A Simple Questionnaire as a First-Step Tool to Detect Specific Frailty Profiles: The Lorraine Frailty-Profiling Screening Scale

Abstract

Objectives

To propose a simple frailty screening tool able to identify frailty profiles.

Design

Cross-sectional observational study.

Setting

Participants were recruited in 3 different clinical settings: a primary care outpatient clinic (RURAL population, N=591), a geriatric day clinic (DAY-CLINIC population, N=76) and healthy volunteers (URBAN population, N=147).

Participants

A total of 817 older adults (>70 years old) living at home were included.

Intervention

A 9-item questionnaire (Lorraine Frailty Profiling Screening Scale, LoFProSS), constructed by an experts’ working group, was administered to participants by health professionals.

Measurements

A Multiple Correspondence Analysis (MCA) followed by a hierarchical clustering of the results of the MCA performed in each population was conducted to identify participant profiles based on their answers to LoFProSS. A response pattern algorithm was resultantly identified in the RURAL (main) population and subsequently applied to the URBAN and DAY-CLINIC populations and, in these populations, the two classification methods were compared. Finally, clinically-relevant profiles were generated and compared for their ability to similarly classify subjects.

Results

The response pattern differed between the 3 sub-populations for all 9 items, revealing significant intergroup differences (1.2±1.4 positive responses for URBAN vs. 2.1±1.3 for RURAL vs. 3.1+2.1 for DAY-CLINIC, all p<0.05). Five clusters were highlighted in the main RURAL population: “non-frail”, “hospitalizations”, “physical problems”, “social isolation” and “behavioral”, with similar clusters highlighted in the remaining two populations. Identification of the response pattern algorithm in the RURAL population yielded a second classification approach, with 83% of tested participants classified in the same cluster using the 2 different approaches. Three clinically-relevant profiles (“non-frail” profile, “physical frailty and diseases” profile and “cognitive-psychological frailty” profile) were subsequently generated from the 5 clusters. A similar double classification approach as above was applied to these 3 profiles revealing a very high percentage (95.6%) of similar profile classifications using both methods.

Conclusion

The present results demonstrate the ability of LoFProSS to highlight 3 frailty-related profiles, in a consistent manner, among different older populations living at home. Such scale could represent an added value as a simple frailty screening tool for accelerated and better-targeted investigations and interventions.

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References

  1. 1.

    Beard JR, Officer A, Araujo De Carvalho I, Sadana R, Pot AM, Michel J-P, Lloyd-Sherlock P et al. The World report on ageing and health: a policy framework for healthy ageing HHS Public Access. World Health Organization. Lancet 2016;387(10033):2145–54. doi: https://doi.org/10.1016/S0140-6736(15)00516-4

    Article  Google Scholar 

  2. 2.

    Clegg A, Young J, Iliff S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013;381(9868):752–62. doi: https://doi.org/10.1016/S0140-6736(12)62167-9

    Article  Google Scholar 

  3. 3.

    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56(3):M146–56. doi: https://doi.org/10.1093/gerona/56.3.m146

    CAS  Article  Google Scholar 

  4. 4.

    Rockwood K, Song X, Macknight C, Bergman H, Hogan DB, Mcdowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173(5):489–95. doi: https://doi.org/10.1503/cmaj.050051

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Cesari M, Carvalho IA De, Thiyagarajan JA, Cooper C, Martin FC, Reginster J, Vellas B and Beard JR. Evidence for the Domains Supporting the Construct of Intrinsic Capacity. J Gerontol A Biol Sci Med Sci. 2018;73(12):1653–1660. doi: https://doi.org/10.1093/gerona/gly011

    Article  PubMed  Google Scholar 

  6. 6.

    Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J, Ebrahim S. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 2008;371(9614):725–35. doi: https://doi.org/10.1016/S0140-6736(08)60342-6

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Stuck AE, Egger M, Minder CE, Beck JC. Home Visits to Prevent Nursing Home Admission and Functional Decline Systematic Review and Meta-regression Analysis. JAMA 2002;287(8):1022–8. doi: https://doi.org/10.1001/jama.287.8.1022

    Article  PubMed  Google Scholar 

  8. 8.

