Measuring Frailty in Health Care Databases for Clinical Care and Research

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Abstract

Considering the increasing burden and serious consequences of frailty in aging populations, there is increasing interest in measuring frailty in health care databases for clinical care and research. This review synthesizes the latest research on the development and application of 21 frailty measures for health care databases. Frailty measures varied widely in terms of target population (16 ambulatory, 1 long-term care, and 4 inpatient), data source (16 claims-based and 5 electronic health records [EHR]-based measures), assessment period (6 months to 36 months), data types (diagnosis codes required for 17 measures, health service codes for 7 measures, pharmacy data for 4 measures, and other information for 9 measures), and outcomes for validation (clinical frailty for 7 measures, disability for 7 measures, and mortality for 16 measures). These frailty measures may be useful to facilitate frailty screening in clinical care and quantify frailty for large database research in which clinical assessment is not feasible.

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The Tilburg Frailty Indicator: psychometric properties.

Robbert Gobbens, Marcel van Assen, Katrien G Luijkx … (2010)

To assess the reliability, construct validity, and predictive (concurrent) validity of the Tilburg Frailty Indicator (TFI), a self-report questionnaire for measuring frailty in older persons. Cross-sectional. Community-based. Two representative samples of community-dwelling persons aged 75 years and older (n = 245; n = 234). The TFI was validated using the LASA Physical Activity Questionnaire, BMI, Timed Up & Go test, Four test balance scale, Grip strength test, Shortened Fatigue Questionnaire, Mini-Mental State Examination, Center for Epidemiologic Studies Depression Scale, Anxiety subscale of the Hospital Anxiety and Depression Scale, Mastery Scale, Loneliness Scale, and the Social Support List. Adverse outcomes were measured using the Groningen Activity Restriction Scale and questions regarding health care use. Quality of life was measured using the WHOQOL-BREF. The test-retest reliability of the TFI was good: 0.79 for frailty, and from 0.67 to 0.78 for its domains for a 1-year time interval. The 15 single components, and the frailty domains (physical, psychological, social) of the TFI correlated as expected with validated measures, demonstrating both convergent and divergent construct validity of the TFI. The predictive validity of the TFI and its physical domain was good for quality of life and the adverse outcomes disability and receiving personal care, nursing, and informal care. This study demonstrates that the psychometric properties of the TFI are good, when performed in 2 samples of community-dwelling older people. The results regarding the TFI's validity provide strong evidence for an integral definition of frailty consisting of physical, psychological, and social domains. Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

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Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments.

Brian J Buta, Jeremy Walston, Job G Godino … (2016)

The medical syndrome of frailty is widely recognized, yet debate remains over how best to measure it in clinical and research settings. This study reviewed the frailty-related research literature by (a) comprehensively cataloging the wide array of instruments that have been utilized to measure frailty, and (b) systematically categorizing the different purposes and contexts of use for frailty instruments frequently cited in the research literature. We identified 67 frailty instruments total; of these, nine were highly-cited (≥ 200 citations). We randomly sampled and reviewed 545 English-language articles citing at least one highly-cited instrument. We estimated the total number of uses, and classified use into eight categories: risk assessment for adverse health outcomes (31% of all uses); etiological studies of frailty (22%); methodology studies (14%); biomarker studies (12%); inclusion/exclusion criteria (10%); estimating prevalence as primary goal (5%); clinical decision-making (2%); and interventional targeting (2%). The most common assessment context was observational studies of older community-dwelling adults. Physical Frailty Phenotype was the most used frailty instrument in the research literature, followed by the Deficit Accumulation Index and the Vulnerable Elders Survey. This study provides an empirical evaluation of the current uses of frailty instruments, which may be important to consider when selecting instruments for clinical or research purposes. We recommend careful consideration in the selection of a frailty instrument based on the intended purpose, domains captured, and how the instrument has been used in the past. Continued efforts are needed to study the validity and feasibility of these instruments.

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The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community.

D. Saliba, M. Elliott, L Rubenstein … (2001)

To develop a simple method for identifying community-dwelling vulnerable older people, defined as persons age 65 and older at increased risk of death or functional decline. To assess whether self-reported diagnoses and conditions add predictive ability to a function-based survey. Analysis of longitudinal survey data. A nationally representative community-based survey. Six thousand two hundred five Medicare beneficiaries age 65 and older. Bivariate and multivariate analyses of the Medicare Current Beneficiary Survey; development and comparison of scoring systems that use age, function, and self-reported diagnoses to predict future death and functional decline. A multivariate model using function, self-rated health, and age to predict death or functional decline was only slightly improved when self-reported diagnoses and conditions were included as predictors and was significantly better than a model using age plus self-reported diagnoses alone. These analyses provide the basis for a 13-item function-based scoring system that considers age, self-rated health, limitation in physical function, and functional disabilities. A score of >or=3 targeted 32% of this nationally representative sample as vulnerable. This targeted group had 4.2 times the risk of death or functional decline over a 2-year period compared with those with scores <3. The receiver operating characteristics curve had an area of.78. An alternative scoring system that included self-reported diagnoses did not substantially improve predictive ability when compared with a function-based scoring system. A function-based targeting system effectively and efficiently identifies older people at risk of functional decline and death. Self-reported diagnoses and conditions, when added to the system, do not enhance predictive ability. The function-based targeting system relies on self-report and is easily transported across care settings.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Geriatr Med Res

Journal ID (iso-abbrev): Ann Geriatr Med Res

Journal ID (publisher-id): AGMR

Title: Annals of geriatric medicine and research

Publisher: Korean Geriatrics Society

ISSN (Print): 2508-4798

ISSN (Electronic): 2508-4909

Publication date (Print): June 2020

Publication date (Electronic): 3 April 2020

Volume: 24

Issue: 2

Pages: 62-74

Affiliations

Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA

Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

Harvard Medical School, Boston, MA, USA

Author notes

Corresponding Author: Dae Hyun Kim, MD, MPH, ScD Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA 02131, USA Email: daehyunkim@ 123456hsl.harvard.edu

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Dae Hyun Kim http://orcid.org/0000-0001-7290-6838

Article

Publisher ID: agmr-20-0002

DOI: 10.4235/agmr.20.0002

PMC ID: 7370795

PubMed ID: 32743326

SO-VID: 0ed5c3db-ac28-4aa4-a755-58bba90ec532

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Measuring Frailty in Health Care Databases for Clinical Care and Research

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Most cited references 69

The Tilburg Frailty Indicator: psychometric properties.

Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments.

The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community.

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