Screening for frailty in older adults using a self-reported instrument

Nunes, Daniella Pires; Duarte, Yeda Aparecida de Oliveira; Santos, Jair Lício Ferreira; Lebrão, Maria Lúcia

doi:10.1590/S0034-8910.2015049005516

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Sumário

Original Articles • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005516 copy

Screening for frailty in older adults using a self-reported instrument

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To validate a screening instrument using self-reported assessment of frailty syndrome in older adults.

METHODS

This cross-sectional study used data from the Saúde, Bem-estar e Envelhecimento study conducted in Sao Paulo, SP, Southeastern Brazil. The sample consisted of 433 older adult individuals (≥ 75 years) assessed in 2009. The self-reported instrument can be applied to older adults or their proxy respondents and consists of dichotomous questions directly related to each component of the frailty phenotype, which is considered the gold standard model: unintentional weight loss, fatigue, low physical activity, decreased physical strength, and decreased walking speed. The same classification proposed in the phenotype was utilized: not frail (no component identified); pre-frail (presence of one or two components), and frail (presence of three or more components). Because this is a screening instrument, “process of frailty” was included as a category (pre-frail and frail). Cronbach’s α was used in psychometric analysis to evaluate the reliability and validity of the criterion, the sensitivity, the specificity, as well as positive and negative predictive values. Factor analysis was used to assess the suitability of the proposed number of components.

RESULTS

Decreased walking speed and decreased physical strength showed good internal consistency (α = 0.77 and 0.72, respectively); however, low physical activity was less satisfactory (α = 0.63). The sensitivity and specificity for identifying pre-frail individuals were 89.7% and 24.3%, respectively, while those for identifying frail individuals were 63.2% and 71.6%, respectively. In addition, 89.7% of the individuals from both the evaluations were identified in the “process of frailty” category.

CONCLUSIONS

The self-reported assessment of frailty can identify the syndrome among older adults and can be used as a screening tool. Its advantages include simplicity, rapidity, low cost, and ability to be used by different professionals.

Aged; Frail Elderly; Physical Fitness; Motor Activity; Diagnostic Self Evaluation; Questionnaires, utilization; Validation Studies

Frailty	Questions and answers
Weight loss (In this component, older adults who reported a loss of > 3 kg received a positive score)	In the last 12 months, did you lose weight without going on any diet?
	If yes, how many kilograms did you lose? Between 1 kg and 3 kg More than 3 kg
	No
Decreased strength	In the last 12 months, do you feel weaker or think your strength has decreased?
	Yes
	No
Decreased walking speed	Do you think that you are walking more slowly than you did 12 months ago?
	Yes
	No
Low physical activity	Do you think that you are currently performing less physical activity than you did 12 months ago?
	Yes
	No
Self-reported fatigue (Older adults who responded “sometimes” or “most of the time” to at least one of these questions received a positive score)	In the past week, how often did you feel that you could not perform daily activities (you started something but could not finish)?
	Never or rarely (less than 1 day)
	A few times (1 - 2 days)
	Sometimes (3 - 4 days)
	Most of the time
	In the past week, how often did the performance of your routine activities require a major effort?
	Never or rarely (less than 1 day)
	A few times (1 - 2 days)
	Sometimes (3 - 4 days)
	Most of the time

Variable	n	%
Sex
Male	150	34.6
Female	283	65.4
Age (mean ± SD)	85.7 (5.1)
Education
Illiterate	111	25.6
1 to 3 years	147	34.0
4 to 7 years	151	34.9
≥ 8 years	24	5.5
Live alone
No	343	79.2
Yes	90	20.8
Proxy respondent
No	273	63.1
Yes	160	36.9
Disease
None	68	15.7
1	90	20.8
≥ 2	275	63.5
Depression^a
No	353	81.5
Yes	80	18.5
Cognitive decline^b
No	320	73.9
Yes	113	26.1
Difficulty in one or more BADL^c
No	228	52.7
Yes	205	47.3
Difficulty in one or more IADL^d
No	148	34.2
Yes	285	65.8
Frailty (Model proposed by Fried et al¹⁰)
Not-fragile	74	17.1
Pre-fragile	199	45.9
Fragile	160	37.0
Total	433	100

Components of assessing frailty syndrome	Sensibility	Specificity	PPV	NPV

	%	%	%	%
Decreased walking speed	79.0	31.4	56.4	57.1
Decreased handgrip strength	77.7	34.9	44.7	69.8
Low physical activity	71.2	50.3	69.1	52.8
Unintentional weight loss	19.7	80.1	26.7	72.9

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Daniella Pires Nunes. Rua Cardeal Arcoverde, 388 apto.121. 05408-000 São Paulo, SP, Brasil. E-mail: dpiresnunes@yahoo.com.br