    Ferrucci L, Guralnik ÃIM, Studenski S, Fried LP, Jr BC, Walston JD. Designing Randomized, Controlled Trials Aimed at Preventing or Delaying Functional Decline and Disability in Frail, Older Persons: A consensus Report. J Am Geriatr Soc. 2004;52(4):625–34. doi: https://doi.org/10.1111/j.1532-5415.2004.52174.x

    Article  Google Scholar 

  9. 9.

    Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J. Prevalence of Frailty in Middle-Aged and Older Community-Dwelling Europeans Living in 10 Countries. J Gerontol Med Sci Cite J as J Gerontol A Biol Sci Med Sci All 2009;64(6):675–81. doi: https://doi.org/10.1093/gerona/glp012

    Article  Google Scholar 

  10. 10.

    Morley JE, Vellas B, Abellan van Kan G, Anker SD, Bauer IM, Bernabei R, Cesari M et al. Frailty Consensus: A Call to Action. J Am Med Dir Assoc. 2013; 14(6): 392–397. doi:https://doi.org/10.1016/j.jamda.2013.03.022

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Oubaya N, Dramé M, Novella J-L, Quignard E, Cunin C, Jolly D, Mahmoudi R. Screening for frailty in community-dwelling elderly subjects: Predictive validity of the modified SEGA instrument. Arch Gerontol Geriatr. 2017;73:177–181. doi: https://doi.org/10.1016/j.archger.2017.07.026

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Barberger-Gateau P, Chaslerie A, Dartigues JF, Commenges D, Gagnon M, Salamon R. Health measures correlates in a French elderly community population: the PAQUID study. J Gerontol. 1992;47(2):S88–95. doi: https://doi.org/10.1093/geronj/47.2.s88

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Cesari M. Role of gait speed in the assessment of older patients. JAMA 2011;305(1):93–4. doi: https://doi.org/10.1001/jama.2010.1970.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J et al. Gait Speed and Survival in Older Adults. JAMA 2011;305(1):50–8. doi: https://doi.org/10.1001/jama.2010.1923

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Perna S, D’ M, Francis A, Bologna C, Moncaglieri F, Riva A, Morazzoni P, Allegrini P et al. Performance of Edmonton Frail Scale on frailty assessment: its association with multi-dimensional geriatric conditions assessed with specific screening tools. BMC Geriatrics 2017;17:2. doi: https://doi.org/10.1186/s12877-016-0382-3

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Bellera CA, Rainfray M, Mathoulin-Pélissier S, Mertens C, Delva F, Fonck M, Soubeyran PL. Screening older cancer patients: First evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012;23(8):2166–72. doi: https://doi.org/10.1093/annonc/mdr587

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Gobbens RJ, van Assen MA, Luijkx KG, Schols JM. The Predictive Validity of the Tilburg Frailty Indicator: Disability, Health Care Utilization, and Quality of Life in a Population at Risk. Gerontologist 2012;52(5):619–31. doi: https://doi.org/10.1093/geront/gnr135

    Article  PubMed  Google Scholar 

  18. 18.

    Gobbens RJ, van Assen MA, Luijkx KG, Wijnen-Sponselee MT, Schols JM. The Tilburg Frailty Indicator: Psychometric Properties. J Am Med Dir Assoc. 2010;11(5):344–55. doi: https://doi.org/10.1016/j.jamda.2009.11.003.

    Article  PubMed  Google Scholar 

  19. 19.

    Metzelthin SF, Daniëls R, van Rossum E, de Witte L, van den Heuvel WJ, Kempen GI. The psychometric properties of three self-report screening instruments for identifying frail older people in the community. BMC Public Health 2010; 10:176. doi: https://doi.org/10.1186/1471-2458-10-176

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Cesari M, Demougeot L, Boccalon H, Guyonnet S, Abellan Van Kan G, Vellas B, Andrieu S. A Self-Reported Screening Tool for Detecting Community-Dwelling Older Persons with Frailty Syndrome in the Absence of Mobility Disability: The FiND Questionnaire. PLoS ONE 2014;9(7):e101745. doi:https://doi.org/10.1371/journal.pone.0101745

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Bielderman A, Van Der Schans CP, Van Lieshout M-RJ, Hg De Greef M, Boersma F, Krijnen WP, Steverink N. Multidimensional structure of the Groningen Frailty Indicator in community-dwelling older people. BMC Geriatrics 2013; 13:86. doi:https://doi.org/10.1186/1471-2318-13-86

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Turner G, Clegg A. Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing 2014;43(6):744–7. doi: https://doi.org/10.1093/ageing/afu138

    Article  PubMed  Google Scholar 

  23. 23.

