The validation of a care partner-derived frailty index based upon comprehensive geriatric assessment (CP-FI-CGA) in emergency medical services and geriatric ambulatory care

Abstract

Background: the derivation of a frailty index (FI) based on deficit accumulation from a Comprehensive Geriatric Assessment (CGA) has been criticised as cumbersome. To improve feasibility, we developed a questionnaire based on a CGA that can be completed by care partners (CP-FI-CGA) and assessed its validity. Methods: we enrolled a convenience sample of patients aged 70 or older (n = 203) presenting to emergency medical services (EMS) or geriatric ambulatory care (GAC). To test construct validity, we evaluated the shape of the CP-FI-CGA distribution, including its maximum value, relationship with age and gender. Criterion validity was evaluated by survival analysis and by the correlation between the CP-FI-CGA and specialist-completed FI-CGA. Results: the mean age was 82.2 ± 5.9 years. Most patients were women (62.1%), unmarried (widowed, divorced and single) (59.6%) and lived in their own home or apartment (78.3%). The mean CP-FI-CGA was 0.41 ± 0.15 and was higher in the EMS group (0.45 ± 0.15) than in GAC (0.37 ± 0.14) (P < 0.001). The CP-FI-CGA correlated well with the specialistcompleted FI-CGA (0.7; P < 0.05). People who died had a higher CP-FI-CGA than did survivors (0.48 ± 0.13 versus 0.38 ± 0.15). Each 0.01 increase in the FI was associated with a higher risk of death (HR 1.04; 95% CI 1.02–1.06). Conclusion: the CP-FI-CGA has properties that resemble other published FIs and may be useful in busy clinical practice for grading degrees of frailty. It efficiently integrates information from care partners so that it can help guide decision-making.