The diagnostic and predictive accuracy of the PRISMA-7 screening tool for frailty in older adults: a systematic review, and meta-analysis.

BACKGROUND

Frailty is associated with adverse outcomes in older adults across healthcare settings. Frailty screening tools can serve to identify older adults living with frailty and direct resources to high-risk older adults. This systematic review and meta-analysis examined the diagnostic and predictive accuracy of the Program of Research to Integrate the Services for the Maintenance of Autonomy 7 (PRISMA-7) frailty screening tool.

METHODS

A systematic literature search was conducted in PubMed, EMBASE, CINAHL, EBSCO and the Cochrane Library. Prospective or retrospective cohort and cross-sectional studies that explored the diagnostic and/or predictive accuracy of the PRISMA-7 tool in older adults were included across all healthcare settings. Study quality was assessed using the QUADAS-2 tool. Statistical analysis was completed using Stata version 12 (StataCorp, TX, USA). A bivariate random effects model was used to generate pooled estimates of sensitivity and specificity. RevMan5 was used to pool data comparing older adults living with frailty versus those without frailty.

RESULTS

Thirty-six studies were included in the review. The overall quality of the studies included was moderate. Meta-analysis of diagnostic accuracy (regardless of reference standard used) showed a pooled sensitivity and specificity of 72% (95% CI 54-84%) and 87% (95% CI 76-93%), respectively. Sub-analysis of the six studies that used Frailty Phenotype as a reference standard demonstrated pooled sensitivity and specificity of 82% (95% CI 73.8-88.2) and 79% (95% CI 72-85.6%), respectively. Meta-analysis of the predictive accuracy of the PRISMA-7 showed that older adults living with frailty spent significantly more time in the emergency department (FEM MD 2.66 h, 95% CI 2.15-3.16 h, I = 25%) and stayed longer in hospital, (REM MD 1.89 days, 95% CI 0.18-3.6 days, I = 86%), respectively.

CONCLUSION

The PRISMA-7 has a moderate sensitivity and high specificity for frailty identification. It has good predictive accuracy for multiple adverse outcomes among older adults, supporting its potential utilization across healthcare settings.