Frailty in community-dwelling older people: comparing screening instruments

Carneiro, Jair Almeida; Souza, Andressa Samantha Oliveira; Maia, Luciana Colares; Costa, Fernanda Marques da; Moraes, Edgar Nunes de; Caldeira, Antônio Prates

doi:10.11606/s1518-8787.2020054002114

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Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054002114 copy

Frailty in community-dwelling older people: comparing screening instruments

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To compare the Edmonton Frail Scale (EFS) and Clinical-Functional Vulnerability Index-20 (CFVI-20) instruments regarding degree of agreement and correlation and compare descriptive models with frailty-associated variables in community-dwelling older people in Brazil.

METHODS:

Cross-sectional study, nested in a population-based and household cohort. Baseline sampling was calculated based on a probabilistic approach by conglomerate in two stages. In the first stage, census tract was used as sampling unit. In the second, the number of households was defined according to the population density of individuals aged ≥ 60 years. The Kappa statistic evaluated the agreement between instruments and Pearson's coefficient their correlation. Factors associated with frailty and high risk of clinical-functional vulnerability were identified by multiple analysis of Poisson regression with robust variance.

RESULTS:

Kappa statistics was 0.599 and Pearson's correlation coefficient 0.755 (p < 0.001). The EFS found a 28.2% prevalence of frailty, and the CFVI-20 found a 19.5% prevalence of high risk of clinical-functional vulnerability. Age equal to or greater than 80 years, history of stroke, polypharmacy, negative self-perceived health, fall in the past 12 months, and hospitalization in the past 12 months were variables associated with frailty in both instruments after multiple analysis. Less than four years of education, osteoarticular disease, and weight loss were associated with frailty only by EFS, and having a caregiver was associated with a high risk of clinical-functional vulnerability only by CFVI-20.

CONCLUSIONS:

Although the analyses show moderate agreement and strong positive correlation between the instruments, the indicated prevalence of frailty is discrepant. Our results attest the need to standardize the instrument for assessing frailty in community-dwelling older people.

DESCRIPTORS:
Aged; Frailty, Epidemiology; Reproducibility of Results; Risk Factors; Health Surveys, Instrumentation

