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. 2016 Jan;71(1):84-9.
doi: 10.1093/gerona/glv096. Epub 2015 Aug 13.

Are Performance Measures Necessary to Predict Loss of Independence in Elderly People?

Claudio Pedone  1 , Luisa Costanzo  2 , Matteo Cesari  3 , Stefania Bandinelli  4 , Luigi Ferrucci  5 , Raffaele Antonelli Incalzi  6
Affiliations

Are Performance Measures Necessary to Predict Loss of Independence in Elderly People?

Claudio Pedone et al. J Gerontol A Biol Sci Med Sci. 2016 Jan.

Abstract

Background: The frailty phenotype (FP) proposed by Fried and colleagues (Fried LP, Tangen CM, Walston J, et al.; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-M156.) requires the administration of performance tests (gait speed, handgrip strength) not always feasible in routine clinical practice. Furthermore, the discriminative capacity of the instrument has been rarely investigated. Aim of this study was to evaluate the discriminative capacity of the FP and compare it with a modified version including only anamnestic information.

Methods: Data are from 890 participants of the InCHIANTI study without impairment in activities of daily living (ADL) at baseline (mean age 74 years, women 55%). Frailty was defined by (a) the presence of ≥ 3 criteria of the FP, and (b) having ≥ 2 criteria of an anamnestic FP (AFP), not including gait speed and handgrip strength. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were used to evaluate the discriminative capacity of both definitions for incident disability (ie, loss of at least one ADL), incidence of "accelerated" disability (loss of >2 ADL) over a 6-year follow-up, and 5-years mortality.

Results: FP and AFP yielded a frailty prevalence of 6.4% and 6.5%, respectively; only 32 patients were considered frail by both indices (kappa: .53). For incident disability, FP showed sensitivity = .194, specificity = .963, PPV = .400, and NPV = .903. Similarly, AFP had sensitivity = .129, specificity = .949, PPV = .245, and NPV = .894. Consistent results were found for accelerated disability and mortality.

Conclusions: In our sample, both FP and AFP showed low sensitivity in identifying older people who would die or develop disability, but they could well discriminate people who would not experience adverse outcomes.

Keywords: Disability; Frailty; Mortality; Predictive value; Sensitivity and specificity..

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Figures

Figure 1.
Figure 1.
Prevalence of frailty indicators in the two groups of participants with frailty phenotype and anamnestic frailty phenotype.
Figure 2.
Figure 2.
Mortality in frail and nonfrail people according to the frailty phenotype (left) or the anamnestic frailty phenotype (right).
Figure 3.
Figure 3.
Incidence of disability and accelerated disability according to different scores of frailty phenotype and anamnestic frailty phenotype.
See this image and copyright information in PMC

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References

    1. Campbell AJ, Buchner DM. Unstable disability and the fluctuations of frailty. Age Ageing. 1997;26:315–318. 10.1093/ageing/26.4.315 - PubMed
    1. Rodríguez-Mañas L, Féart C, Mann G, et al. ; FOD-CC group (Appendix 1). Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci. 2013;68:62–67. 10.1093/gerona/gls119 - PMC - PubMed
    1. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60:1487–1492. 10.1111/j.1532-5415.2012.04054.x - PubMed
    1. Fried LP, Tangen CM, Walston J, et al. ; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–M156. 10.1093/gerona/56.3.M146 - PubMed
    1. Rockwood K, Howlett SE, MacKnight C, et al. Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging. J Gerontol A Biol Sci Med Sci. 2004;59:1310–1317. 10.1093/gerona/59.12.1310 - PubMed