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BMC Geriatrics

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Open Access 01-12-2022 | Research

Agreement between standard and self-reported assessments of physical frailty syndrome and its components in a registry of community-dwelling older adults

Authors: Brian Buta, Scott Zheng, Jackie Langdon, Bukola Adeosun, Karen Bandeen-Roche, Jeremy Walston, Qian-Li Xue

Published in: BMC Geriatrics | Issue 1/2022

Abstract

Background

The ability to identify frail older adults using a self-reported version of the physical frailty phenotype (PFP) that has been validated with the standard PFP could facilitate physical frailty detection in clinical settings.

Methods

We collected data from volunteers (N = 182), ages 65 years and older, in an aging research registry in Baltimore, Maryland. Measurements included: standard PFP (walking speed, grip strength, weight loss, activity, exhaustion); and self-reported questions about walking and handgrip strength. We compared objectively-measured gait speed and grip strength to self-reported questions using Cohen’s Kappa and diagnostic accuracy tests. We used these measures to compare the standard PFP with self-reported versions of the PFP, focusing on a dichotomized identification of frail versus pre- or non-frail participants.

Results

Self-reported slowness had fair-to-moderate agreement (Kappa(k) = 0.34–0.56) with measured slowness; self-reported and objective weakness had slight-to-borderline-fair agreement (k = 0.10–0.21). Combining three self-reported slowness questions had highest sensitivity (81%) and negative predictive value (NPV; 91%). For weakness, three questions combined had highest sensitivity (72%), while all combinations had comparable NPV. Follow-up questions on level of difficulty led to minimal changes in agreement and decreased sensitivity. Substituting subjective for objective measures in our PFP model dichotomized by frail versus non/pre-frail, we found substantial (k = 0.76–0.78) agreement between standard and self-reported PFPs. We found highest sensitivity (86.4%) and NPV (98.7%) when comparing the dichotomized standard PFP to a self-reported version combining all slowness and weakness questions. Substitutions in a three-level model (frail, vs pre-frail, vs. non-frail) resulted in fair-to-moderate agreement (k = 0.33–0.50) with the standard PFP.

Conclusions

Our results show potential utility as well as challenges of using certain self-reported questions in a modified frailty phenotype. A self-reported PFP with high agreement to the standard phenotype could be a valuable frailty screening assessment in clinical settings.

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Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56. https://doi.org/10.1093/gerona/56.3.m146 PubMed PMID: 11253156.CrossRefPubMed

Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–7. https://doi.org/10.1016/j.jamda.2013.03.022 PubMedPMID:23764209;PubMedCentralPMCID:PMCPMC4084863.CrossRefPubMedPubMedCentral

Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59(3):255–63. https://doi.org/10.1093/gerona/59.3.m255 PubMed PMID: 15031310.CrossRefPubMed

Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, et al. Frailty in older adults: a nationally representative profile in the United States. J Gerontol A Biol Sci Med Sci. 2015;70(11):1427–34. https://doi.org/10.1093/gerona/glv133 PubMedPMID:26297656;PubMedCentralPMCID:PMCPMC4723664.CrossRefPubMedPubMedCentral

Xue QL, Buta B, Varadhan R, Szanton SL, Chaves P, Walston J, et al. Frailty and Geriatric Syndromes. In: Satariano WA, Maus M, editors., et al., Aging, Place, and Health: A Global Perspective. Burlington, MA: Jones & Bartlett Learning; 2018. p. 191–230.

Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL, et al. Frailty assessment instruments: systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev. 2016;26:53–61. https://doi.org/10.1016/j.arr.2015.12.003 PubMedPMID:26674984;PubMedCentralPMCID:PMCPMC4806795.CrossRefPubMed

Bandeen-Roche K, Xue QL, Ferrucci L, Walston J, Guralnik JM, Chaves P, et al. Phenotype of frailty: characterization in the women’s health and aging studies. J Gerontol A Biol Sci Med Sci. 2006;61(3):262–6. https://doi.org/10.1093/gerona/61.3.262 PubMed PMID: 16567375.CrossRefPubMed

Theou O, Cann L, Blodgett J, Wallace LM, Brothers TD, Rockwood K. Modifications to the frailty phenotype criteria: Systematic review of the current literature and investigation of 262 frailty phenotypes in the Survey of Health, ageing, and retirement in Europe. Ageing Res Rev. 2015;21:78–94. https://doi.org/10.1016/j.arr.2015.04.001 PubMed PMID: 25846451.CrossRefPubMed

Lacas A, Rockwood K. Frailty in primary care: a review of its conceptualization and implications for practice. BMC Med. 2012;10:4. https://doi.org/10.1186/1741-7015-10-4 PubMedPMID:22236397;PubMedCentralPMCID:PMCPMC3271962.CrossRefPubMedPubMedCentral

10.

