Diagnose- und Screening-Instrumente der Frailty bei älteren Menschen

Zusammenfassung

Hintergrund: Frailty (Gebrechlichkeit) ist durch eine reduzierte Reserve und verminderte Abwehrfähigkeit von Stressoren charakterisiert. Sie beschreibt den vulnerablen Zustand älterer Menschen für negative Gesundheitsereignisse. Die Diagnostik von Frailty ist wichtig, um betroffenen Personen eine angepasste Versorgung zukommen zu lassen.

Ziel: Die vorliegende Übersichtsarbeit stellt wichtige Diagnose- und Screening-Instrumente der Frailty anhand internationaler Reviews dar.

Methode: Die systematische Literaturrecherche anhand der Datenbank MEDLINE schloss ausschließlich systematische Reviews ein, die die Gütekriterien von Diagnose- und Screening-Instrumenten der Frailty analysierten. Die Verfügbarkeit deutschsprachiger Testversionen wird dargestellt.

Ergebnisse: Die insgesamt eingeschlossenen 6 Reviews beschreiben, dass die Gütekriterien der meisten Messinstrumente nicht ausführlich untersucht wurden und daher unklar bleiben. Der Frailty Phänotyp (Frailty als physisches Syndrom) und der Frailty Index (Akkumulation von Defiziten) sind gängige Modelle zur Definition und Diagnosestellung von Frailty. Als Screening-Instrumente der Frailty mit den besten Gütekriterien gelten momentan die Gehgeschwindigkeit, der Timed-up-and-go-Test, der PRISMA-7 Fragebogen, der Tilburg Frailty Indicator sowie das SHARE-Frailty Instrument. Für das Screening im klinischen Alltag scheint ein zweistufiger Prozess nötig.

Schlussfolgerungen: Die vorliegende Übersichtsarbeit bietet eine umfassende Übersicht der verfügbaren Diagnose- und Screening-Instrumente der Frailty. Deutschsprachige Versionen der Messinstrumente werden bereitgestellt oder auf ihre entsprechenden Quellen verwiesen.

Abstract

Background: Frailty is characterised by a reduced reserve and decreased resistance to stressors. It describes a state of high vulnerability of older individuals towards negative health outcomes. Diagnosis of frailty is important to provide frail older people with appropriate care.

Object: The aim of this review was to describe diagnostic tools and screening instruments of frailty based on international reviews.

Method: This systematic literature research using the MEDLINE database included only systematic reviews that analysed the quality criteria of frailty diagnostic and screening tools. The availability of German-language test versions is described.

Results: The included 6 reviews report that the quality criteria of most instruments have not been evaluated extensively and therefore remain unclear. The frailty phenotype (frailty as physical syndrome) and the frailty index (accumulation of deficits) are prevalent models for the definition and assessment of frailty. Gait speed, the timed-up-and-go test, the PRISMA-7 questionnaire, the Tilburg Frailty Indicator and the SHARE-Frailty Instrument are considered as frailty screening tools implementing the best quality criteria.

Conclusions: This review provides a comprehensive overview of the available diagnosis and screening tools for frailty. German-language versions of these assessment tools are provided or referred to their concordant references.

Schlüsselwörter

Frailty - Diagnose - Screening - Frailty Phänotyp - Frailty Index - geriatrisches Assessment

Key words

frailty - diagnosis - screening - frailty phenotype - frailty index - geriatric assessment

