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A reliable and record-based frailty assessment method for older medical inpatients

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Key summary points

AbstractSection Aim

To examine the reproducibility and diagnostic accuracy of a comprehensive frailty assessment method based solely on the older medical inpatient’s electronic medical record.

AbstractSection Findings

We found good reliability, high agreement, and considerable diagnostic accuracy when comparing the record-based method to the bedside method.

AbstractSection Message

The record-based MPI is highly desirable. It seems feasible, reproducible, accurate, and worth exploring in larger datasets and other settings.

Abstract

Purpose

The comprehensive geriatric assessment (CGA) including frailty assessment is considered the gold standard of assessment in geriatric patients. The Multidimensional Prognostic Index (MPI) is a CGA-based bedside assessment tool. Older medical inpatients’ medical records comprehensively describe the MPI-featured components. Consequently, MPI-based frailty assessment may be accomplished retrospectively. We found no previous studies concerning record-based MPI. We studied the reproducibility and diagnostic accuracy of a record-based MPI.

Methods

The study was designed as a fully crossed, prospective, and cross-sectional study. A total of 50 inpatients aged ≥ 75 years were included from two medical wards. Record-based MPI was assessed by two independent raters in patients who required personal assistance on a daily basis or had a Charlson Comorbidity Index (CCI) ≥ 1. In the same patients, a bedside MPI rating was performed. Inter-rater and inter-method reproducibility and diagnostic accuracy measures were calculated.

Results

Evaluating the inter-rater reproducibility; the mean difference was -0.02 points [95% confidence interval (CI) − 0.06 to 0.01, p = 0.20]. Intraclass correlation coefficient (ICC) was 0.71. Evaluating inter-method reproducibility; the mean difference was -0.02 (95% CI − 0.04 to 0.01, p = 0.18); ICC = 0.83. Sensitivity was 100% and specificity 80%. The areas under the receiver operating curves (ROC) was 0.92 (95% CI 0.75–1.00) and 0.77 (95% CI 0.52–1.00).

Conclusion

The record-based MPI rating method has an acceptable inter-rater reliability, good inter-method reliability, and high agreement as compared to the bedside-rated MPI. The diagnostic accuracy seems considerable. The record-based MPI seems useful in retrospective frailty assessment among older medical inpatients.

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Acknowledgements

We would like to thank the patients and the bedside raters Bodil Thomsen, Maria S. Kallehauge, and Dorthe Gadegaard for their profound work. Furthermore, we give thanks to the collaborators at the two participating medical departments.

Funding

This work was supported by A.P. Møller Fonden, Helsefonden (Grant No. 350,000 DKK) and the Health Research Fund of Central Denmark Region (Grant No. 100,000 DKK) and Fonden til Lægevidenskabens Fremme (45,000 DKK).

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Authors and Affiliations

  1. Department of Geriatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Troels K. Hansen, Else Marie Damsgaard & Merete Gregersen

  2. Randers Regional Hospital, Skovlyvej 1, 8930, Randers NØ, Denmark

    Seham Shahla & Jens M. Bruun

  3. Department of Clinical Medicine, University of Aarhus, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark

    Else Marie Damsgaard & Jens M. Bruun

Authors
  1. Troels K. Hansen
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  2. Else Marie Damsgaard
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  3. Seham Shahla
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  4. Jens M. Bruun
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  5. Merete Gregersen
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Contributions

All authors meet all four criteria for authorship as stated in the ICMJE criteria for authorship: study concept and design: TKH, EMD, SS, JMB, and MG. Acquisition of data: TKH and MG. Analysis and interpretation of data: TKH, EMD, SS, JMB, and MG. Drafting the manuscript: TKH, EMD, SS, JMB, and MG. Critical revision of the manuscript for important intellectual content: TKH, EMD, SS, JMB, and MG.

Corresponding author

Correspondence to Troels K. Hansen.

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Conflict of interest

None of the authors had any conflicts of interest to declare.

Ethics approval

The study was approved by the Danish Data Protection Agency (1-16-02-28-17) and approved as a quality development project by the Regional Research Ethics Committee (Journal no. 197/2017).

Informed consent

No patient consent form was needed, and no further referral required.

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Appendix

Appendix

See Table 4.

Table 4 MPI score calculation
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Hansen, T.K., Damsgaard, E.M., Shahla, S. et al. A reliable and record-based frailty assessment method for older medical inpatients. Eur Geriatr Med 11, 803–812 (2020). https://doi.org/10.1007/s41999-020-00345-8

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