Bertrand Fougère1, Marie-Josée Sirois2, Pierre-Hugues Carmichael2, Brice-Lionel Batomen-Kuimi2, Bruno Chicoulaa3, Emile Escourrou3, Fati Nourhashémi4, Stéphane Oustric5, Bruno Vellas4. 1. Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France. Electronic address: b.fougere@gmail.com. 2. Centre d'Excellence sur le Vieillissement de Québec, Québec, Canada. 3. Département Universitaire de Médecine Générale, Université de Toulouse III Paul Sabatier, Toulouse, France. 4. Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France. 5. Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France; Département Universitaire de Médecine Générale, Université de Toulouse III Paul Sabatier, Toulouse, France.
Abstract
BACKGROUND: The progression of frailty is marked by an increased risk of adverse health outcomes in the elderly including falls, physical and/or cognitive disability, hospitalizations, and mortality. In primary care, the general practitioner's (GP's) clinical impression about their elderly patients' frailty state seems to be a key point in identifying frail individuals in their clinical practice. The aim of this article is to examine if GPs' clinical impressions regarding frailty concurs with objective measures of the gold standard frailty phenotype as described by Fried in community-dwelling older persons. DESIGN: Cross-sectional study in 14 primary care GP offices in the Toulouse area from May 1st to October 31st, 2015. PARTICIPANTS: Fourteen GPs screened their patients ≥70 years old. MEASUREMENTS: GPs' "frailty impression" was based on the Gérontopôle Frailty Screening Tool. "Objective measures of the five Fried frailty criteria" were obtained by a geriatric nurse through standardized testing. The capacity of the GPs' clinical impression to detect participants objectively measured as frail was examined with diagnostic values of observed sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV). RESULTS: A total of 268 participants were screened by GPs and assessed by a nurse. Mean age was 81 years and 62.3% were female. According to the objective measures of Fried's criteria, frailty (three to five criteria) and pre-frailty (one to two criteria) states were identified in 31% and 45.2% of participants, respectively. The Se of the GPs' impression was good (80.39%; 95% confidence interval [CI], 74.27%-85.61%), and the Sp was moderate (64.06%; 95% CI, 5.10%-75.68%). The overall PPV of the GPs' impression was 87.70% (95% CI, 82.12%-92.04%), and the NPV was 50.51% (95% CI, 39.27%-61.91%). Although the PPV increased with age reaching 93.33% (95% CI, 85.12%-97.80%) among patients ≥ 85 years old, the NPV decreased accordingly to a minimal 21.43% (95% CI, 4.66%-50.80%) in that subgroup. CONCLUSION: The present study highlights the importance of the GPs' clinical impression on frailty as a fair means to identify this syndrome in community-dwelling older patients in primary care. This clinical impression may not be sufficient, however, and some objective tests could be added to improve the accuracy of frailty detection in older patients in primary care.
BACKGROUND: The progression of frailty is marked by an increased risk of adverse health outcomes in the elderly including falls, physical and/or cognitive disability, hospitalizations, and mortality. In primary care, the general practitioner's (GP's) clinical impression about their elderly patients' frailty state seems to be a key point in identifying frail individuals in their clinical practice. The aim of this article is to examine if GPs' clinical impressions regarding frailty concurs with objective measures of the gold standard frailty phenotype as described by Fried in community-dwelling older persons. DESIGN: Cross-sectional study in 14 primary care GP offices in the Toulouse area from May 1st to October 31st, 2015. PARTICIPANTS: Fourteen GPs screened their patients ≥70 years old. MEASUREMENTS: GPs' "frailty impression" was based on the Gérontopôle Frailty Screening Tool. "Objective measures of the five Fried frailty criteria" were obtained by a geriatric nurse through standardized testing. The capacity of the GPs' clinical impression to detect participants objectively measured as frail was examined with diagnostic values of observed sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV). RESULTS: A total of 268 participants were screened by GPs and assessed by a nurse. Mean age was 81 years and 62.3% were female. According to the objective measures of Fried's criteria, frailty (three to five criteria) and pre-frailty (one to two criteria) states were identified in 31% and 45.2% of participants, respectively. The Se of the GPs' impression was good (80.39%; 95% confidence interval [CI], 74.27%-85.61%), and the Sp was moderate (64.06%; 95% CI, 5.10%-75.68%). The overall PPV of the GPs' impression was 87.70% (95% CI, 82.12%-92.04%), and the NPV was 50.51% (95% CI, 39.27%-61.91%). Although the PPV increased with age reaching 93.33% (95% CI, 85.12%-97.80%) among patients ≥ 85 years old, the NPV decreased accordingly to a minimal 21.43% (95% CI, 4.66%-50.80%) in that subgroup. CONCLUSION: The present study highlights the importance of the GPs' clinical impression on frailty as a fair means to identify this syndrome in community-dwelling older patients in primary care. This clinical impression may not be sufficient, however, and some objective tests could be added to improve the accuracy of frailty detection in older patients in primary care.
Authors: B Fougère; M Cesari; H Arai; J Woo; R A Merchant; L Flicker; A Cherubini; J M Bauer; B Vellas; J E Morley Journal: J Nutr Health Aging Date: 2018 Impact factor: 4.075
Authors: B Fougère; C Lagourdette; P Abele; B Resnick; M Rantz; C Kam Yuk Lai; Q Chen; W Moyle; B Vellas; J E Morley Journal: J Nutr Health Aging Date: 2018 Impact factor: 4.075
Authors: Reshma Aziz Merchant; Richard Jor Yeong Hui; Sing Cheer Kwek; Meena Sundram; Arthur Tay; Jerome Jayasundram; Matthew Zhixuan Chen; Shu Ee Ng; Li Feng Tan; John E Morley Journal: Front Med (Lausanne) Date: 2020-07-08
Authors: Vanessa Fillion; Marie-Josée Sirois; Philippe Gamache; Jason Robert Guertin; Suzanne N Morin; Sonia Jean Journal: BMC Health Serv Res Date: 2019-01-25 Impact factor: 2.655