General Practitioners' Clinical Impression in the Screening for Frailty: Data From the FAP Study Pilot

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• 作者：Bertrand Fougè ; re ; MD ; PhD^a ; ^b ; ^{b.fougere@gmail.com} ; Marie-José ; e Sirois ; PhD^c ; Pierre-Hugues Carmichael ; MSc^c ; Brice-Lionel Batomen-Kuimi ; MSc^c ; Bruno Chicoulaa ; MD^d ; Emile Escourrou ; MD^d ; Fati Nourhashé ; mi ; MD ; PhD^a ; ^b ; Sté ; phane Oustric ; MD^b ; ^d ; Bruno Vellas ; MD ; PhD^a ; ^b ; the FAP group^&lowast ; &lowast ; ; Serge Ané ; Marie Baillou-Dé ; couard ; Elisabeth Barberan ; Marguerite Bayart ; Jean-Philippe Becq ; Michel Bismuth ; Jeremy Blanco ; Odile Bourgeois ; Valerie Boyer ; Pierre Boyer ; Jean-Paul Boyes ; Claude Burguier ; Bruno Chicoulaa ; Claude Gendre ; Michel Combier ; Sophie Cot ; Michel Dutech ; Brigitte Escourou ; Christian Gaillard ; Sté ; phane Oustric ; Jean-Luc Rastrelli ; Bernard Rico ; Jean-Luc Souyri ; André ; Stillmunkes ; Julie Subra ; Eric Vergnes ; Marc Vidal ; Henri Boccalon ; Laure Bouchon ; Julien Delrieu ; Bertrand Fougè ; re ; Christine Lagourdette ; Fati Nourhashé ; mi ; Maryse Pé ; dra ; Yves Rolland ; Maria Soto ; Bruno Vellas
• 关键词：FAP ; frailty ; cognitive function ; older adults ; prevention ; primary care
• 刊名：Journal of the American Medical Directors Association
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：18
• 期：2
• 页码：193.e1-193.e5
• 全文大小：244 K
• 卷排序：18

文摘

The progression of frailty is marked by an increased risk of adverse health outcomes in the elderly including falls, physical and/or cognitive disability, hospitalizations, and mortality. In primary care, the general practitioner's (GP's) clinical impression about their elderly patients' frailty state seems to be a key point in identifying frail individuals in their clinical practice. The aim of this article is to examine if GPs' clinical impressions regarding frailty concurs with objective measures of the gold standard frailty phenotype as described by Fried in community-dwelling older persons.DesignCross-sectional study in 14 primary care GP offices in the Toulouse area from May 1st to October 31st, 2015.ParticipantsFourteen GPs screened their patients ≥70 years old.MeasurementsGPs' “frailty impression” was based on the Gérontopôle Frailty Screening Tool. “Objective measures of the five Fried frailty criteria” were obtained by a geriatric nurse through standardized testing. The capacity of the GPs' clinical impression to detect participants objectively measured as frail was examined with diagnostic values of observed sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV).ResultsA total of 268 participants were screened by GPs and assessed by a nurse. Mean age was 81 years and 62.3% were female. According to the objective measures of Fried's criteria, frailty (three to five criteria) and pre-frailty (one to two criteria) states were identified in 31% and 45.2% of participants, respectively. The Se of the GPs' impression was good (80.39%; 95% confidence interval [CI], 74.27%–85.61%), and the Sp was moderate (64.06%; 95% CI, 5.10%–75.68%). The overall PPV of the GPs' impression was 87.70% (95% CI, 82.12%–92.04%), and the NPV was 50.51% (95% CI, 39.27%–61.91%). Although the PPV increased with age reaching 93.33% (95% CI, 85.12%–97.80%) among patients ≥ 85 years old, the NPV decreased accordingly to a minimal 21.43% (95% CI, 4.66%–50.80%) in that subgroup.ConclusionThe present study highlights the importance of the GPs' clinical impression on frailty as a fair means to identify this syndrome in community-dwelling older patients in primary care. This clinical impression may not be sufficient, however, and some objective tests could be added to improve the accuracy of frailty detection in older patients in primary care.