چکیده (انگلیسی):

Background:Many instruments have been developed to identify frail older adults in primary care. A direct
comparison of the accuracy and prevalence of identification methods is rare and most studies ignore the stepped
selection typically employed in routine care practice. Also it is unclear whether the various methods select persons
with different characteristics. We aimed to estimate the accuracy of 10 single and stepped methods to identify
frailty in older adults and to predict adverse health outcomes. In addition, the methods were compared on their
prevalence of the identified frail persons and on the characteristics of persons identified.
Methods:The Groningen Frailty Indicator (GFI), the PRISMA-7, polypharmacy, the clinical judgment of the general
practitioner (GP), the self-rated health of the older adult, the Edmonton Frail Scale (EFS), the Identification Seniors
At Risk Primary Care (ISAR PC), the Frailty Index (FI), the InterRAI screener and gait speed were compared to three
measures: two reference standards (the clinical judgment of a multidisciplinary expert panel and Fried’s frailty
criteria) and 6-years mortality or long term care admission. Data were used from the Dutch Identification of Frail
Elderly Study, consisting of 102 people aged 65 and over from a primary care practice in Amsterdam. Frail older
adults were oversampled. The accuracy of each instrument and several stepped strategies was estimated by
calculating the area under the ROC-curve.
Results:Prevalence rates of frailty ranged from 14.8 to 52.9 %. The accuracy for recommended cut off values
ranged from poor (AUC = 0.556 ISAR-PC) to good (AUC = 0.865 gait speed). PRISMA-7 performed best over two
reference standards, GP predicted adversities best. Stepped strategies resulted in lower prevalence rates and
accuracy. Persons selected by the different instruments varied greatly in age, IADL dependency, receiving homecare
and mood.
Conclusion:We found huge differences between methods to identify frail persons in prevalence, accuracy and in
characteristics of persons they select. A necessary next step is to find out which frail persons can benefit from
intervention before case finding programs are implemented. Further evidence is needed to guide this emerging
clinical field.