Independent variables		Sample		Frailty in the Edmonton Frail Scale (n = 394)					Frailty in the Clinical-Functional Vulnerability Index-20 (n = 394)
		n	%	Yes		No		p	Yes		No		p
		n	%	n	%	n	%	p	n	%	n	%	p
Gender								0.982					0.871
	Male	131	33.2	37	28.2	94	71.8		25	19.1	106	80.9
	Female	263	66.8	74	28.1	189	71.9		52	19.8	211	80.2
Age group								< 0.001					< 0.001
	Up to 79 years	302	76.6	70	23.2	232	77.8		35	11.6	267	88.4
	≥ 80 years	92	23.4	41	44.6	51	55.4		42	45.7	50	54.3
Marital status								0.378					0.039
	With partner	195	49.5	51	26.2	144	73.8		30	15.4	165	84.6
	Without partner	199	50.6	60	30.2	139	69.8		47	23.6	152	76.4
Family arrangement								0.977					0.218
	Living alone	50	12.7	14	28.0	36	72.0		13	26.0	37	74.0
	Living accompanied	344	87.3	97	28.2	247	71.8		64	18.6	280	81.4
Education level								< 0.001					0.002
	Up to 4 years	295	74.9	100	33.9	195	66.1		68	23.1	227	76.9
	> 4 years	99	25.1	11	11.1	88	88.9		9	9.1	90	90.9
Literacy								0.001					0.023
	Yes	300	76.1	72	24.0	228	76.0		51	17.0	249	83.0
	No	94	23.9	39	41.5	55	58.5		26	27.7	68	72.3
Own income								0.263					0.123
	No	39	9.9	8	20.5	31	79.5		4	10.3	35	89.7
	Yes	355	90.1	103	29.0	252	71.0		73	20.6	282	79.4
Household monthly income								0.109					0.040
	Up to one minimum wage	102	25.9	35	34.3	67	65.7		27	26.5	75	73.5
	> one minimum wage	292	74.1	76	26.0	216	74.0		50	17.1	242	82.9
Hypertension								0.029					0.047
	Yes	281	71.3	88	31.3	193	68.7		62	22.1	219	77.9
	No	113	28.7	23	20.4	90	79.6		15	13.3	98	86.7
Diabetes mellitus								0.215					0.631
	Yes	90	22.8	30	33.3	60	66.7		16	17.8	74	82.2
	No	304	77.2	81	26.6	223	73.4		61	20.1	243	79.9
Heart disease								0.003					< 0.001
	Yes	110	27.9	43	39.1	67	60.9		35	31.8	75	68.2
	No	284	72.1	68	23.9	216	76.1		42	14.8	242	85.2
Osteoarticular disease								0.002					0.040
	Yes	189	48.0	67	35.4	122	64.6		45	23.8	144	76.2
	No	205	52.0	44	21.5	161	78.5		32	15.6	173	84.4
Neoplasia								0.045					0.001
	Yes	38	9.6	16	42.1	22	57.9		15	39.5	23	60.5
	No	356	90.4	95	26.7	261	73.3		62	17.4	294	82.6
Cerebrovascular accident								0.001					< 0.001
	Yes	29	7.4	16	55.2	13	44.8		13	44.8	16	55.2
	No	365	92.6	95	26.0	270	74.0		64	17.5	301	82.5
Polypharmacy								< 0.001					< 0.001
	Yes	107	27.2	53	49.5	54	50.5		35	32.7	72	67.3
	No	287	72.8	58	20.2	229	79.8		42	14.6	245	85.4
Self-perceived health								< 0.001					< 0.001
	Negative	207	52.5	90	43.5	117	56.5		62	30.0	145	70.0
	Positive	187	47.5	21	11.2	166	88.8		15	8.0	172	92.0
Weight loss								< 0.001					0.001
	Yes	59	15.0	31	52.5	28	47.5		21	35.6	38	64.4
	No	335	85.0	80	23.9	255	76.1		56	16.7	279	83.3
Presence of caregiver								< 0.001					< 0.001
	Yes	46	11.7	25	54.3	21	45.7		23	50.0	23	50.0
	No	348	88.3	86	24.7	262	75.3		54	15.5	294	84.5
Fall in the past 12 months								< 0.001					< 0.001
	Yes	123	31.2	54	43.9	69	56.1		39	31.7	84	68.3
	No	271	68.8	57	21.0	214	79.0		38	14.0	233	86.0
Hospitalization in the past 12 months								< 0.001					< 0.001
	Yes	57	14.5	33	57.9	24	42.1		22	38.6	35	61.4
	No	337	85.5	78	23.1	259	76.9		55	16.3	282	83.7

Edmonton Frail Scale components		n	%
Cognition (clock drawing test)	Accepted	78	19.8
	Rejected with minor mistakes	64	16.2
	Rejected with major mistakes	252	64.0
General health status (hospitalization in the past 12 months)	None	337	85.5
	1 to 2	48	12.2
	More than 2	9	2.3
Self-perceived health	Excellent/very good/good	187	47.5
	Poor	180	45.7
	Very poor	27	6.8
Functional independence (activities in which assistance is required)	0–1	267	67.8
	2–4	123	31.2
	5–8	4	1.0
Social support (when assistance is needed, the older adult has someone to count on)	Always	332	84.3
	Sometimes	57	14.5
	Never	5	1.2
Medication (five or more)	No	287	72.8
Medication (five or more)	Yes	107	27.2
Forget to take a medication	No	269	68.3
Forget to take a medication	Yes	125	31.7
Nutrition (weight loss)	No	335	85.0
Nutrition (weight loss)	Yes	59	15.0
Mood (feel sad or depressed)	No	297	75.4
Mood (feel sad or depressed)	Yes	97	24.6
Urinary incontinence	No	298	75.6
Urinary incontinence	Yes	96	24.4
Functional performance (Timed Up & Go test)	0–10 seconds	121	30.7
	11–20 seconds	189	48.0
	More than 20 seconds	84	21.3

