methods. J Gerontol A Biol Sci Med Sci 66: 1226–1237.
    1. Hirvensalo M, Rantanen T, Heikkinen E (2000) Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population. J Am Geriatr Soc 48: 493–498.
    1. Hardy SE, Kang Y, Studenski S, Degenholtz HB (2011) Ability to walk 1/4 mile predicts subsequent disability, mortality, and health care costs. J Gen Intern Med 26: 130–135.
    1. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189–198.
    1. Newman AB, Simonsick EM, Naydeck BL, Boudreau R, Kritchevsky SB, et al. (2006) Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA 295: 2018–2026.
    1. Pahor M, Blair SN, Espeland M, Fielding R, Gill TM, et al. (2006) Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci 61: 1157–1165.
    1. Rolland YM, Cesari M, Miller ME, Penninx BW, Atkinson HH, et al. (2004) Reliability of the 400-m usual-pace walk test as an assessment of mobility limitation in older adults. J Am Geriatr Soc 52: 972–976.
    1. Orme JG, Reis J, Herz EJ (1986) Factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale. J Clin Psychol 42: 28–33.
    1. Martin MY, Powell MP, Peel C, Zhu S, Allman R (2006) Leisure-time physical activity and health-care utilization in older adults. J Aging Phys Act 14: 392–410.
    1. Siscovick DS, Fried L, Mittelmark M, Rutan G, Bild D, et al. (1997) Exercise intensity and subclinical cardiovascular disease in the elderly. The Cardiovascular Health Study. Am J Epidemiol 145: 977–986.
    1. Flack VF, Afifi AA, Lachenbruch PA, Schouten HJA (1988) Sample size determinations for the two rater Kappa statistic. Psychometrika 53: 321–325.
    1. Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J (2009) Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci 64: 675–681.
    1. Raphael D, Cava M, Brown I, Renwick R, Heathcote K, et al. (1995) Frailty: a public health perspective. Can J Public Health 86: 224–227.
    1. Katz S, Downs TD, Cash HR, Grotz RC (1970) Progress in development of the index of ADL. Gerontologist 10: 20–30.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren