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Validity, reliability and feasibility of tools to identify frail older patients in inpatient hospital care: A systematic review

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The journal of nutrition, health & aging

Abstract

Background

The objective of this study is to identify and review screening tools for frailty in older adults admitted to inpatient hospital care with respect to their validity, reliability and feasibility.

Methods

Studies were identified through systematically searching PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and PsycINFO and screening reference lists till June 2014. Papers dealing with screening tools aimed at identifying frail older patients in in-hospital care, and including information about validity, reliability or feasibility, were included in the review. The quality of the included studies was critically appraised via the Quality Assessment of Diagnostic Accuracy Studies (QUADAS).

Results

From the originally identified 2001 studies 32 studies met the inclusion criteria, in which 16 screening tools were presented. The screening tools showed different characteristics with respect to the number of items, the method of administration and the domains included. The most frequently studied tools with respect to predictive validity were the Identification Seniors At Risk (ISAR) and Triage Risk Stratification Tool (TRST). Studies retrieved poorer information about reliability and feasibility. Overall sensitivity was fairly good. The ISAR, ISAR-HP (Identification Seniors At Risk Hospitalized Patients) and Multidimensional Prognostic Index (MPI) generally had the best sensitivity.

Conclusions

Many screening tools are available for daily practice. These tools to identify frail older patients in inpatient hospital care could be useful. For no tool, however, is clear evidence available yet regarding validity, reliability and feasibility. The overall sensitivity of the included screening tools was fairly good, whereas information on reliability and feasibility was lacking for most tools. In future research more attention should be given to the latter items.

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References

  1. http://apps.who.int/gho/data/view.main.POP2040?lang=en. Accessed October 14, 2014.

  2. Blokstra A, Verschuren WMM, Baan CA, et al. Vergrijzing en toekomstige ziektelast, Prognose chronische ziektenprevalentie 2005–2025 (in Dutch: Aging and future Disease burden, Prognosis prevalence of chronic diseases in the Netherlands 2005–2025). RIVM, Bilthoven,2007.

    Google Scholar 

  3. Statistics NCfH. Health, United States 2011. With Special Feature on Socioeconomic Status and Health. Hyattsville: National Center for Health Statistics.

    Google Scholar 

  4. CBO (2006) Move your Dot: Handleiding Kwetsbare Ouderen (in Dutch: Move your Dot: Toolkit Frail Elderly). Utrecht: CBO. Dutch, 2012

    Google Scholar 

  5. Cornette P, Swine C, Malhomme B, et al. Early evaluation of the risk of functional decline following hospitalization of older patients: development of a predictive tool. Eur J Public Health 2006;16(2):203–8

    Article  PubMed  Google Scholar 

  6. Andela RM, Dijkstra A, Slaets JP, Sanderman R. Prevalence of frailty on clinical wards: description and implications. Int J Nurs Pract 2010;16(1):14–9

    Article  PubMed  Google Scholar 

  7. Bagshaw SM, Stelfox HT, McDermid RC, et al. Association between frailty and short- and long-term outcomes among critically ill patients: a multicenter prospective cohort study. CMAJ 2014;186(2):95–102

    Article  Google Scholar 

  8. Khandelwal D, Goel A, Kumar U, et al. Frailty is associated with longer hospital stay and increased mortality in hospitalized older patients. J Nutr Health Aging 2012;16(8):732–5

    Article  CAS  PubMed  Google Scholar 

  9. Hoogerduijn JG, Schuurmans MJ, De Rooij SE, et al. A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. J Clin Nurs 2007;16:46–57

    Article  PubMed  Google Scholar 

  10. Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatr 2014;14:1

    Article  PubMed Central  PubMed  Google Scholar 

  11. Carpenter GI, Teare GF, Steel K, et al. A new assessment for elders admitted to acute care: reliability of the MDS-AC. Aging (Milano) 2001;13(4):316–30

    CAS  Google Scholar 

  12. Fiolet J. Flankerend Geriatrisch Beleid, Het functioneren van geriatrische patienten tijdens de ziekenhuisopname (in Dutch: Supportive Geriatric Care, The functioning of geriatric patients during hospitalization). Dissertation Maastricht University, 1993.

