General Practitioners' Clinical Impression in the Screening for Frailty: Data From the FAP Study Pilot

Area of Science:

• Gerontology
• Primary Care Medicine
• Geriatric Medicine

Background:

• Frailty progression increases adverse health outcomes in the elderly, including falls, disability, hospitalization, and mortality.
• General practitioners' (GPs') clinical impressions are crucial for identifying frail individuals in primary care settings.
• Accurate frailty assessment is vital for timely intervention and improved geriatric care.

Purpose of the Study:

• To evaluate the concordance between GPs' clinical impressions of frailty and objective measures using Fried's frailty phenotype criteria.
• To determine the diagnostic accuracy of GPs' frailty assessments in community-dwelling older adults.
• To explore the utility of clinical judgment versus objective testing in primary care frailty screening.

Main Methods:

• A cross-sectional study conducted in 14 primary care GP offices in the Toulouse area.
• Fourteen GPs screened patients aged 70 years and older using the Gérontopôle Frailty Screening Tool for their 'frailty impression'.
• A geriatric nurse obtained objective measures of Fried's five frailty criteria through standardized testing for comparison.

Main Results:

• 268 participants were assessed; 31% were objectively frail and 45.2% were pre-frail.
• GPs' frailty impression demonstrated good sensitivity (80.39%) and moderate specificity (64.06%).
• The positive predictive value (PPV) was high (87.70%), but the negative predictive value (NPV) was moderate (50.51%), decreasing with age.

Conclusions:

• GPs' clinical impression is a valuable tool for identifying frailty in older primary care patients.
• While useful, GPs' clinical impression alone may be insufficient for accurate frailty detection.
• Integrating objective frailty assessment tools could enhance diagnostic accuracy in primary care settings.