Identifying frailty in primary care: A systematic review
Corresponding Author
Linda Lee
Center for Family Medicine Family Health Team, Kitchener, Ontario, Canada
Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
Correspondence: Dr Linda Lee MD, MClSc(FM), CCFP, FCFP, Centre for Family Medicine, 10B Victoria Street South, Kitchener, ON, Canada, N2G 1C5. Email: [email protected]Search for more papers by this authorTejal Patel
Center for Family Medicine Family Health Team, Kitchener, Ontario, Canada
Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
University of Waterloo School of Pharmacy, Waterloo, Ontario, Canada
Search for more papers by this authorLoretta M. Hillier
St. Joseph's Health Care, London, Ontario, Canada
Aging, Rehabilitation and Geriatric Care Research Center of the Lawson Health Research Institute, London, Ontario, Canada
Search for more papers by this authorNiraj Maulkhan
Center for Family Medicine Family Health Team, Kitchener, Ontario, Canada
Search for more papers by this authorKaren Slonim
Center for Family Medicine Family Health Team, Kitchener, Ontario, Canada
Search for more papers by this authorAndrew Costa
Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada
Search for more papers by this authorCorresponding Author
Linda Lee
Center for Family Medicine Family Health Team, Kitchener, Ontario, Canada
Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
Correspondence: Dr Linda Lee MD, MClSc(FM), CCFP, FCFP, Centre for Family Medicine, 10B Victoria Street South, Kitchener, ON, Canada, N2G 1C5. Email: [email protected]Search for more papers by this authorTejal Patel
Center for Family Medicine Family Health Team, Kitchener, Ontario, Canada
Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
University of Waterloo School of Pharmacy, Waterloo, Ontario, Canada
Search for more papers by this authorLoretta M. Hillier
St. Joseph's Health Care, London, Ontario, Canada
Aging, Rehabilitation and Geriatric Care Research Center of the Lawson Health Research Institute, London, Ontario, Canada
Search for more papers by this authorNiraj Maulkhan
Center for Family Medicine Family Health Team, Kitchener, Ontario, Canada
Search for more papers by this authorKaren Slonim
Center for Family Medicine Family Health Team, Kitchener, Ontario, Canada
Search for more papers by this authorAndrew Costa
Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada
Search for more papers by this authorAbstract
Aim
Identification of frailty in the primary care setting could be improved with the availability of easily identifiable markers of frailty. The purpose of this article was to systematically review markers for frailty or risk tools that have been validated in the ambulatory care setting.
Methods
Medline, PubMed, CIHAHL and Embase databases were searched up to March 2016 for studies on frailty markers in community-dwelling individuals 65 years or older. Studies were included for review if they were carried out in primary care or outpatient settings, used a validated definition of frailty, compared two or more markers, and used randomized controlled trial, quasi-experimental or prospective cohort designs.
Results
Of the 3405 titles screened, 12 were retained for review. All of the studies were prospective cohort designs. Studies most frequently assessed biological markers, such as immune, inflammation, endocrine biomarkers and metabolic syndrome markers. Not one specific marker was repeatedly identified as a definitive marker for frailty.
Conclusions
There is a lack of psychometrically sound and clinically useful frailty markers. There is a need for further research to identify highly sensitive, specific and accurate markers that are feasible to use in the context of busy primary care practice. Geriatr Gerontol Int 2017; 17: 1358–1377.
References
- 1Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med 2011; 27: 1–15.
- 2DeLepeleire J, Iliffe S, Mann E et al. Frailty: an emerging concept for general practice. Br J Gen Pract 2009; 59: e177–e182.
- 3Fulop T, Larbi A, Witkowski JM et al. Aging, frailty and age-related diseases. Biogerontology 2010; 11: 547–563.
- 4Markle-Reid M, Browne G. Conceptualizations of frailty in relation to older adults. J Adv Nurs 2003; 44: 58–68.
- 5Martin FC, Brighton P. Frailty: different tools for different purposes? Age Ageing 2008; 37: 129–131.
