My passion is working with older adults. About 60+% of my patients are older than 65. I've had a burning question in my mind for years: does frailty play a role in the outcomes of care?
I've learned from the FOTO Research Advisory Board that it's best to use science to actually answer a question like that.
To my knowledge, this kind of study really hasn't happened. One area that is problematic is an agreeable definition of frail. From my perspective frailty is associated with slower gait speed, higher incidence of falls and a high dependence of others to live (even when still living in one's own home). Earlier this year at the American Physical Therapy Association Combined Sections Meeting, I learned it can take a couple of years to move from frail to not frail. Since I'm one to just jump into my own thoughts based on clinical experience (without always having direct evidence to support my thoughts), I believe the answer to my question is that frailty does affect outcomes. FOTO captures some factors involved in frailty because comorbidities are included in the risk adjustment process. The full picture involved in frailty is not truly captured.
Do you consider the frailty of the older adults you treat? If you do, do you formally measure it? The two measures I'm more familiar with are the Fried phenotype and the Short Physical Performance Battery. This recent study compares these measures.
Below you will find the abstract.
Measuring frailty in clinical practice: a comparison of physical frailty assessment methods in a geriatric out-patient clinic.
The objectives of this study were to determine: 1) the prevalence of frailty using Fried's phenotype method and the Short Performance Physical Battery (SPPB), 2) agreement between frailty assessment methods, 3) the feasibility of assessing frailty using Fried's phenotype method and the SPPB.
This cross-sectional study was conducted at a geriatric out-patient clinic in Hamilton, Canada. A research assistant conducted all frailty assessments. Patients were classified as non-frail, pre-frail or frail according to Fried's phenotype method and the SPPB. Agreement among methods is reported using the Cohen kappa statistic (standard error). Feasibility data included the percent of eligible participants agreeing to attempt the frailty assessments (criterion for feasibility: ≥90% of patients agreeing to the frailty assessment), equipment required, and safety considerations. A p-value of <0.05 is considered significant.
A total of 110 participants (92%) and 109 participants (91%) agreed to attempt Fried's phenotype method and SPPB, respectively. No adverse events occurred during any assessments. According to Fried's phenotype method, the prevalence of frailty and pre-frailty was 35% and 56%, respectively, and according to the SPPB, the prevalence of frailty and pre-frailty was 50% and 35%, respectively. There was fair to moderate agreement between methods for determining which participants were frail (0.488 [0.082], p < 0.001) and pre-frail (0.272 [0.084], p = 0.002).
Frailty and pre-frailty are common in this geriatric outpatient population, and there is fair to moderate agreement between Fried's phenotype method and the SPPB. Over 90% of the patients who were eligible for the study agreed to attempt the frailty assessments, demonstrating that according to our feasibility criteria, frailty can be assessed in this patient population. Assessing frailty may help clinicians identify high-risk patients and tailor interventions based on baseline frailty characteristics.
BMC Geriatr.2017 Nov 13;17(1):264. doi: 10.1186/s12877-017-0623-0.