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Validation of the Pictorial Fit-Frail Scale in a memory clinic setting

Published online by Cambridge University Press:  16 September 2019

Lindsay M. K. Wallace ,
Lisa McGarrigle ,
Kenneth Rockwood Open the ORCID record for Kenneth Rockwood [Opens in a new window] ,
Melissa K. Andrew  and
Olga Theou
Lindsay M. K. Wallace
Affiliation:
Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Canada
Lisa McGarrigle
Affiliation:
Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Canada
Kenneth Rockwood
Affiliation:
Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Canada Department of Medicine, Dalhousie University, Halifax, Canada
Melissa K. Andrew
Affiliation:
Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Canada Department of Medicine, Dalhousie University, Halifax, Canada
Olga Theou*
Affiliation:
Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, Canada Department of Medicine, Dalhousie University, Halifax, Canada
*
Correspondence should be addressed to: Olga Theou, PhD, Nova Scotia Health Authority/Dalhousie University, 5955 Veterans’ Memorial Lane, Room 1313 Halifax, NS, Canada B3H 2E1. Phone: +1(902)473-4846. Email: Olga.Theou@dal.ca.
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Abstract

Objective:

To assess the feasibility, reliability, and validity of the Pictorial Fit-Frail Scale (PFFS) among patients, caregivers, nurses, and geriatricians in an outpatient memory clinic.

Design:

Observational study.

Setting:

A Canadian referral-based outpatient memory clinic.

Participants:

Fifty-one consecutive patients and/or their caregivers, as well as attending nurses and geriatricians.

Measurements:

Participants (patients, caregivers, nurses, and geriatricians) were asked to complete the PFFS based on the patient’s current level of functioning. Time-to-complete and level of assistance required was recorded. Participants also completed a demographic survey and patients’ medical history (including the Mini-Mental State Examination [MMSE], and Comprehensive Geriatric Assessment [CGA]) was obtained via chart review.

Results:

Patient participants had a mean age of 77.3±10.1 years, and average MMSE of 22.0±7.0, and 53% were female. Participants were able to complete the PFFS with minimal assistance, and their average times to completion were 4:38±2:09, 3:11±1:16, 1:05±0:19, and 0:57±0:30 (mins:sec) for patients, caregivers, nurses, and geriatricians, respectively. Mean PFFS scores as rated by patients, caregivers, nurses, and geriatricians were 9.0±5.7, 13.1±6.6, 11.2±4.5, 11.9±5.9, respectively. Patients with low MMSE scores (0–24) took significantly longer to complete the scale and had higher PFFS scores. Inter-rater reliability between nurses and geriatricians was 0.74, but it was lower when assessments were done for patients with low MMSE scores (0.47, p<0.05). The correlation between PFFS and a Frailty Index based on the CGA was moderately high and statistically significant for caregivers, nurses, and geriatricians (r=0.66, r=0.59, r=0.64, respectively), but not patients.

Conclusions:

The PFFS is feasible, even among people with some slight cognitive impairment, though it may be less useful when patients with severe dementia administer it to themselves. Further, the PFFS may help inform clinicians about areas of concern as identified by patients, enabling them to contribute more to diagnostic and treatment decisions or helping with health tracking and care planning.

Keywords

frailtyfrail elderlypsychometricsagingdementia
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 9: Issue Theme: Enhanced Assessment Instruments for Older Adults with Major Neurocognitive Disorders , September 2020 , pp. 1063 - 1072
Copyright
© International Psychogeriatric Association 2019