Rouge Bugat ME, Cestac P, Oustric S, Vellas B, Nourhashemi F. Detecting frailty in primary care: a major challenge for primary care physicians. J Am Med Dir Assoc. 2012;13(8):669–72. https://doi.org/10.1016/j.jamda.2012.07.015 PubMed PMID: 22959605.CrossRefPubMed

11.

Sourial N, Bergman H, Karunananthan S, Wolfson C, Payette H, Gutierrez-Robledo LM, et al. Implementing frailty into clinical practice: a cautionary tale. J Gerontol A Biol Sci Med Sci. 2013;68(12):1505–11. https://doi.org/10.1093/gerona/glt053 PubMedPMID:23640761;PubMedCentralPMCID:PMCPMC3806754.CrossRefPubMed

12.

Gobbens RJ, van Assen MA, Schalk MJ. The prediction of disability by self-reported physical frailty components of the Tilburg Frailty Indicator (TFI). Arch Gerontol Geriatr. 2014;59(2):280–7. https://doi.org/10.1016/j.archger.2014.06.008 PubMed PMID: 25042994.CrossRefPubMed

13.

Paulson D, Lichtenberg PA. The Paulson-Lichtenberg Frailty Index: evidence for a self-report measure of frailty. Aging Ment Health. 2015;19(10):892–901. https://doi.org/10.1080/13607863.2014.986645 PubMedPMID:25537004;PubMedCentralPMCID:PMCPMC4480217.CrossRefPubMed

14.

Papachristou E, Wannamethee SG, Lennon LT, Papacosta O, Whincup PH, Iliffe S, et al. Ability of Self-Reported Frailty Components to Predict Incident Disability, Falls, and All-Cause Mortality: Results From a Population-Based Study of Older British Men. J Am Med Dir Assoc. 2017;18(2):152–7. https://doi.org/10.1016/j.jamda.2016.08.020 PubMedPMID:27742583;PubMedCentralPMCID:PMCPMC5270459.CrossRefPubMedPubMedCentral

15.

Op Het Veld LPM, de Vet HCW, van Rossum E, Kempen G, van Kuijk SMJ, Beurskens A. Substitution of Fried's performance-based physical frailty criteria with self-report questions. Arch Gerontol Geriatr. 2018;75:91–5 https://doi.org/10.1016/j.archger.2017.11.009. PubMed PMID: 29202326.

16.

Nunes DP, Duarte YA, Santos JL, Lebrao ML. Screening for frailty in older adults using a self-reported instrument. Rev Saude Publica. 2015;49:2. https://doi.org/10.1590/s0034-8910.2015049005516 PubMedPMID:25741658;PubMedCentralPMCID:PMCPMC4386551.CrossRefPubMedPubMedCentral

17.

Johansen KL, Dalrymple LS, Delgado C, Kaysen GA, Kornak J, Grimes B, et al. Comparison of self-report-based and physical performance-based frailty definitions among patients receiving maintenance hemodialysis. Am J Kidney Dis. 2014;64(4):600–7. https://doi.org/10.1053/j.ajkd.2014.03.016 PubMedPMID:24793033;PubMedCentralPMCID:PMCPMC4177262.CrossRefPubMedPubMedCentral

18.

Syddall HE, Westbury LD, Cooper C, Sayer AA. Self-reported walking speed: a useful marker of physical performance among community-dwelling older people? J Am Med Dir Assoc. 2015;16(4):323–8. https://doi.org/10.1016/j.jamda.2014.11.004 PubMedPMID:25523286;PubMedCentralPMCID:PMCPMC6600869.CrossRefPubMed

19.

Fried LP, Young Y, Rubin G, Bandeen-Roche K, Group WICR. Self-reported preclinical disability identifies older women with early declines in performance and early disease. J Clin Epidemiol. 2001;54(9):889–901. https://doi.org/10.1016/s0895-4356(01)00357-2 PubMed PMID: 11520648.CrossRefPubMed

20.

Cong GT, Cohn MR, Villa JC, Kerwin LJ, Rosen N, Fang XZ, et al. The walking speed questionnaire: assessing walking speed in a self-reported format. J Orthop Trauma. 2016;30(4):e132–7. https://doi.org/10.1097/BOT.0000000000000476. PubMedPMID:26569186;PubMedCentralPMCID:PMCPMC4801662.CrossRefPubMedPubMedCentral

21.

Wolinsky FD, Miller DK, Andresen EM, Malmstrom TK, Miller JP. Further evidence for the importance of subclinical functional limitation and subclinical disability assessment in gerontology and geriatrics. J Gerontol B Psychol Sci Soc Sci. 2005;60(3):S146–51. https://doi.org/10.1093/geronb/60.3.s146 (PubMed PMID: 15860791).CrossRefPubMed

22.