- 6van Iersel MB, Rikkert MG. Frailty criteria give heterogeneous results when applied in clinical practice. J Am Geriatr Soc 2006; 54: 728–729.
- 7Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56A: M146–M156.
- 8Inouye SK, Studenski S, Tinetti ME et al. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 2007; 55: 780–791.
- 9Mitnitski AB, Mogilner AJ, MacKnight C et al. The mortality rate as a function of accumulated deficits in a frailty index. Mech Ageing Dev 2002; 123: 1457–1460.
- 10Rockwood K, Song X, MacKnight C et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489–495.
- 11Gill TM, Gahbauer EA, Allore HG et al. Transitions between frailty states among community-living older persons. Arch Intern Med 2006; 166: 418–423.
- 12Landi F, Russo A, Liperoti R et al. Anorexia, physical function, and incident disability among the frail elderly population: results from the ilSIRENTE study. J Am Med Dir Assoc 2010; 11: 268–274.
- 13Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc 2010; 58: 681–687.
- 14Woods NF, LaCroix AZ, Gray SL et al. Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. J Am Geriatr Soc 2005; 53: 1321–1330.
- 15Szanton SL, Seplaki CL, Thorpe RJ Jr et al. Socioeconomic status is associated with frailty: the Women's Health and Aging Studies. J Epidemiol Community Health 2010; 64: 63–67.
- 16Lang IA, Hubbard RE, Andrew MK et al. Neighborhood deprivation, individual socioeconomic status, and frailty in older adults. J Am Geriatr Soc 2009; 57: 1776–1780.
- 17Reiner AP, Aragaki AK, Gray SL et al. Inflammation and thrombosis biomarkers and incident frailty in postmenopausal women. Am J Med 2009; 122: 947–954.
- 18Barzilay JI, Blaum C, Moore T et al. Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study. Arch Intern Med 2007; 167: 635–641.
- 19Semba RD, Bartali B, Zhou J et al. Low serum micronutrient concentrations predict frailty among older women living in the community. Nutrit Aging 2006; 61A: 594–599.
- 20Fried LP, Tangen CM, Walston J et al. Frailty in older adults: Evidence for phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–M156.
- 21Fried LP, Ferrucci L, Darer J et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59: 255–263.
- 22Shamliyan T, Talley KMC, Ramakrishnan R et al. Association of frailty with survival: A systematic literature review. Ageing Res Rev 2013; 12: 719–736.
- 23McNallan SM, Singh M, Chamberlain AM et al. Frailty and healthcare utilization among patients with heart failure in the community. J Am Col Cardiol Heart Failure 2013; 1: 135–141.
- 24Pugh JA, Wang CP, Espinoza SE et al. Influence of frailty-related diagnoses, high-risk prescribing in elderly adults, and primary care use on readmissions in fewer than 30 days for veterns aged 65 years and older. J Am Geriatr Soc 2014; 62: 291–298.
- 25Bagshaw SM, Stelfox HT, McDermid RC et al. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ 2014; 186: E95–E102.
- 26Lee DH, Buth KJ, Martin BJ et al. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation 2010; 121: 973–978.
- 27Afilalo J, Eisenberg MJ, Morin JF et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Col Cardiol Heart Failure 2010; 56: 1668–1676.
- 28Farhat JS, Velanovich V, Flavo AJ et al. Are the frail destined to fail? Frailty index as a predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg 2012; 72: 1526–1530.
- 29Makary MA, Segev DL, Pronovost PJ et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010; 10: 901–908.
- 30Lacas A, Rockwood K. Frailty in primary care: a review of its conceptualization and implications for practice. BMC Med 2012; 10: 4.
- 31Bouillon K, Kivimaki M, Hamer M et al. Measures of frailty in population-based studies: An overview. BMC Geriatr 2013; 10: 104–114.
- 32Abellan van Kan G, Rolland Y, Houles M et al. The assessment of frailty in older adults. Clin Geriatr Med 2010; 26: 275–286.
