Danilovich Margaret K, Diaz Laura, Johnson Colton, Holt Erin, Ciolino Jody D
1Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N. Michigan Suite 1100, Chicago, IL 60611 USA.
2Department of Preventive Medicine, Northwestern University, 680 N. Lake Shore Drive Suite 1400, Chicago, IL 60611 USA.
Pilot Feasibility Stud. 2019 Mar 20;5:48. doi: 10.1186/s40814-019-0429-2. eCollection 2019.
Frailty assessment most commonly occurs within health care settings by health care providers. Implementing frailty assessment within non-medical settings that provide comprehensive social services for older adults may be an opportunity for population-based frailty screening and care. One such non-medical setting in which older adults receive care is Medicaid Home and Community-based Services (HCBS). Determining the feasibility of frailty screening within this non-medical setting is the first step towards population-based frailty assessment and care. The aims of this study were to (1) determine the feasibility of evaluating frailty using two different approaches (the Survey of Health Among Retired Europeans-Frailty Instrument (SHARE-FI) and Short Physical Performance Battery (SPPB)) among HCBS clients, (2) determine the agreement between the methods, and (3) explore specific frailty deficits on these measures to provide detailed knowledge on HCBS client impairments.
This cross-sectional study occurred in HCBS client homes throughout the Chicagoland area. A research assistant with no health care provider training conducted all frailty assessments. We used the freely available SHARE-FI calculator to generate both a categorical and continuous frailty score. We used the SPPB to capture both a categorical score with frailty categories assigned as 0-6 (frail), 7-9 (pre-frail), and 10-12 (non-frail) and continuous score. We evaluated feasibility via domains of acceptability, implementation, adaptation, and practicality. We used Cohen's kappa and Spearman's correlation to determine agreement between frailty tools.
We enrolled = 139 HCBS clients. Frailty assessment was feasibility via both the SHARE-FI and SPPB. The SHARE-FI was more practical given the fewer training needs, shorter administration time, and reduced equipment needs. There was a statically significant fair agreement between SHARE-FI and SPPB categorical scores with stronger agreement between SHARE-FI and SPPB continuous scores ( = - 0.448, < .005; 95% CI, - 0.571, - 0.305). Among the five frailty criteria on the SHARE-FI, a pattern emerged of the highest frequency of positive responses to each criterion among frail clients followed by pre-frail and then non-frail.
Frailty assessment is feasible within HCBS settings conducted by a non-medical provider. Using continuous frailty scores provides stronger agreement between measures compared with categorical scores. Frailty can be feasibly measured in a non-medical setting providing initial evidence for a mechanism for population screening and care for frailty in HCBS.
衰弱评估最常由医疗保健提供者在医疗保健环境中进行。在为老年人提供全面社会服务的非医疗环境中实施衰弱评估，可能是进行基于人群的衰弱筛查和护理的一个契机。老年人接受护理的一种此类非医疗环境是医疗补助家庭和社区服务（HCBS）。确定在这种非医疗环境中进行衰弱筛查的可行性，是迈向基于人群的衰弱评估和护理的第一步。本研究的目的是：（1）确定在HCBS客户中使用两种不同方法（欧洲退休人员健康调查 - 衰弱量表（SHARE - FI）和简短体能状况量表（SPPB））评估衰弱的可行性；（2）确定两种方法之间的一致性；（3）探索这些测量方法上的特定衰弱缺陷，以提供关于HCBS客户损伤的详细知识。
这项横断面研究在整个芝加哥地区的HCBS客户家中进行。一名未接受过医疗保健提供者培训的研究助理进行了所有的衰弱评估。我们使用免费的SHARE - FI计算器生成分类和连续的衰弱评分。我们使用SPPB来获取分类评分，将衰弱类别分为0 - 6（衰弱）、7 - 9（衰弱前期）和10 - 12（非衰弱），以及连续评分。我们通过可接受性、实施、适应性和实用性等领域评估可行性。我们使用科恩kappa系数和斯皮尔曼相关性来确定衰弱工具之间的一致性。
我们招募了n = 139名HCBS客户。通过SHARE - FI和SPPB进行衰弱评估都是可行的。鉴于培训需求更少（、管理时间更短以及设备需求减少），SHARE - FI更具实用性。SHARE - FI和SPPB分类评分之间存在统计学上显著的中等一致性，而SHARE - FI和SPPB连续评分之间的一致性更强（r = - 0.448，P <.005；95% CI， - 0.571， - 0.305）。在SHARE - FI的五个衰弱标准中，出现了一种模式，即衰弱客户对每个标准的阳性反应频率最高，其次是衰弱前期客户，然后是非衰弱客户。
由非医疗提供者在HCBS环境中进行衰弱评估是可行的。与分类评分相比，使用连续衰弱评分在测量方法之间提供了更强的一致性。在非医疗环境中可以切实可行地测量衰弱，为HCBS中衰弱的人群筛查和护理机制提供了初步证据。
