Validation of the self-reported domains of the Edmonton Frail Scale in patients 65 years of age and older

Luxey Sirisegaram; Oluwafemi P Owodunni; April Ehrlich; Caroline Xu Qin; Dianne Bettick; Susan L Gearhart

doi:10.1186/s12877-022-03623-1

Validation of the self-reported domains of the Edmonton Frail Scale in patients 65 years of age and older

BMC Geriatr. 2023 Jan 11;23(1):15. doi: 10.1186/s12877-022-03623-1.

Authors

Luxey Sirisegaram^{1

2}, Oluwafemi P Owodunni³, April Ehrlich⁴, Caroline Xu Qin⁴, Dianne Bettick³, Susan L Gearhart^{5

6}

Affiliations

¹ The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
² Schulich School of Medicine, University of Western Ontario, London, ON, Canada.
³ Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. sdemees1@jhmi.edu.
⁶ Department of Surgery, Johns Hopkins Bayview Medical Center, A Building, 4940 Eastern Avenue, Baltimore, MD, 21286, USA. sdemees1@jhmi.edu.

Abstract

Introduction: In the era of virtual care, self-reported tools are beneficial for preoperative assessments and facilitating postoperative planning. We have previously reported the use of the Edmonton Frailty Scale (EFS) as a valid preoperative assessment tool.

Objective: We wished to validate the self-reported domains of the EFS (srEFS) by examining its association with loss of independence (LOI) and mortality.

Methods: This is a post-hoc analysis of a single-institution observational study of patients 65 years of age or older undergoing multi-specialty surgical procedures and assessed with the EFS in the preoperative setting. Exploratory data analysis was used to determine the threshold for identifying frailty using the srEFS. Procedures were classified using the Operative Stress Score (OSS) scored 1 to 5 (lowest to highest). Hierarchical Condition Category (HCC) was utilized to risk-adjust. LOI was described as requiring more support at discharge and mortality was defined as death occurring up to 30 days following surgery. Receiver operating characteristic (ROC) curves were used to determine the ability of the srEFS to predict the outcomes of interest in relation to the EFS.

Results: Five hundred thirty-five patients were included. Exploratory analysis confirmed best positive predictive value for srEFS was greater or equal to 5. Overall, 113 (21 percent) patients were considered high risk for frailty (HRF) and 179 (33 percent) patients had an OSS greater or equal to 5. LOI occurred in 7 percent (38 patients) and the mortality rate was 4 percent (21 patients). ROC analysis showed that the srEFS performed similar to the standard EFS with no difference in discriminatory thresholds for predicting LOI and mortality. Examination of the domains of the EFS not included in the srEFS demonstrated a lack of association between cognitive decline and the outcomes of interest. However, functional status assessed with either the Get up and Go (EFS only) or self-reported ADLs was independently associated with increased risk for LOI.

Conclusion: This study shows that self-reported EFS may be an optional preoperative tool that can be used in the virtual setting to identify patients at HRF. Early identification of patients at risk for LOI and mortality provides an opportunity to implement targeted strategies to improve patient care.

Keywords: Edmonton frail scale; Frailty; Preoperative.

Publication types

Observational Study

MeSH terms

Activities of Daily Living
Aged
Cognitive Dysfunction* / complications
Frail Elderly
Frailty* / complications
Frailty* / diagnosis
Geriatric Assessment / methods
Humans
Postoperative Complications / etiology
Risk Factors
Self Report