- 33Rodriguez-Manas L, Feart C, Mann G et al. Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci 2013; 68: 62–67.
- 34Chou CH, Hwang CL, Wu YT. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Arch Phys Med Rehabil 2012; 93: 237–244.
- 35Theou O, Brothers TD, Rockwood MR et al. Exploring the relationship between national economic indicators and relative fitness and frailty in middle-aged and older Europeans. Age Ageing 2013; 42: 614–629.
- 36Lee L, Heckman G, Molnar FJ. Frailty: Identifying elderly patients at high risk of poor outcomes. Can Fam Physician 2015; 61: 227–231.
- 37Theou O, Stathokostas L, Roland KP et al. The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res 2011; 2011: 569194.
- 38Abellan van KG, Rolland Y, Andrieu S et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 2009; 13: 881–889.
- 39Moher D, Liberati A, Tetzlaff J et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264–269.
- 40Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62: 722–727.
- 41Guyatt G, Drummond R, Mead MO et al. Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. Chicago: AMA Press, 2002.
- 42Pai M, McCulloch M, Gorman JD et al. Systematic reviews and meta-analyses: an illustrated, step-by-step guide. Natl Med J India 2004; 17: 86–95.
- 43Viera AJ, Garrett JM. Understanding interobserver agreement: The kappa statistic. Fam Med 2005; 37: 360–363.
- 44Baylis D, Bartlett DB, Syddall HE et al. Immune-endocrine biomarkers as predictors of frailty and mortality: a 10-year longitudinal study in community-dwelling older people. Age (Dordrecht, Netherlands) 2013; 35: 963–971.
- 45Doba N, Tokuda Y, Goldstein NE et al. A pilot trial to predict frailty syndrome: the Japanese Health Research Volunteer Study. Exp Gerontol 2012; 47: 638–643.
- 46Paulson D, Lichtenberg PA. Vascular depression: an early warning sign of frailty. Aging Ment Health 2013; 17: 85–93.
- 47Xue Q, Bandeen-Roche K, Varadhan R et al. Initial manifestations of frailty criteria and the development of frailty phenotype in the Women's Health and Aging Study II. J Gerontol A Biol Sci Med Sci 2008; 63A: 984–990.
- 48Garcia-Esquinas E, Graciani A, Guallar-Castillon P et al. Diabetes and risk of frailty and its potential mechanisms: a prospective cohort study of older adults. J Am Med Dir Assoc 2015; 16: 748–754.
- 49Cawthon PM, Ensrud KE, Laughlin GA et al. Sex hormones and frailty in older men: The osteoporotic fractures in men (MrOS) study. J Clin Endocrinol Metab 2009; 94: 3806–3815.
- 50Gruenewald TL, Seeman TE, Karlamangla AS et al. Allostatic load and frailty in older adults. J Am Geriatr Soc 2009; 57: 1525–1531.
- 51Lakey SL, LaCroix AZ, Gray SL et al. Antidepressant use, depressive symptoms, and incident frailty in women aged 65 and older from the Women's Health Initiative Observational Study. J Am Geriatr Soc 2012; 60: 854–861.
- 52Rothman MD, Leo-Summers L, Gill TM. Prognostic significance of potential frailty criteria. J Am Geriatr Soc 2008; 56: 2211–2216.
- 53Studenski S, Perera S, Patel K et al. Gait speed and survival in older adults. JAMA 2011; 305: 50–58.
- 54Clegg A, Rogers L, Young J. Diagnostic accuracy of simple instruments for identifying frailty in community-dwelling older people: A systematic review. Age Ageing 2015; 44: 148–152.
- 55Lee L, Patel T, Costa A et al. Accuracy of Gait Speed and Handgrip Strength as a Screen for Frailty in Primary Care. Canadian Family Physician [In Press]
- 56Afilalo J, Eisenberg MJ, Morin JF et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol 2010; 56: 1668–1676.
- 57Farhat JS, Velanovich V, Falvo AJ et al. Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg 2012; 72: 1526–1530.
