Comparing Diagnostic Properties of the FRAIL-NH Scale and 4 Frailty Screening Instruments among Chinese...

Area of Science:

• Gerontology
• Diagnostic Test Accuracy
• Geriatric Medicine

Background:

• Frailty is a significant health concern in older adults, particularly those in institutionalized settings.
• Accurate screening tools are crucial for timely intervention and management of frailty.
• Existing frailty screening instruments require validation in diverse populations and settings.

Purpose of the Study:

• To evaluate the diagnostic test accuracy (DTA) of the FRAIL-NH and four other frailty screening instruments.
• To compare the performance of these instruments against the Comprehensive Geriatric Assessment (CGA) as a reference standard.
• To determine the optimal cut-points for enhancing the diagnostic properties of the screening tools.

Main Methods:

• A cross-sectional study was conducted with 305 institutionalized older adults in Jinan, China.
• Five frailty screening instruments were used: FRAIL-NH, Physical Frailty Phenotype (PFP), FRAIL, Tilburg Frailty Indicator (TFI), and Groningen Frailty Indicator (GFI).
• Receiver operating characteristic (ROC) curve analysis was employed to assess DTA, with the Youden index used to find optimal cut-points.

Main Results:

• The prevalence of frailty varied across instruments, ranging from 25.9% (FRAIL) to 56.4% (GFI).
• All instruments showed good diagnostic accuracy (AUCs 0.80-0.83) against the CGA.
• At optimal cut-points, FRAIL-NH, PFP, and FRAIL showed balanced sensitivity and specificity, with improved classification rates.

Conclusions:

• The FRAIL-NH, self-report FRAIL, TFI, GFI, and hybrid PFP exhibit comparable and good diagnostic properties for identifying frailty in institutionalized older adults.
• These validated screening tools can be effectively utilized in nursing home settings for frailty assessment.
• The findings support the use of these instruments for improving geriatric care and management of frailty.