    Google Scholar 

  13. Pepersack T. Minimum geriatric screening tools to detect common geriatric problems. J Nutr Health Aging 2008;12(5):348–52

    Article  PubMed  Google Scholar 

  14. De Saint-Hubert M, Schoevaerdts D, Cornette P, et al. Predicting functional adverse outcomes in hospitalized older patients: a systematic review of screening tools. J Nutr Health Aging 2010;14(5):394–9

    Article  PubMed  Google Scholar 

  15. Beaton K, Grimmer K. Tools that assess functional decline: systematic literature review update. Clin Interv Aging 2013;8:485–94

    Article  PubMed Central  PubMed  Google Scholar 

  16. Sutton M, Grimmer-Somers K, Jeffries L. Screening tools to identify hospitalized elderly patients at risk of functional decline: a systematic review. Int J Clin Pract 2008;62(12):1900–9

    Article  CAS  PubMed  Google Scholar 

  17. Bissett M, Cusick A, Lannin NA. Functional assessments utilized in emergency departments: a systematic review. Age Ageing 2013;42(2):163–72

    Article  PubMed  Google Scholar 

  18. Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003;3:25

    Article  PubMed Central  PubMed  Google Scholar 

  19. Lalkhen AG, McCluskey A. Clinical tests: sensitivity and specificity. Continuing Education in Anaesthesia, Critical Care and Pain 2008;8(6) 221–23

    Google Scholar 

  20. Crichton N. Information Point: Odds Ratio. J Clin Nurs 2001;10(2):268–69

    Google Scholar 

  21. Fleis JL (1981) Statistical Methodes for rater and proportions 2nd ed. John Wiley, New York, 1981

    Google Scholar 

  22. Vet de HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in medicine. Cam,bridge University Press, Cambridge, 2011

    Book  Google Scholar 

  23. Stevens A, Beurskens A, Koke A, van der Weijden T. The use of patient-specific measurement instruments in the process of goal-setting: a systematic review of available instruments and their feasibility. Clin Rehabil 2013;27(11):1005–19

    Article  PubMed  Google Scholar 

  24. Buurman BM, van den Berg W, Korevaar JC, et al. Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments. Eur J Emerg Med 2011;18(4):215–20

    Article  PubMed  Google Scholar 

  25. Dendukuri N, McCusker J, Belzile E. The identification of seniors at risk screening tool: further evidence of concurrent and predictive validity. J Am Ger Soc 2004;52(2):290–6

    Article  Google Scholar 

  26. Geyskens K, De Ridder K, Sabbe M, et al. Prediction of functional decline in elderly patients discharged from the accident and emergency department. Tijdschrift voor Gerontologie en Geriatrie 2008;39(1):16–25.

    Article  CAS  PubMed  Google Scholar 

  27. Hoogerduijn JG, Schuurmans MJ, Korevaar JC, et al. Identification of older hospitalized patients at risk for functional decline, a study to compare the predictive values of three screening instruments. J Clin Nurs 2010;19(9–10):1219–25

    Article  PubMed  Google Scholar 

  28. Mc-Cusker J, Bellavance F, Cardin S, et al. Prediction of hospital utilization among elderly patients during the 6 months after an emergency department visit. Ann Emerg Med 2000;36(5):438–45

    CAS  Google Scholar 

  29. Mc-Cusker J, Bellavance F, Cardin S, et al. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Ger Soc 1999;47(10):1229–37

    Article  CAS  Google Scholar 

  30. Moons P, De Ridder K, Geyskens K, et al. Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments. Eur J Emerg Med 2007;14(6):315–23

