Sensitivity and specificity of three screening tools for frailty in hospitalized older adults.

AIM To determine the test accuracy, including sensitivity, specificity, positive predictive value, negative predictive value and area under curve, of three frailty screening tools in identifying the risk of frail outcomes among hospitalized older patients. DESIGN Prospective longitudinal study. METHODS The screening tools [Frail-PPS (Frail-Physical, Psychological and Social), Frailty Assessment Measure (FAM), and Identification of seniors at-risk hospitalized patients (ISAR-HP)] were administered by ward nurses to patients aged 65 years and older within 24 h of admission to an acute hospital. Sensitivity, specificity, positive predictive value, negative predictive value and area under curve analysis of the three tools in the context of three frail outcomes, (a) functional decline at three months after discharge-defined as a decline of at least one point on the Katz Index, (ii) requiring a full-time caregiver upon discharge, and (iii) death by three months after discharge, was assessed. RESULTS Of 366 patients enrolled in the study, 78 (21.3%) experienced one or more frail outcomes, with 65 (17.76%) experiencing functional decline, 61 (16.67%) requiring a full-time caregiver upon discharge and 8 (2.19%) dying by three months. Frail-PPS had sensitivity 12.5% to 31.4% and specificity 91.2% to 94.8%, varying by the considered frail outcome. Similarly, FAM had sensitivity 12.5% to 29.4% and specificity 90.9% to 94.1%, and ISAR-HP had sensitivity 2.9% to 19.2% and specificity 92.2% to 99.1%. positive predictive value of the FAM, Frail-PPS and ISAR-HP ranged from 3.0 to 45.5%, 3.1 to 50.0% and 3.9 to 23.6% respectively, while their negative predictive value ranged from 87.1% to 97.9%, 87.7% to 97.9% and 92.2% to 99.4% respectively. The area under curve values were moderate for the Frail-PPS (0.56 to 0.75), FAM (0.58 to 0.70) and ISAR-HP (0.71 to 0.77) for the three outcomes. CONCLUSIONS With high specificity and negative predictive values, as well as low sensitivity, FAM and Frail-PPS may be beneficial in identifying older individuals who are not frail, minimizing unnecessary further assessment and intervention.

[1]  Rachel Marie Towle,et al.  A descriptive study on reasons for prolonged hospital stay in a tertiary hospital in Singapore. , 2021, Journal of nursing management.

[2]  A. Kitson,et al.  Feasibility and acceptability of commonly used screening instruments to identify frailty among community-dwelling older people: a mixed methods study , 2020, BMC Geriatrics.

[3]  M. Huecker,et al.  Diagnostic Testing Accuracy: Sensitivity, Specificity, Predictive Values and Likelihood Ratios , 2020 .

[4]  S. Thilarajah,et al.  Promotion of mobility among hospitalised older adults: An exploratory study on perceptions of patients, carers and nurses. , 2020, Geriatric nursing.

[5]  Truls Østbye,et al.  An integrative review on screening for frailty in acute care: Accuracy, barriers to implementation and adoption strategies. , 2019, Geriatric nursing.

[6]  R. Malhotra,et al.  Identification and Measurement of Frailty: A Scoping Review of Published Research from Singapore. , 2018, Annals of the Academy of Medicine, Singapore.

[7]  Lina Ma.  Current Situation of Frailty Screening Tools for Older Adults , 2018, The journal of nutrition, health & aging.

[8]  R. Trevethan,et al.  Sensitivity, Specificity, and Predictive Values: Foundations, Pliabilities, and Pitfalls in Research and Practice , 2017, Front. Public Health.

[9]  W. J. Mulder,et al.  The Maastricht Frailty Screening Tool for Hospitalised Patients (MFST‐HP) to Identify Non‐Frail Patients , 2017, International journal of clinical practice.

[10]  Kenneth Rockwood,et al.  The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. , 2017, Journal of the American Medical Directors Association.

[11]  L. Tay,et al.  Frailty and Risk of Adverse Outcomes in Hospitalized Older Adults: A Comparison of Different Frailty Measures. , 2017, Journal of the American Medical Directors Association.

[12]  Silvina Santana,et al.  Predicting risk and outcomes for frail older adults: an umbrella review of frailty screening tools , 2017, JBI database of systematic reviews and implementation reports.

[13]  Ann-Katrin Habbig,et al.  Linking Frailty Instruments to the International Classification of Functioning, Disability, and Health: A Systematic Review. , 2016, Journal of the American Medical Directors Association.

[14]  Job G. Godino,et al.  Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments , 2016, Ageing Research Reviews.

[15]  Emma V. Ward,et al.  Psychometric properties of multicomponent tools designed to assess frailty in older adults: A systematic review , 2016, BMC Geriatrics.

[16]  W. J. Mulder,et al.  Validity, reliability and feasibility of tools to identify frail older patients in inpatient hospital care: A systematic review , 2016, The journal of nutrition, health & aging.

[17]  A. Drummond,et al.  22IMPLEMENTATION OF A FRAILTY SCREENING TOOL WITHIN ACUTE MEDICAL UNIT (AMU) AT SOUTHERN GENERAL HOSPITAL (SGH) , 2015 .

[18]  T. Bartol.  Thoughtful use of diagnostic testing: Making practical sense of sensitivity, specificity, and predictive value. , 2015, The Nurse practitioner.

[19]  G. Blauw,et al.  Optimal screening for increased risk for adverse outcomes in hospitalised older adults , 2014, Age and ageing.

[20]  D. Grobbee,et al.  Predicting functional decline in older patients undergoing cardiac surgery. , 2014, Age and ageing.

[21]  Jesse M. Pines,et al.  National Trends in Emergency Department Use, Care Patterns, and Quality of Care of Older Adults in the United States , 2013, Journal of the American Geriatrics Society.

[22]  D. Grobbee,et al.  The prediction of functional decline in older hospitalised patients. , 2012, Age and ageing.

[23]  P. Langhorne,et al.  Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials , 2011, BMJ : British Medical Journal.

[24]  B. Buurman,et al.  Identification of older hospitalised patients at risk for functional decline, a study to compare the predictive values of three screening instruments. , 2010, Journal of clinical nursing.

[25]  D. Rolfson,et al.  The assessment of frailty in older people in acute care , 2009, Australasian journal on ageing.

[26]  Abdul Ghaaliq Lalkhen,et al.  Clinical tests: sensitivity and specificity , 2008 .

[27]  M. Shelkey,et al.  Katz Index of Independence in Activities of Daily Living. , 1999, Journal of gerontological nursing.

[28]  S. Iliffe,et al.  Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations. , 2006, The Gerontologist.

[29]  Philippe Meert,et al.  Early evaluation of the risk of functional decline following hospitalization of older patients: development of a predictive tool. , 2006, European journal of public health.

[30]  Muhammad Jalaluddin,et al.  Hospital Admission Risk Profile (HARP): Identifying Older Patients at Risk for Functional Decline Following Acute Medical Illness and Hospitalization , 1996, Journal of the American Geriatrics Society.

[31]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[32]  S. Z. Nagi.  An epidemiology of disability among adults in the United States. , 1976, The Milbank Memorial Fund quarterly. Health and society.

[33]  E. Pfeiffer.  A Short Portable Mental Status Questionnaire for the Assessment of Organic Brain Deficit in Elderly Patients † , 1975, Journal of the American Geriatrics Society.

[34]  E. Chan,et al.  Older patients' participation in physical activity during hospitalization: A qualitative study of ward nurses' perceptions in an Asian context , 2019, Geriatric nursing.

[35]  Susan Fowler,et al.  Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta-analysis. , 2015, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.