- •There is no international standard measurement for frailty.
- •Multiple frailty measurements exist, with varying levels of quality.
- •Frailty measurements can be used for population screening or clinical screening/assessment.
- •The two most common measurements are Fried's phenotype and Rockwood and Mitnitski's Frailty Index.
- •Frailty should be measured in clinical practice as part of routine care for older patients.
- Sanchez-Garcia S.
- Sanchez-Arenas R.
- Garcia-Pena C.
- Rosas-Carrasco O.
- Avila-Funes J.A.
- Ruiz-Arregui L.
- et al.
1.1 What is frailty?
- Berrut G.
- Andrieu S.
- Araujo de Carvalho I.
- Baeyens J.P.
- Bergman H.
- Cassim B.
- et al.
1.2 What causes frailty?
1.3 Frailty measurement
- Berrut G.
- Andrieu S.
- Araujo de Carvalho I.
- Baeyens J.P.
- Bergman H.
- Cassim B.
- et al.
1.4 Research question
- •Population: aged ≥65 years.
- •Implementation/indicator: frailty objectively measured in either observational, cross-sectional or randomised control trials.
- •Comparator: n/a.
- •Outcome: frailty classification or frailty prognosis.
2.1 Critiquing of frailty measurements
- 1.Time taken to perform the measurement.
- 2.Data used to derive the frailty measurement is available from routinely collected CGA data.
- 3.Specialised equipment is required to measure frailty (for instance, a grip strength dynamometer).
- 4.Requirement for assessor training.
- 5.Validity and reliability. Reviews were initially consulted to determine the reliability and validity of frailty measurements. If no discussion of validity/reliability was included in these reviews, then relevant individual articles were searched.
- 6.The measurement is based on an underlying biological theory.
- 7.The measurement takes into account the continuum of frailty.
- 8.The measurement is able to predict surgical/medical outcomes and/or mortality.
|Index||Country of origin||Time (min)||# items||Components||Frailty||Requirements of frailty measurements||Measurement used in the clinical or population setting?|
|Special equipment||Assessor training||Valid & reliable||Outcome prediction|
|CHS||USA||<10||5||Weight loss, low physical activity, exhaustion, slowness, weakness||Frailty ≥3items; pre-frail 1–2 items; Robust = none||x||✓||✓||✓||✓||Both|
|FI-CD||Canada||20–30||30+||Accumulated health deficits: score of 0 (no deficits) to 1.0 (all deficits)||A continuous score. Frailty cut-off suggested >0.25||✓||x||✓||✓||✓||Both|
|FI-CGA||Canada||<15||30+||10 domains, 52 items (originally 14): including ADL, IADL, Co-morbidities, Mood & Cognition||A continuous score. Frailty cut-off suggested >0.25||✓||x||✓||✓||✓||Clinical|
|SOF||USA||<5||3||Weight Loss, Exhaustion, Unable to Rise from Chair 5 times||Frailty ≥2 items; pre-frail = 1 item; robust = 0 items||x||x||x||✓||✓||Both|
|EFS||Canada||<5||9||Cognition, health (2×), hospitalisation, social support, nutrition, mood, function, continence||Frailty = scores ≥7||x||x||✓||✓||✓||Clinical|
|FRAIL||USA||<10||5||Fatigue, Resistance, Ambulation, Illness, Loss of Weight||Frailty ≥3 items; Pre-frail 1–2 items; robust = 0 items||✓||x||x||✓||More studies needed||Both|
|CFS||Canada||<5||1||Visual and written chart for frailty with 9 graded pictures. 1 = very fit; 9 = terminally ill||A continuous score. Frailty cut-off point ≥5||x||x||✓||✓||✓||Clinical|
|MPI||Italy||<15||8||Co-morbidity, Nutrition, Cognition, Polypharmacy, Pressure Sore Risk, Living Status, ADL, IADL||Frailty >0.66; Pre-frailty = 0.34–0.66; robust <0.34||✓||x||✓||✓||More studies needed||Both|
|TFI||The Netherlands||<15||15||Self-reported in 3 domains: physical, psychological and social||Frailty = scores ≥5||x||x||x||✓||More studies needed||Population-level screening|
|PRISMA-7||Canada||<10||7||Self-reported: age (>85 years), male, social support and ADLs||Frailty = scores ≥3||x||x||x||✓||More studies needed||Population-level screening|
|GFI||The Netherlands||<15||15||Self-reported in 4 domains: physical, cognitive, social and psychological||Frailty = scores ≥4||x||x||x||x||More studies needed||Population-level screening|
|SPQ||Canada||<5||6||Self-reported: living alone, polypharmacy, mobility, eyesight, hearing, memory||Frailty = scores ≥2||x||x||x||x||More studies needed||Population-level screening|
|GFST||France||<5||6||2 parts: (i) self-report (lives alone, weight loss, fatigue, mobile, memory, gait (ii) clinical judgement||Identified by clinical judgement, after screening||x||x||✓||x||More studies needed||Population-level screening|
|KCL||Japan||<10||25||25 items from CGA, scoring as per FI-CGA||A continuous score. Frailty cut-off suggested >0.25||✓||x||✓||✓||More studies needed||Population-level screening|
3.1 Fried's Frailty Phenotype — the Cardiovascular Health Study (CHS) index
3.2 Frailty Index of Accumulative Deficits (FI-CD)
3.3 Frailty index derived from comprehensive geriatric assessment (FI-CGA)
3.4 Study of Osteoporotic Fractures (SOF) Index
- Bilotta C.
- Nicolini P.
- Case A.
- Pina G.
- Rossi S.
- Vergani C.
3.5 Edmonton Frailty Scale (EFS)
3.6 Fatigue, Resistance, Ambulation, Illness, Loss of Weight (FRAIL) Index
3.7 Clinical Frailty Scale (CFS)
3.8 Multidimensional Prognostic Instrument (MPI)
3.9 Tilburg Frailty Indicator (TFI)
3.11 Groningen Frailty Indicator (GFI)
3.12 Sherbrooke Postal Questionnaire (SPQ)
3.13 Gérontopôle Frailty Screening Tool (GFST)
3.14 Kihon Check-list (KCL)
- Fukutomi E.
- Okumiya K.
- Wada T.
- Sakamoto R.
- Ishimoto Y.
- Kimura Y.
- et al.
3.15 Individual frailty measurements
3.16 Other frailty measurements
- Guralnik J.M.
- Simonsick E.M.
- Ferrucci L.
- Glynn R.J.
- Berkman L.F.
- Blazer D.G.
- Scherr P.A.
- Wallace R.B.
- •Frailty measurement should be incorporated into clinical practice as part of routine care for older patients.
- •There is no international standard measurement for frailty.
- •A large number of frailty measurements exist, making it difficult to choose which frailty measurement to use.
- •Frailty measurements range from short, fast and crude frailty screening instruments to sophisticated, time-consuming measurements.
- •The quality of frailty measurements varies widely, with many measurements needing cross-cultural validation studies.
- •The two most commonly used frailty measurements (both with high validity and reliability) are Fried's frailty phenotype and Rockwood and Mitnitski's Frailty Index.
- •There is no “one” perfect frailty measurement in existence today. Some measurements are better for population-level frailty screening, whereas others are best suited for clinical screening, or assessment.
Conflict of interest statement
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