    Article  PubMed  Google Scholar 

  31. Salvi F, Morichi V, Grilli A, et al. Screening for frailty in elderly emergency department patients by using the Identification of Seniors At Risk (ISAR). J Nutr Health Aging 2012;16(4):313–8

    Article  CAS  PubMed  Google Scholar 

  32. Salvi F, Morichi V, Grilli A, et al. Predictive validity of the Identification of Seniors At Risk (ISAR) screening tool in elderly patients presenting to two Italian Emergency Departments. Aging Clin Exp Res 2009;21(1):69–75

    Article  PubMed  Google Scholar 

  33. Salvi F, Morichi V, Lorenzetti B, et al. Risk stratification of older patients in the emergency department: comparison between the Identification of Seniors at Risk and Triage Risk Screening Tool. Rejuvenation Res 2012;15(3):288–94

    Article  PubMed  Google Scholar 

  34. Fan J, Worster A, Fernandes C. Predictive validity of the triage risk screening tool for elderly patients in a Canadian emergency department. Am J Emerg Med 2006;24(5):540–4

    Article  PubMed  Google Scholar 

  35. Graf CE, Giannelli SV, Herrmann FR, et al. Identification of older patients at risk of unplanned readmission after discharge from the emergency department–comparison of two screening tools. Swiss Med Wkly 2012;141:13327

    Google Scholar 

  36. Hustey FM, Mion LC, Connor JT, et al. A brief risk stratification tool to predict functional decline in older adults discharged from emergency departments. J Am Ger Soc 2007;55(8):1269–74

    Article  Google Scholar 

  37. Lee JS, Schwindt G, Langevin M, et al. Validation of the triage risk stratification tool to identify older persons at risk for hospital admission and returning to the emergency department. J Am Ger Soc 2008;56(11):2112–7

    Article  Google Scholar 

  38. Meldon SW, Mion LC, Palmer RM, et al. A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department. Acad Emerg Med 2003;10(3):224–32

    Article  PubMed  Google Scholar 

  39. Mc-Cusker J, Bellavance F, Cardin S, Belzile E. Validity of an activities of daily living questionnaire among older patients in the emergency department. J Clin Epidemiol 1999;52(11):1023–30

    Article  CAS  Google Scholar 

  40. Schoenenberger AW, Bieri C, Ozguler O, et al. A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance. Am J Emerg Med 2014;32(6):623–8

    Article  PubMed  Google Scholar 

  41. Hoogerduijn JG, de Rooij SE, Grobbee DE, Schuurmans MJ. Predicting functional decline in older patients undergoing cardiac surgery. Age Ageing 2014;43(2):218–21

    Article  PubMed  Google Scholar 

  42. Evans S, Sayers M, Rockwood K. The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment. Age Ageing 2014;43(1):6

    Article  Google Scholar 

  43. Aronow HU, Borenstein J, Haus F, et al. Validating SPICES as a screening tool for frailty risks among hospitalized older adults. Nurs Res Pract 2014

    Google Scholar 

  44. Boyd M, Koziol-McLain J, Yates K, et al. Emergency department case-finding for high-risk older adults: the Brief Risk Identification for Geriatric Health Tool (BRIGHT). Ac Em Med 2008;15(7):598–606

    Article  Google Scholar 

  45. Inouye SK, Wagner DR, Acampora D, et al. A predictive index for functional decline in hospitalized elderly medical patients. J Gen Int Med 1993;8(12):645–52

    Article  CAS  Google Scholar 

  46. Pilotto A, Addante F, Ferrucci L, et al. The multidimensional prognostic index predicts short- and long-term mortality in hospitalized geriatric patients with pneumonia. J Gerontol A Biol Med Sci 2009;64(8):880–7