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References

Afilalo, J.et al. (2014). Frailty assessment in the cardiovascular care of older adults. Journal of the American College of Cardiology, 63, 747–762. doi: 10.1016/j.jacc.2013.09.070.CrossRefGoogle ScholarPubMed
Baitar, A.et al. (2013). Evaluation of the Groningen Frailty Indicator and the G8 questionnaire as screening tools for frailty in older patients with cancer. Journal of Geriatric Oncology, 4, 32–38. doi: 10.1016/j.jgo.2012.08.001.CrossRefGoogle ScholarPubMed
Bouillon, K.et al. (2013). Measures of frailty in population-based studies: an overview. BMC Geriatrics, 13, 64. doi: 10.1186/1471-2318-13-64.CrossRefGoogle ScholarPubMed
Brundle, C.et al. (2018). Convergent validity of the electronic frailty index. Age and Ageing, 48, 152–156. doi: 10.1093/ageing/afy162.CrossRefGoogle Scholar
Buchman, A. S., Boyle, P. A., Wilson, R. S., Tang, Y. and Bennett, D. A. (2007). Frailty is associated with incident Alzheimer’s disease and cognitive decline in the elderly. Psychosomatic Medicine, 69, 483–489. doi: 10.1097/psy.0b013e318068de1d.CrossRefGoogle ScholarPubMed
Buta, B. J.et al. (2016). Frailty assessment instruments: systematic characterization of the uses and contexts of highly-cited instruments. Ageing Research Reviews, 26, 53–61. doi: 10.1016/j.arr.2015.12.003.CrossRefGoogle ScholarPubMed
Clegg, A.et al. (2016). Development and validation of an electronic frailty index using routine primary care electronic health record data. Age and Ageing, 45, 353–360. doi: 10.1093/ageing/afw039.CrossRefGoogle ScholarPubMed
Clegg, A.Young, J., Iliffe, S., Rikkert, M. O. and Rockwood, K. (2013). Frailty in elderly people. The Lancet, 381, 752–762. doi: 10.1016/S0140-6736(12)62167-9.CrossRefGoogle ScholarPubMed
Cook, D. A. and Beckman, T. J. (2006). Current concepts in validity and reliability for psychometric instruments: theory and application. The American Journal of Medicine, 119, 166.e7-166.e16. doi: 10.1016/j.amjmed.2005.10.036.CrossRefGoogle ScholarPubMed
de Vries, N. M., Staal, J. B., van Ravensberg, C. D., Hobbelen, J. S. M., Olde Rikkert, M. G. M. and Nijhuis-van der Sanden, M. W. G. (2011). Outcome instruments to measure frailty: a systematic review. Ageing Research Reviews, 10, 104–114. doi: 10.1016/j.arr.2010.09.001.CrossRefGoogle ScholarPubMed
Ellis, G. and Langhorne, P. (2004). Comprehensive geriatric assessment for older hospital patients. British Medical Bulletin, 71, 45–59. doi: 10.1093/bmb/ldh033.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi: 10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Freitag, S., Schmidt, S. and Gobbens, R. J. J. (2016). Tilburg frailty indicator: German translation and psychometric testing. Zeitschrift für Gerontologie und Geriatrie, 49, 86–93. doi: 10.1007/s00391-015-0889-9.CrossRefGoogle ScholarPubMed
Fried, L. P.et al. (2001). Frailty in older adults evidence for a phenotype. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56, M146–M157. doi: 10.1093/gerona/56.3.M146.CrossRefGoogle ScholarPubMed
Haaksma, M. L.et al. (2018). The impact of frailty and comorbidity on institutionalization and mortality in persons with dementia: a prospective cohort study. Journal of the American Medical Directors Association, 20, 165–170.e2. doi: 10.1016/j.jamda.2018.06.020.CrossRefGoogle ScholarPubMed
Hoover, M., Rotermann, M., Sanmartin, C. and Bernier, J. (2013). Validation of an index to estimate the prevalence of frailty among community-dwelling seniors. Health Reports, 24, 10–17.Google ScholarPubMed
Jones, D. M., Song, X. and Rockwood, K. (2004). Operationalizing a Frailty Index from a standardized Comprehensive Geriatric Assessment. Journal of the American Geriatrics Society, 52, 1929–1933. doi: 10.1111/j.1532-5415.2004.52521.xCrossRefGoogle ScholarPubMed
Kiyak, H. A., Teri, L. and Borson, S. (1994). Physical and functional health assessment in normal aging and in Alzheimer’s disease: self-reports vs family reports. The Gerontologist, 34, 324–331. doi: 10.1093/geront/34.3.324.CrossRefGoogle ScholarPubMed
Martin, F. C. and Brighton, P. (2008). Frailty: different tools for different purposes? Age and Ageing, 37, 129–131. doi: 10.1093/ageing/afn011.CrossRefGoogle ScholarPubMed
Mitnitski, A. B., Mogilner, A. J. and Rockwood, K. (2001). Accumulation of deficits as a proxy measure of aging. The Scientific World Journal, 1, 323–336. doi: 10.1100/tsw.2001.58.CrossRefGoogle ScholarPubMed
Morley, J. E., Malmstrom, T. K. and Miller, D. K. (2012). A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. The Journal of Nutrition, Health and Aging, 16, 601–608. doi: 10.1007/s12603-012-0084-2.CrossRefGoogle ScholarPubMed
Ngandu, T.et al. (2015). A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet. doi: 10.1016/S0140-6736(15)60461-5.CrossRefGoogle Scholar
