The online version of this article (https://doi.org/10.1186/s12877-018-0718-2) contains supplementary material, which is available to authorized users.
Demographic changes have led to an increase in the number of elderly frail persons and, consequently, systematic geriatric assessment is more important than ever. Frailty Indexes (FI) may be particularly useful to discriminate between various degrees of frailty but are not routinely assessed due, at least in part, to the large number of deficits assessed (from 30 to 70). Therefore, we have developed a new, more concise FI for rapid geriatric assessment (RGA)—the Frail-VIG index (“VIG” is the Spanish/Catalan abbreviation for Comprehensive Geriatric Assessment), which contains 22 simple questions that assess 25 different deficits. Here we describe this FI and report its ability to predict mortality at 24 months.
Prospective, observational, longitudinal study of geriatric patients followed for 24 months or until death. The study participants were patients (n = 590) admitted to the Acute Geriatric Unit at the at the University Hospital of Vic (Barcelona) during the year 2014. Participants were classified into one of seven groups based on their Frail-VIG score (0–0.15; 0.16–0.25; 0.26–0.35; 0.36–0.45; 0.46–0.55; 0.56–0.65; and 0.66–1). Survival curves for these groups were compared using the log-rank test. ROC curves were used to assess the index’s capacity to predict mortality at 24 months.
Mean (standard deviation) patient age was 86.4 (5.6) years. The 24-month mortality rate was 57.3% for the whole sample. Significant between-group (deceased vs. living) differences (p < 0.05) were observed for most index variables. Survival curves for the seven Frail-VIG groups differed significantly (X2 = 433.4, p < 0.001), with an area under the ROC curve (confidence interval) of 0.90 (0.88–0.92) at 12 months and 0.85 (0.82–0.88) at 24 months. Administration time for the Frail-VIG index ranged from 5 to 10 min.
The Frail-VIG index, which requires less time to administer than previously validated FIs, presents a good discriminative capacity for the degree of frailty and a high predictive capacity for mortality in the present cohort. Although more research is needed to confirm the validity of this instrument in other populations and settings, the Frail-VIG may provide clinicians with a RGA method and also a reliable tool to assess frailty in routine practice.
Additional file 1: Percentage of variables by domain versus the other four validated frailty indices. The distribution of variables by domain (as a percentage of the overall index) was similar to other validated FIs: the Original Canadian Study of Health and Aging – Frailty Index (CSHA-FI70), the Searle version of Canadian Study of Health and Aging – Frailty Index (CSHA-FI40), the Frailty Index based on Comprehensive Geriatric Assessment (FI-CGA) and the SHARE-Frailty Index (SHARE-FI). However, the Frail-VIG showed a higher weighting of geriatric syndromes and symptoms and a lower weighting for the functional domain; it should be noted that the Frail-VIG is the only index to include the social domain. (DOCX 14 kb)
Additional file 2: Specific NECPAL severity criteria / progression / advanced disease. Severity and/or progression criteria for advanced chronic illness (oncological, pulmonary, cardiovascular, neurological, hepatobiliary-digestive, kidney) defined in the NECPAL test. Abbreviations: FEV1: forced expiratory volume in 1 s. VC: Vital Capacity; DLCO: Diffusion capacity for carbon monoxide; NYHA: New York Hearth Association. EF: Ejection Fraction; PAH: Pulmonary Arterial Hypertension; PAPs: pulmonary artery pressure; GFR: glomerular filtration rate; MS: multiple sclerosis; ALS: amyotrophic lateral sclerosis. (DOCX 15 kb)
Additional file 3: ROC curves. (Panel A) Area Under the Curve (AUC) at 3, 6, 9, 12, and 24 months. (Panel B) Changes in the AUC over the course of the follow-up period. This shows how the AUC tends to increase up to month 12 after which the prognostic accuracy begins to decline until month 24. (TIFF 700 kb)
Additional file 4: Area Under the Curve (AUC), optimal cut-off point of the Frail-VIG index related to the sensitivity and specificity and Youden’s index at 3, 6, 9, 12, and 24 months. The optimal cut-off point is 0.46 in all cases, with the best performance according to Youden’s index observed at 12 months (0.62), with a sensitivity and specificity of 0.80 and 0.83, respectively. (DOCX 14 kb)
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- Frail-VIG index: a concise frailty evaluation tool for rapid geriatric assessment
Joan Carles Martori
- BioMed Central
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