    Romero-Ortuno R, Walsh CD, Lawlor BA, Kenny RA. A frailty instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatr. 2010;10:57. doi: https://doi.org/10.1186/1471-2318-10-57

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Vellas B, Balardy L, Gillette-Guyonnet S, Abellan Van Kan G, Ghisolfi-Marque A, Subra J, Bismuth S, Oustric S CM. Looking for frailty in community-dwelling older persons: the Gérontopôle Frailty Screening Tool (GFST). J Nutr Health Aging 2013;17(7):629–31. doi: https://doi.org/10.1007/s12603-013-0363-6

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA and Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94. doi: https://doi.org/10.1093/geronj/49.2.m85

    CAS  Article  PubMed  Google Scholar 

  26. 26.

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

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL, Bandeen-Roche K, Varadhan R. Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev. 2016; Mar;26:53–61. doi: https://doi.org/10.1016/j.arr.2015.12.003

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012; Jul;16(7):601–8

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Berrut G, Andrieu S, Araujo De Carvalho I, Baeyens JP, Bergman H, Cassim B, Cerreta F, et al. Promoting access to innovation for frail old persons. IAGG (International Association of Gerontology and Geriatrics), WHO (World Health Organization) and SFGG (Société Française de Gériatrie et de Gérontologie) Workshop-Athens January 20–21, 2012. J Nutr Health Aging. 2013;17:688–93. doi: https://doi.org/10.1007/s12603-013-0039-2.

    CAS  Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the European FrailSafe project (H2020-PHC-2014-2015, Contract number 690140), the French national PHRC 2010-A01399-30 program, the regional CPER-ITM2P 2015–2020 project, the French «Lorraine Université d’Excellence» PIA project, reference ANR-15-IDEX-04-LUE and the Investments for the Future program under grant agreement No. ANR-15-RHU-0004. The authors thank the Agence Régionale de Santé (ARS) de Lorraine for supporting this study. The authors thank the Filleris group for its contribution in the conduct of this study and in particular the individuals of this group mentioned below who actively participated in the geriatric evaluations: Dr C. Berard, Dr F. Block, Mrs MF. Cangini, Mrs C. Clement, Dr J. Crestani, Mrs F. Delesse, Mrs F. Iochem, Mrs P. Leroij, Mrs C. Lesniak, Dr F. Sprenger, Dr D. Stock, Dr M. Wilczewski, Dr M. Zanetti. We also thank the personnel of the CHRU Nancy for the assessments of the URBAN and DAY-CLINIC participants. Special thanks are also given to Mrs F. Bardin, ANGDM (Agence Nationale Pour La Garantie Des Droits Des Mineurs — National Agency for the Rights of Miners).

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Correspondence to Athanase Benetos.

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Disclosure of conflict of inetrest: Authors have no potential conflict of interest to report.

Ethical Standards: Participants of the URBAN population signed an informed consent. For subjects of the DAY-CLINIC and RURAL populations, current policy regarding data collection for research purposes during standard clinical practice was applied (subjects underwent this questionnaire in the context of their routine examination and were informed prior to the interview regarding the anonymous use of these explorations for the purpose of the present clinical study and were given the opportunity to express their opposition, in which case their responses were not recorded).

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Kotsani, M., Aromatario, O., Labat, C. et al. A Simple Questionnaire as a First-Step Tool to Detect Specific Frailty Profiles: The Lorraine Frailty-Profiling Screening Scale. J Nutr Health Aging (2020). https://doi.org/10.1007/s12603-020-1420-6

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Key words

  • Frailty
  • screening
  • profile
  • tool