Date Published: April 29, 2019
Publisher: Public Library of Science
Author(s): Jossiana Wilke Faller, David do Nascimento Pereira, Suzana de Souza, Fernando Kenji Nampo, Fabiana de Souza Orlandi, Silvia Matumoto, Antony Bayer.
Frailty is a dynamic process in which there is a reduction in the physical, psychological and/or social function associated with aging. The aim of this study was to identify instruments for the detection of frailty in older adults, characterizing their components, application scenarios, ability to identify pre-frailty and clinimetric properties evaluated. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), under registration number CRD42017039318. A total of 14 electronic sources were searched to identify studies that investigated instruments for the detection of frailty or that presented the construction and/or clinimetric evaluation of the instrument, according to criteria established by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 96 studies were included in the qualitative synthesis: 51 instruments for the detection of frailty were identified, with predominantly physical domains; 40 were constructed and/or validated for use in the older adult community population, 28 only highlighted the distinction between frail and non-frail individuals and 23 presented three or more levels of frailty. The FRAGIRE, FRAIL Scale, Edmonton Frail Scale and IVCF-20 instruments were the most frequently analyzed in relation to clinimetric properties. It was concluded that: (I) there is a large number of instruments for measuring the same construct, which makes it difficult for researchers and clinicians to choose the most appropriate; (II) the FRAGIRE and CFAI stand out due to their multidimensional aspects, including an environmental assessment; however, (III) the need for standardization of the scales was identified, since the use of different instruments in clinical trials may prevent the comparability of the results in systematic reviews and; (IV) considering the different instruments identified in this review, the choice of researchers/clinicians should be guided by the issues related to the translation and validation for their location and the suitability for their context.
Frailty is a dynamic process in which there is a reduction in the physical, psychological and/or social functions, associated with aging and detrimental to the health. This condition represents a potential public health problem due to the multiple clinical and social consequences and its dynamic nature . Identifying frail older adults or those at risk of frailty should be one of the foundations of geriatric care, since it is a complex and important issue associated with aging, with implications for both the patients and the use of the health services . Adequate recognition of frailty may reduce risks from possibly detrimental interventions, with it being unacceptable to consider patients only on the basis of chronological age . The dynamic nature of frailty highlights a potential for preventive and restorative interventions , so that when detected early, it is possible to preserve the functional and cognitive reserves, to maintain the capacity for self-care and to prevent disabilities, falls, functional decline, institutionalization, hospitalization and death.
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) . The steps followed in preparing this review were: 1. Elaboration of the research question; 2. Elaboration of the protocol and registration in the International prospective register of systematic reviews (PROSPERO), under number CRD42017039318; 3. Execution of the searches in the databases; 4. Selection of studies according to the eligibility criteria; 5. Extraction of data from the primary studies and; 6. Synthesis of results [16, 17].
The electronic searches returned a total of 5,604 records. After removing duplicates and including results of the handsearch (n = 14), 3,391 records remained, of which 3,180 were excluded based on title and abstract. The reading of the 211 remaining full-text publications led to the exclusion of 115 studies, since they included measures of constructs other than frailty (n = 66) or did not present information on the clinimetric evaluation of the instrument (n = 49). Accordingly, 96 studies met the pre-established criteria and were included in this review (Fig 1).
In this review, 51 instruments that tested for frailty in older adults were presented. The domains that constituted these instruments were predominantly physical; however, elements of a psychological, social and environmental order were observed in the instruments developed more recently. Using broader approaches is one of the points of relevance in the context of frailty, since the exclusive focus on physical problems can lead to the fragmentation of care for older adults . The association between frailty and social factors has been widely recognized, with social isolation also being significantly associated with mortality. Social relations play a central role in human well-being and are directly involved in maintaining health .
The strengths of this review include the comprehensive electronic search of 14 sources, with no limitations regarding language or date of publication, as well as the manual search in the references of the included studies. In addition, as far as is known, this review was the first to present a broad view of instruments that detect frailty, with information that includes the domains, population, setting, type of scale, outcome mortality and clinimetric properties. This contributes so that professionals and researchers can make a better choice of the instrument, specific to the scenario and the scope of each study.