Clinical-Functional Vulnerability Index-20 components				n	%
AGE		60 to 74 years old		226	57.4
		75 to 84 years old		128	32.5
		≥ 85 years		40	10.1
SELF-PERCEIVED HEALTH	Health compared to other people from the same age group	Excellent/very good/good		226	57.4
SELF-PERCEIVED HEALTH	Health compared to other people from the same age group	Fair or bad		168	42.6
ACTIVITIES OF DAILY LIVING (ADLs)	Instrumental (ADL)	Stopped grocery shopping	Yes	85	21.6
		Stopped grocery shopping	No	309	78.4
		Stopped managing finances	Yes	71	18.1
		Stopped managing finances	No	323	81.9
		Stopped performing minor housework	Yes	80	20.3
		Stopped performing minor housework	No	314	79.7
	Basic (ADL)	Stopped bathing alone	Yes	24	6.1
	Basic (ADL)	Stopped bathing alone	No	370	93.9
COGNITION	Forgetfulness		Yes	103	26.1
	Forgetfulness		No	291	73.9
	Worsening of forgetfulness in the past months		Yes	68	17.3
	Worsening of forgetfulness in the past months		No	326	82.7
	Forgetfulness preventing the performance of daily activities		Yes	55	14.0
			No	339	86.0
MOOD	Dismay, sadness, or hopelessness in the past month		Yes	109	27.7
	Dismay, sadness, or hopelessness in the past month		No	285	72.3
	Loss of interest or pleasure in the past month in previously enjoyable activities		Yes	81	20.6
			No	313	79.4
MOBILITY	Reach, graspingness, and pincer grip	Inability to raise the arm above shoulder level	Yes	35	8.9
		Inability to raise the arm above shoulder level	No	359	91.1
		Inability to handle or hold small objects	Yes	31	7.8
		Inability to handle or hold small objects	No	363	92.2
	Aerobic and muscle capacity	Unintentional weight loss, BMI < 22 kg/m2, calf circumference < 31 cm, or gait speed (4 m) > 5 sec.	Yes	49	12.4
	Aerobic and muscle capacity		No	345	87.6
	Gait	Walking difficulties preventing to perform some daily activities	Yes	109	27.7
			No	285	72.3
		Two or more falls in the past year	Yes	110	27.9
		Two or more falls in the past year	No	284	72.1
	Sphincteral incontinence	Involuntary loss of urine or feces	Yes	117	29.7
	Sphincteral incontinence	Involuntary loss of urine or feces	No	277	70.3
COMMUNICATION	Vision	Vision impairment that may prevent the performance of some daily activities	Yes	80	20.3
	Vision		No	314	79.7
	Hearing	Hearing impairment that may prevent the performance of some daily activities	Yes	79	20.1
	Hearing		No	315	79.9
MULTIPLE COMORBIDITIES	Polypathology	≥ 5 chronic diseases ≥ 5 daily medications Hospitalization in the past 6 months	Yes	83	21.1
MULTIPLE COMORBIDITIES	Polypharmacy		Yes	83	21.1

	Edmonton Frail Scale (EFS)				Total
	No frailty		Frailty		Total
CFVI-20:	(n)	(%)	(n)	(%)
No frailty	271	85.5	46	14.5	317
Frailty	12	15.6	65	84.4	77

Independent variables		Frailty in the Edmonton Frail Scale			Frailty in the CFVI-20
Independent variables		PR	95%CI	p	PR	95%CI	p
Age group				0.001			< 0.001
	≥ 80 years	1.643	1.239 – 2.178		3.327	2.204 – 5.021
	Up to 79 years	1			1
Education level				0.002
	Up to 4 years	2.171	1.314 – 3.589
	> 4 years	1
Osteoarticular disease				0.016
	Yes	1.410	1.065 – 1.865
	No	1
Cerebrovascular accident				< 0.001			< 0.001
	Yes	2.139	1.484 – 3.082		2.546	1.619 – 4.004
	No	1			1
Polypharmacy				0.001			0.004
	Yes	1.610	1.217 – 2.130		1.657	1.174 – 2.337
	No	1			1
Self-perceived health				< 0.001			< 0.001
	Negative	3.115	2.085 – 4.654		3.294	2.081 – 5.213
	Positive	1			1
Weight loss				0.006
	Yes	1.542	1.132 – 2.102
	No	1
Presence of caregiver							0.020
	Yes				1.615	1.078 – 2.419
	No				1
Fall in the past 12 months				0.037			0.029
	Yes	1.363	1.019 – 1.824		1.503	1.043 – 2.166
	No	1			1
Hospitalization in the past 12 months				< 0.001			0.005
	Yes	1.825	1.382 – 2.409		1.715	1.181 – 2.490
	No	1			1

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[1] Correspondence: Jair Almeida Carneiro, Rua Pequizeiro, 145 39402-603 Montes Claros, MG, Brasil. E-mail: jair.carneiro@unimontes.br