Background: A scoping search
identified systematic reviews on diagnostic accuracy and predictive ability of
frailty measures in older adults. In most cases, research was confined to
specific assessment measures related to a specific clinical model.
Objectives: To summarize the best
available evidence from systematic reviews in relation to reliability,
validity, diagnostic accuracy and predictive ability of frailty measures in
Inclusion criteria population: Older adults aged 60 years or older recruited from community, primary care, long-term residential care and hospitals.
Index test: Available frailty
measures in older adults.
Reference test: Cardiovascular
Health Study phenotype model, the Canadian Study of Health and Aging cumulative
deficit model, Comprehensive Geriatric Assessment or other reference tests.
Diagnosis of interest: Frailty
defined as an age-related state of decreased physiological reserves
characterized by an increased risk of poor clinical outcomes.
Types of studies: Quantitative
Search strategy: A three-step
search strategy was utilized to find systematic reviews, available in English,
published between January 2001 and October 2015.
Methodological quality: Assessed by
two independent reviewers using the Joanna Briggs Institute critical appraisal
checklist for systematic reviews and research synthesis.
Data extraction: Two independent reviewers extracted data using the standardized data extraction tool designed for umbrella reviews.
Data synthesis: Data were only
presented in a narrative form due to the heterogeneity of included reviews.
Results: Five reviews with a total
of 227,381 participants were included in this umbrella review. Two reviews
focused on reliability, validity and diagnostic accuracy; two examined
predictive ability for adverse health outcomes; and one investigated validity,
diagnostic accuracy and predictive ability. In total, 26 questionnaires and
brief assessments and eight frailty indicators were analyzed, most of which
were applied to community-dwelling older people. The Frailty Index was examined
in almost all these dimensions, with the exception of reliability, and its
diagnostic and predictive characteristics were shown to be satisfactory. Gait
speed showed high sensitivity, but only moderate specificity, and excellent
predictive ability for future disability in activities of daily living. The
Tilburg Frailty Indicator was shown to be a reliable and valid measure for
frailty screening, but its diagnostic accuracy was not evaluated. Screening
Letter, Timed-up-and-go test and PRISMA 7 (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) demonstrated high sensitivity and
moderate specificity for identifying frailty. In general, low physical
activity, variously measured, was one of the most powerful predictors of future
decline in activities of daily living.
Conclusion: Only a few frailty measures seem to be demonstrably valid, reliable and diagnostically accurate, and have good predictive ability. Among them, the Frailty Index and gait speed emerged as the most useful in routine care and community settings. However, none of the included systematic reviews provided responses that met all of our research questions on their own and there is a need for studies that could fill this gap, covering all these issues within the same study. Nevertheless, it was clear that no suitable tool for assessing frailty appropriately in emergency departments was identified.
|Number of pages||55|
|Journal||JBI Database of Systematic Reviews and Implementation Reports|
|Publication status||Published - 1 Apr 2017|