Facilitating Frailty Identification: Comparison of Two Methods among Community-Dwelling Order Adults.

BACKGROUND

Frailty is characterized by increased vulnerability for adverse events such as falls, fractures, placement, and death. Several frailty models have been developed, including the widely accepted Frailty Phenotype. However, the Frailty Phenotype can be difficult to apply in clinical practice. Alternatively, the Clinical Frailty Scale has been proposed based on its simplicity. To date, the Clinical Frailty Scale has not been validated against the Frailty Phenotype.

OBJECTIVE

We aimed to test the inter-rater reliability of the Clinical Frailty Scale and its agreement with the Frailty Phenotype in frailty identification.

DESIGN

Cross-sectional study.

SETTING

Retirement community in London, Ontario, Canada.

PARTICIPANTS

One hundred and four community-dwelling older adults (age ≥75 years).

MEASUREMENTS

Participants were first classified using the Frailty Phenotype criteria as not frail, pre-frail or frail. Subsequently, two clinicians blinded to the first assessment, determined frailty status using the Clinical Frailty Scale. Differences between assessments were resolved by consensus. Inter-rater reliability was assessed using kappa statistics. Spearman Rho correlation coefficients evaluated the concurrent validity of the Clinical Frailty Scale against Frailty Phenotype components.

RESULTS

Analysis with kappa statistic showed substantial agreement between raters in applying the Clinical Frailty Scale to the sample (κw= 0.76, 95% CI 0.68, 0.84). The Clinical Frailty Scale scores also positively correlated with an increasing number of Frailty Phenotype components (ρ=0.69, p<0.01).

CONCLUSION

The Clinical Frailty Scale is reliable and comparable to the Frailty Phenotype in identifying frailty in community-dwelling older adults with the advantage of being easy to administer in clinical settings. Reliable tools to identify frailty in community-dwelling older adults may help provide timely interventions to ameliorate risk of adverse events.