Provider miscategorization of frailty in an outpatient urogynecologic population

Routine assessment of frailty preoperatively is recommended for older adults, because frailty is associated with adverse surgical outcomes. This study was aimed at describing the percentage of patients whose frailty status was correctly categorized by Female Pelvic Medicine and Reconstructive Surgery (FPRMS) providers and to determine patient predictors of accurate categorization.

Cross-sectional study was carried out of English speaking, new patients, >65 years old, presenting from March to June 2018. Providers categorized patients as frail, pre-frail, or not frail based on clinical impression. Frailty was defined using the Fried Frailty Assessment (FFA), a validated, objective measure including weight loss, exhaustion, physical activity, walk speed, and grip strength. Provider categorizations were compared with FFA results. Multiple logistic regression was used to estimate patient predictors of frailty categorization. Data from other fields that approximated a 45% proportion of miscategorization guided sample size estimates.

Ten FPMRS providers participated, and 106 out of 110 patients (96%) had complete data. Primary diagnoses were pelvic organ prolapse (37%), incontinence (20%), and overactive bladder (17%). On FFA, 16 (15%) patients were frail, 50 (47%) were pre-frail, and 40 (38%) were not frail. The overall proportion of miscategorization was 58% (95% confidence interval 49-68%). Providers correctly categorized 50% of frail patients, 34% of pre-frail patients, and 48% of non-frail patients. Slow walk time was associated with provider categorization of frailty, regardless of frailty status (p = 0.01).

Clinical impression may not adequately assess frailty. Miscategorization of frailty by FPMRS providers was higher than in other fields.