• Literatur

• 1 Abellan van Kan G, Rolland Y, Bergman H et al. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 2008; 12: 29-37
• 2 Abellan van Kan G, Rolland Y, Andrieu S et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people – an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 2009; 13: 881-889
• 3 Abellan van Kan G, Rolland Y, Houles M et al. The assessment of frailty in older adults. Clin Geriatr Med 2010; 26: 275-286
• 4 Andrew MK, Fisk JD, Rockwood K. Psychological well-being in relation to frailty: a frailty identity crisis?. Int Psychogeriatr 2012; 24: 1347-1353
• 5 Avila-Funes JA, Amieva H, Barberger-Gateau P et al. Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. J Am Geriatr Soc 2009; 57: 453-461
• 6 Bakker FC, Robben SHM, Olde Rikkert MGM. Effects of hospital-wide interventions to improve care for frail older inpatients: a systematic review. BMJ Qual Saf 2011; 20: 680-691
• 7 Bouillon K, Kivimaki M, Hamer M et al. Measures of frailty in population-based studies: an overview. BMC Geriatr 2013; 13: 64
• 8 Cameron ID, Fairhall N, Langron C et al. A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial. BMC Med 2013; 11: 65
• 9 Cameron ID, Kurrle SE. Frailty and Rehabilitation. In: Theou O, Rockwood K, (eds) Frailty in aging: Biological, clinical, and social implications. Basel: Karger; 2015
• 10 Castell M, Sánchez M, Julián R et al. Frailty prevalence and slow walking speed in persons age 65 and older: implications for primary care. BMC Fam Pract 2013; 14: 86
• 11 Cesari M, Gambassi G, van Abellan Kan G et al. The frailty phenotype and the frailty index: different instruments for different purposes. Age Ageing 2014; 43: 10-12
• 12 Chin A, Paw MJM, van Uffelen JGZ et al. The functional effects of physical exercise training in frail older people: A systematic review. Sports Med 2008; 38: 781-793
• 13 Clegg A, Young J, Iliffe S et al. Frailty in elderly people. Lancet 2013; 381: 752-762
• 14 Clegg A, Rogers L, Young J. Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age Ageing 2015; 44: 148-152
• 15 Evans SJ, Sayers M, Mitnitski A et al. 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: 127-132
• 16 Fairhall N, Langron C, Sherrington C et al. Treating frailty – a practical guide. BMC Med 2011; 9: 83
• 17 Ferrucci L, Guralnik JM, Studenski S et al. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 2004; 52: 625-634
• 18 Freitag S, Schmidt S, Gobbens RJ et al. Tilburg Frailty Indicator – German translation and psychometric testing. Z Gerontol Geriatr 2016; 49: 86-93
• 19 Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-M156
• 20 Fritz S, Lusardi M. White paper: “walking speed: the sixth vital sign”. J Geriatr Phys Ther 2009; 32: 46-49
• 21 Fuchs J, Scheidt-Nave C, Gaertner B et al. Frailty in Germany: status and perspectives: Results from a workshop of the German Society for Epidemiology. Z Gerontol Geriatr 2015; [Epub ahead of print]
• 22 Gobbens RJJ, van Assen MALM, Luijkx KG et al. The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc 2010; 11: 344-355
• 23 Gobbens RJJ, van Assen MALM, Luijkx KG et al. The Predictive Validity of the Tilburg Frailty Indicator: Disability, Health Care Utilization, and Quality of Life in a Population at Risk. Gerontologist 2012; 52: 619-631
• 24 Gordon AL, Masud T, Gladman JRF. Now that we have a definition for physical frailty, what shape should frailty medicine take?. Age Ageing 2014; 43: 8-9
• 25 Guilley E, Ghisletta P, Armi F et al. Dynamics of frailty and adl dependence in a five-year longitudinal study of octogenarians. Research on Aging 2008; 30: 299-317
• 26 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. Lancet Oncol 2012; 13: e437-e444
• 27 Hebert R, Durand PJ, Dubuc N et al. Frail elderly patients. New model for integrated service delivery. Can Fam Physician 2003; 49: 992-997
• 28 Hoogendijk EO, van der Horst HE, Deeg DJH et al. The identification of frail older adults in primary care: comparing the accuracy of five simple instruments. Age Ageing 2013; 42: 262-265
• 29 Jones D, Song X, Mitnitski A et al. Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians. Aging Clin Exp Res 2005; 17: 465-471
• 30 Koller K, Rockwood K. Frailty in older adults: implications for end-of-life care. Cleve Clin J Med 2013; 80: 168-174
• 31 Kulminski AM, Ukraintseva SV, Kulminskaya IV et al. Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc 2008; 56: 898-903
• 32 Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of Deficits as a Proxy Measure of Aging. The Scientific World Journal 2001; 1: 323-336
• 33 Mitnitski AB, Mogilner AJ, MacKnight C et al. The accumulation of deficits with age and possible invariants of aging. Scientific World Journal (The Scientific World Journal) 2002; 2: 1816-1822