Pransky G, Feuerstein M, Himmelstein J, Katz JN, Vickers-Lahti M. Measuring functional outcomes in work-related upper extremity disorders. Development and validation of the Upper Extremity Function Scale. Occup Environ Med. 1997;39(12):1195–202. https://doi.org/10.1097/00043764-199712000-00014 PubMed PMID: 9429173.CrossRef

23.

Schuler PB, Marzilli TS. Use of self-reports of physical fitness as substitutes for performance-based measures of physical fitness in older adults. Percept Mot Skills. 2003;96(2):414–20. https://doi.org/10.2466/pms.2003.96.2.414 (PubMed PMID: 12776822).CrossRefPubMed

24.

Cohen J. A Coefficient of Agreement for Nominal Scales. Educ Psychol Measur. 1960;20(1):37–46.CrossRef

25.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74 (PubMed PMID: 843571).CrossRef

26.

McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276–82 PubMed PMID: 23092060; PubMed Central PMCID: PMCPMC3900052.CrossRef

27.

Trevethan R. Sensitivity, specificity, and predictive values: foundations, pliabilities, and pitfalls in research and practice. Front Public Health. 2017;5:307. https://doi.org/10.3389/fpubh.2017.00307 (PubMedPMID:29209603;PubMedCentralPMCID:PMCPMC5701930).CrossRefPubMedPubMedCentral

28.

Glass TA. Conjugating the “tenses” of function: discordance among hypothetical, experimental, and enacted function in older adults. Gerontologist. 1998;38(1):101–12. https://doi.org/10.1093/geront/38.1.101 (PubMed PMID: 9499658).CrossRefPubMed

29.

Coman L, Richardson J. Relationship between self-report and performance measures of function: a systematic review. Can J Aging. 2006;25(3):253–70. https://doi.org/10.1353/cja.2007.0001 (PubMed PMID: 17001588).CrossRefPubMed

30.

Ferrer M, Lamarca R, Orfila F, Alonso J. Comparison of performance-based and self-rated functional capacity in Spanish elderly. Am J Epidemiol. 1999;149(3):228–35. https://doi.org/10.1093/oxfordjournals.aje.a009796 (PubMed PMID: 9927217).CrossRefPubMed

31.

Alexander NB, Guire KE, Thelen DG, Ashton-Miller JA, Schultz AB, Grunawalt JC, et al. Self-reported walking ability predicts functional mobility performance in frail older adults. J Am Geriatr Soc. 2000;48(11):1408–13. https://doi.org/10.1111/j.1532-5415.2000.tb02630.x (PubMed PMID: 11083316).CrossRefPubMed

32.

Young Y, Boyd CM, Guralnik JM, Fried LP. Does self-reported function correspond to objective measures of functional impairment? J Am Med Dir Assoc. 2010;11(9):645–53. https://doi.org/10.1016/j.jamda.2009.12.084 (PubMedPMID:21029999;PubMedCentralPMCID:PMCPMC2966843).CrossRefPubMedPubMedCentral

33.

Simonsick EM, Kasper JD, Guralnik JM, Bandeen-Roche K, Ferrucci L, Hirsch R, et al. Severity of upper and lower extremity functional limitation: scale development and validation with self-report and performance-based measures of physical function. WHAS research group. women’s health and aging study. J Gerontol B Psychol Sci Soc Sci. 2001;56(1):S10-9. https://doi.org/10.1093/geronb/56.1.s10 (PubMed PMID: 11192340).CrossRefPubMed

34.

Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54(6):991–1001. https://doi.org/10.1111/j.1532-5415.2006.00745.x PubMed PMID: 16776798.CrossRefPubMed

35.

Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008;12(1):29–37. https://doi.org/10.1007/BF02982161 PubMed PMID: 18165842.CrossRefPubMed

36.

Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95. https://doi.org/10.1503/cmaj.050051 (PubMedPMID:16129869;PubMedCentralPMCID:PMCPMC1188185).CrossRefPubMedPubMedCentral

37.

Aguayo GA, Donneau AF, Vaillant MT, Schritz A, Franco OH, Stranges S, et al. Agreement Between 35 Published Frailty Scores in the General Population. Am J Epidemiol. 2017;186(4):420–34. https://doi.org/10.1093/aje/kwx061 (PubMedPMID:28633404;PubMedCentralPMCID:PMCPMC5860330).CrossRefPubMedPubMedCentral

Title: Agreement between standard and self-reported assessments of physical frailty syndrome and its components in a registry of community-dwelling older adults
Authors: Brian Buta
Scott Zheng
Jackie Langdon
Bukola Adeosun
Karen Bandeen-Roche
Jeremy Walston
Qian-Li Xue
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: BMC Geriatrics / Issue 1/2022
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-022-03376-x

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