    Article  Google Scholar 

  47. Sancarlo D, D’Onofrio G, Franceschi M, et al. Validation of a Modified-Multidimensional Prognostic Index (m-MPI) including the Mini Nutritional Assessment Short-Form (MNA-SF) for the prediction of one-year mortality in hospitalized elderly patients. J Nutr Healt Aging 2011;15(3):169–73

    Article  CAS  Google Scholar 

  48. Kim SW, Han HS, Jung HW, et al. Multidimensional Frailty Score for the Prediction of Postoperative Mortality Risk. JAMA Surg 2014;149(7):633–40

    Article  PubMed  Google Scholar 

  49. Hilmer SN, Perera V, Mitchell S, et al. The assessment of frailty in older people in acute care. Aust J Ageing 2009;28(4):182–8

    Article  Google Scholar 

  50. Pilotto A, Ferrucci L, Franceschi M, et al. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008;11(1):151–61

    Article  PubMed Central  PubMed  Google Scholar 

  51. Huyse FJ, de Jonge P, Slaets JP, et al. COMPRI—an instrument to detect patients with complex care needs: results from a European study. Psychosomatics 2001;42(3):222–8

    Article  CAS  PubMed  Google Scholar 

  52. Sager MA, Rudberg MA, Jalaluddin M, et al. Hospital admission risk profile (HARP): identifying older patients at risk for functional decline following acute medical illness and hospitalization. J Am Ger Soc 1996;44(3):251–7

    Article  CAS  Google Scholar 

  53. Hamaker ME, Jonker JM, de Rooij SE, et al. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. The Lancet Oncol 2012;13(10):437–44.

    Article  Google Scholar 

  54. McCusker J, Bellavance F, Cardin S, Trepanier S. Screening for geriatric problems in the emergency department: reliability and validity. Identification of Seniors at Risk (ISAR) Steering Committee. Acad Em Med 1998;5(9):883–93

    CAS  Google Scholar 

  55. Hoogerduijn JG, Buurman BM, Korevaar JC, et al. The prediction of functional decline in older hospitalised patients. Age Ageing 2012;41(3):381–7

    Article  PubMed  Google Scholar 

  56. Jacques TS, Sebire NJ. The impact of article titles on citation hits: an analysis of general and specialist medical journals. JRSM Short Rep 2010;1(1):2

    Article  PubMed Central  PubMed  Google Scholar 

  57. Krishnan M, Beck S, Havelock W, et al. Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results. Age Ageing 2014;43:122–126

    Article  PubMed  Google Scholar 

  58. Bernabeu-Wittel M, Ollero-Baturone M, Ruiz-Cantero A, et al. Functional decline over 1-year follow-up in a multicenter cohort of polypathological patients: A new approach to functional prognostication. Int J Gerontol 2012;6:68–74

    Article  Google Scholar 

  59. De Jonge P, Bauer I, Huyse FJ, Latour CH. Medical inpatients at risk of extended hospital stay and poor discharge health status: detection with COMPRI and INTERMED. Psychosom Med 2003;65(4):534–41

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands

    R. M. J. Warnier, E. van Rossum, E. van Velthuijsen, J. M. G. A. Schols & G. I. J. M. Kempen

  2. Department of Internal Medicine, Geriatrics, Maastricht University Medical Centre, Maastricht, The Netherlands

    R. M. J. Warnier & W. J. Mulder

  3. Department of Integrated Care, Elderly care, Maastricht University Medical Center, PO-Box 5800, 6202 AZ, Maastricht, The Netherlands

    R. M. J. Warnier

  4. School CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands

    J. M. G. A. Schols

  5. Zuyd University of Applied sciences, Heerlen, The Netherlands

    E. van Rossum

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Warnier, R.M.J., van Rossum, E., van Velthuijsen, E. et al. Validity, reliability and feasibility of tools to identify frail older patients in inpatient hospital care: A systematic review. J Nutr Health Aging 20, 218–230 (2016). https://doi.org/10.1007/s12603-015-0567-z

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