• 34 Mitnitski AB, Mogilner AJ, MacKnight C et al. The mortality rate as a function of accumulated deficits in a frailty index. Mech Ageing Dev 2002; 123: 1457-1460
• 35 Morley JE, Vellas B, van Abellan Kan G et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14: 392-397
• 36 Morley JE. Frailty screening comes of age. J Nutr Health Aging 2014; 18: 453-454
• 37 Perera S, Patel KV, Rosano C et al. Gait Speed Predicts Incident Disability: A Pooled Analysis. J Gerontol A Biol Sci Med Sci 2016; 71: 63-71
• 38 Pialoux T, Goyard J, Lesourd B. Screening tools for frailty in primary health care: a systematic review. Geriatr Gerontol Int 2012; 12: 189-197
• 39 Pijpers E, Ferreira I, Stehouwer CD et al. The frailty dilemma. Review of the predictive accuracy of major frailty scores. European Journal of Internal Medicine 2012; 23: 118-123
• 40 Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142-148
• 41 Raîche M, Hébert R, Dubois M. PRISMA-7: a case-finding tool to identify older adults with moderate to severe disabilities. Arch Gerontol Geriatr 2008; 47: 9-18
• 42 Rockwood K, Song X, MacKnight C et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489-495
• 43 Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62: 722-727
• 44 Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci 2007; 62: 738-743
• 45 Rockwood K, Theou O, Mitnitski A. What are frailty instruments for?. Age Ageing 2015; 44: 545-547
• 46 Romero-Ortuno R, Walsh CD, Lawlor BA et al. A Frailty Instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatr 2010; 10: 57
• 47 Romero-Ortuno R. The Frailty Instrument for primary care of the Survey of Health, Ageing and Retirement in Europe predicts mortality similarly to a frailty index based on comprehensive geriatric assessment. Geriatr Gerontol Int 2013; 13: 497-504
• 48 Romero-Ortuno R. The SHARE operationalized frailty phenotype: a comparison of two approaches. European Geriatric Medicine 2013; 4: 255-259
• 49 Romero-Ortuno R, O’Shea D. Fitness and frailty: opposite ends of a challenging continuum! Will the end of age discrimination make frailty assessments an imperative?. Age Ageing 2013; 42: 279-280
• 50 Schädler S, Kool J, Lüthi H et al. Assessments in der Rehabilitation. Bd. 1: Neurologie. Bern: Huber; 2012
• 51 Schuurmans H, Steverink N, Lindenberg S et al. Old or frail: what tells us more?. J Gerontol A Biol Sci Med Sci 2004; 59: 5
• 52 Searle SD, Mitnitski A, Gahbauer EA et al. A standard procedure for creating a frailty index. BMC Geriatr 2008; 8: 24
• 53 Shamliyan T, Talley KMC, Ramakrishnan R et al. Association of frailty with survival: a systematic literature review. Ageing Res Rev 2013; 12: 719-736
• 54 Shea BJ, Grimshaw JM, Wells GA et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology 2007; 7: 10
• 55 Sieliwonczyk E, Perkisas S, Vandewoude M. Frailty indexes, screening instruments and their application in Belgian primary care. Acta Clinica Belgica 2014; 69: 233-239
• 56 Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc 2010; 58: 681-687
• 57 Sourial N, Wolfson C, Bergman H et al. A correspondence analysis revealed frailty deficits aggregate and are multidimensional. J Clin Epidemiol 2010; 63: 647-654
• 58 Sternberg SA, Wershof Schwartz A, Karunananthan S et al. The identification of frailty: a systematic literature review. J Am Geriatr Soc 2011; 59: 2129-2138
• 59 Stuck AE, Siu AL, Wieland GD et al. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993; 342: 1032-1036
• 60 Studenski S, Perera S, Patel K et al. Gait speed and survival in older adults. JAMA 2011; 305: 50-58
• 61 Sustakoski A, Perera S, Vanswearingen JM et al. The impact of testing protocol on recorded gait speed. Gait Posture 2015; 41: 329-331
• 62 Terwee CB, Jansma EP, Riphagen II et al. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res 2009; 18: 1115-1123
• 63 Terwee CB, Prinsen CAC, Ricci Garotti MG et al. The quality of systematic reviews of health-related outcome measurement instruments. Qual Life Res 2016; 25: 767-779
• 64 Theou O, Brothers TD, Mitnitski A et al. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. J Am Geriatr Soc 2013; 61: 1537-1551
• 65 Theou O, Yu S, Rockwood K et al. Focus on frailty: essential as the population ages. Medicine Today 2015; 16: 28-33
• 66 Theou O, Cann L, Blodgett J et al. 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 Res Rev 2015; 21: 78-94
• 67 Turner G, Clegg A. Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing 2014; 43: 744-747
• 68 de Vries NM, Staal JB, van Ravensberg CD et al. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev 2011; 10: 104-114
• 69 Walston JD, Bandeen-Roche K. Frailty: a tale of two concepts. BMC Med 2015; 13: 991
• 70 Whiting PF. QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies. Ann Intern Med 2011; 155: 529
• 71 Xue QL, Varadhan R. What is missing in the validation of frailty instruments?. J Am Med Dir Assoc 2014; 15: 141-142