Pialoux, T., Goyard, J. and Lesourd, B. (2012). Screening tools for frailty in primary health care: a systematic review. Geriatrics & Gerontology International, 12, 189–197. doi: 10.1111/j.1447-0594.2011.00797.xCrossRefGoogle ScholarPubMed
Reeves, D.et al. (2018). The challenge of ageing populations and patient frailty: can primary care adapt? The BMJ, 362, k3349. doi: 10.1136/bmj.k3349.CrossRefGoogle ScholarPubMed
Rockwood, K., Fay, S., Hamilton, L., Ross, E. and Moorhouse, P. (2014). Good days and bad days in dementia: a qualitative chart review of variable symptom expression. International Psychogeriatrics, 26, 1239–1246. doi: 10.1017/S1041610214000222.CrossRefGoogle ScholarPubMed
Rockwood, K. and Mitnitski, A. (2011). Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clinics in Geriatric Medicine, 27, 17–26. doi: 10.1016/j.cger.2010.08.008.CrossRefGoogle ScholarPubMed
Rockwood, K.et al. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173, 489–495. doi: 10.1503/cmaj.050051.CrossRefGoogle ScholarPubMed
Rockwood, K., Theou, O. and Mitnitski, A. (2015). What are frailty instruments for? Age and Ageing, 44, 545–547. doi: 10.1093/ageing/afv043.CrossRefGoogle Scholar
Rolfson, D. B., Majumdar, S. R., Tsuyuki, R. T., Tahir, A. and Rockwood, K. (2006). Validity and reliability of the Edmonton Frail Scale. Age and Ageing, 35, 526–529.CrossRefGoogle ScholarPubMed
Rothman, M. D., Leo-Summers, L. and Gill, T. M. (2008). Prognostic significance of potential frailty criteria. Journal of the American Geriatrics Society, 56, 2211–2216. doi: 10.1111/j.1532-5415.2008.02008.xCrossRefGoogle ScholarPubMed
Rubenstein, L. Z., Josephson, K. R., Wieland, G. D., English, P. A., Sayre, J. A. and Kane, R. L. (1984). Effectiveness of a geriatric evaluation unit. a randomized clinical trial. The New England Journal of Medicine, 311, 1664–1670. doi: 10.1056/NEJM198412273112604.CrossRefGoogle ScholarPubMed
Rubin, C. D., Sizemore, M. T., Loftis, P. A., Adams-Huet, B. and Anderson, R. J. (1992). The effect of geriatric evaluation and management on Medicare reimbursement in a large public hospital: a randomized clinical trial. Journal of the American Geriatrics Society, 40, 989–995.CrossRefGoogle Scholar
Sepehri, A.et al. (2014). The impact of frailty on outcomes after cardiac surgery: a systematic review. The Journal of Thoracic and Cardiovascular Surgery, 148, 3110–3117. doi: 10.1016/j.jtcvs.2014.07.087.CrossRefGoogle ScholarPubMed
Song, X., Mitnitski, A. and Rockwood, K. (2011). Nontraditional risk factors combine to predict Alzheimer disease and dementia. Neurology, 77, 227–234. doi: 10.1212/WNL.0b013e318225c6bc.CrossRefGoogle ScholarPubMed
Sternberg, S. A., Schwartz, A. W., Karunananthan, S., Bergman, H. and Clarfield, A. M. (2011). The identification of frailty: a systematic literature review. Journal of the American Geriatrics Society, 59, 2129–2138. doi: 10.1111/j.1532-5415.2011.03597.xCrossRefGoogle ScholarPubMed
Stuck, A. E., Siu, A. L., Wieland, G. D., Adams, J. and Rubenstein, L. Z. (1993). Comprehensive geriatric assessment: a meta-analysis of controlled trials. The Lancet, 342, 1032–1036.CrossRefGoogle ScholarPubMed
Studenski, S.et al. (2004). Clinical global impression of change in physical frailty: development of a measure based on clinical judgment. Journal of the American Geriatrics Society, 52, 1560–1566. doi: 10.1111/j.1532-5415.2004.52423.CrossRefGoogle ScholarPubMed
Syddall, H., Cooper, C., Martin, F., Briggs, R. and Aihie Sayer, A. (2003). Is grip strength a useful single marker of frailty? Age and Ageing, 32, 650–656.CrossRefGoogle ScholarPubMed
Theou, O.et al. (2019). The Pictorial Fit-Frail Scale: developing a visual scale to assess frailty. Canadian Geriatrics Journal, 21, 78–94. doi: 10.1016/j.arr.2015.04.001.Google Scholar
Theou, O., Campbell, S., Malone, M. L. and Rockwood, K. (2018). Older adults in the emergency department with frailty. Clinics in Geriatric Medicine, 34, 369–386. doi: 10.1016/j.cger.2018.04.003.CrossRefGoogle ScholarPubMed
Theou, O., Cann, L., Blodgett, J., Wallace, L. M. K., Brothers, T. D. and Rockwood, K. (2015). Modifications to the frailty phenotype criteria: systematic review of the current literature and investigation of 262 frailty phenotypes in the Survey of Health, Ageing, and Retirement in Europe. Ageing Research Reviews, 21, 78–94. doi: 10.1016/j.arr.2015.04.001.CrossRefGoogle ScholarPubMed
Travers, J., Romero-Ortuno, R., Bailey, J. and Cooney, M.-T. (2018). Delaying and reversing frailty: a systematic review of primary care interventions. British Journal of General Practice, 69, e61–e69. doi: 10.17863/CAM.27224.CrossRefGoogle ScholarPubMed
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