The predictive validity of three self-report screening instruments for identifying frail older people in the community Hierarchical components of physical frailty predicted incidence of dependency in a cohort of elderly women. Performance measures predict onset of activity of daily living difficulty in community-dwelling older adults. A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients. One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial; “Continuum of care for frail older people” Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Effectiveness of a multicomponent exercise program in the attenuation of frailty in long-term nursing home residents: study protocol for a randomized clinical controlled trial Design and pilot results of a single blind randomized controlled trial of systematic demand-led home visits by nurses to frail elderly persons in primary care [ISRCTN05358495] Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Further validation of the Elderly Mobility Scale for measurement of mobility of hospitalized elderly people Does monitoring change in function in community-dwelling older adults alter outcome? A randomized controlled trial A global clinical measure of fitness and frailty in elderly people Stability of physical assessment of older drivers over 1 year. Frailty and functional decline indices predict poor outcomes in hospitalised older people. Efficacy of a nurse-led multidimensional preventive programme for older people at risk of functional decline. A randomized controlled trial. Reliability of Six Physical Performance Tests in Older People With Dementia Transitions in cognitive status in relation to frailty in older adults: A Comparison of three frailty measures
Background If brief and easy to use self report screening tools are available to identify frail elderly , this may avoid costs and unnecessary assessment of healthy people . This study investigates the predictive validity of three self-report instruments for identifying community-dwelling frail elderly . Methods This is a prospect i ve study with 1-year follow-up among community-dwelling elderly aged 70 or older ( n = 430 ) to test sensitivity , specificity , and positive and negative predicted values of the Groningen Frailty Indicator , Tilburg Frailty Indicator and Sherbrooke Postal Question naire on development of disabilities , hospital admission and mortality . Odds ratios were calculated to compare frail versus non-frail groups for their risk for the adverse outcomes . Results Adjusted odds ratios show that those identified as frail have more than twice the risk ( GFI , 2.62 ; TFI , 2.00 ; SPQ , 2,49 ) for developing disabilities compared to the non-frail group ; those identified as frail by the TFI and SPQ have more than twice the risk of being admitted to a hospital . Sensitivity and specificity for development of disabilities are 71 % and 63 % ( GFI ) , 62 % and 71 % ( TFI ) and 83 % and 48 % ( SPQ ) . Regarding mortality , sensitivity for all tools are about 70 % and specificity between 41 % and 61 % . For hospital admission , SPQ scores the highest for sensitivity ( 76 % ) . Conclusion All three instruments do have potential to identify older persons at risk , but their predictive power is not sufficient yet . Further research on these and other instruments is needed to improve targeting frail elderly OBJECTIVE To identify the most important predictors of early disability  incidence and devise a simple score of physical frailty . METHODS A cohort of 545 high-functioning women aged 75 years and older was followed for 7 years . Every year , the self-reported loss of at least one instrumental activity of daily living was chosen as definition of disability . An extension of the logistic regression for repeated responses , the r and om-effect model , was used to assess the effects of baseline predictors . The regression coefficients of the final multivariate model were scaled and rounded to create a practical score . RESULTS The proportion of women reporting disability increased from 22.1 % to 52.1 % throughout the follow-up . In the multivariate model , increasing age , lower performances in mobility and balance tests , bad perceived health , lower muscle strength , higher body mass index , lower educational level , and lower reported physical activity were strong predictors of disability . Evaluating the predictive value of the simplified predictive score on an independent cohort gave a c-statistic equal to .71 . CONCLUSION The use of a powerful fitting method allows to establish a hierarchy between the components of physical frailty and to provide a predictive score with substantial practical value for clinicians and public health professionals OBJECTIVES To assess the predictive value of five performance-based measures for the onset of difficulty in activities of daily living ( ADLs ) . DESIGN A prospect i ve cohort study ; home visits every 6 months for 18 months . SETTING Community-based . PARTICIPANTS Community-dwelling older adults , n=110 , ( mean age 80.3+/-7.0 ; range 67 - 98 ) who reported no difficulty in basic ADLs .  MEASUREMENTS The  Short Physical Performance Battery ( SPPB ) , gait speed , Berg Balance Scale ( BBS ) , grip strength , and Timed Up and Go Test ( TUG ) were evaluated at baseline . Seven ADL items  were assessed at baseline and 6 , 12 , and 18 months . The onset of ADL disability was self-report of difficulty in any of the seven ADL items . Logistic regression models were fitted for each of the physical performance measures to predict onset of ADL difficulty at 6 , 12 , and 18 months . RESULTS After controlling for age , comorbid conditions , and sex , the BBS was the most consistent and best predictor for the onset of ADL difficulty over an 18-month period ( 6 months , c-statistic=0.725 , ( 95 % confidence interval (CI)=0.60 - 0.85 ; 12 months , c-statistic=0.840 95 % CI=0.75 , 0.93 ; 18 months , c-statistic=0.821 , 95 % CI=0.71 , 0.93 ) . The SPPB showed excellent predictive value for the onset of difficulty at 12 months . Ninety-five , 89 , and 75 older adults completed the 6 , 12 , and 18-month follow-up visits , respectively . CONCLUSION BBS , followed by SPPB , TUG , gait speed , and grip strength , were predictive of the onset of ADL difficulty over an 18-month period in community-dwelling older adults . Screening nondisabled older adults with simple performance tests could allow clinicians to identify those at risk for ADL difficulty and may help to detect early functional decline OBJECTIVES To test the hypothesis that scores on 4 falls risk measures  will differ significantly in patients reporting recurrent falls compared with those who do not ; and to explore the validity of each measure to predict such falls status . DESIGN A convenience sample was tested to establish the sensitivity and specificity of the  Functional Reach Test , Timed Up & Go test , one-leg stance test ( OLST )  , and  balance subsection of the Performance Oriented Mobility Assessment ( B-POMA ) . A 12-month retrospective falls history was used to identify recurrent fallers . SETTING A day hospital for the elderly . PARTICIPANTS Convenience sample of 30 day hospital patients . The inclusion criteria were : ability to rise from a chair and walk 6 m ; no severe cognitive impairment or blindness ; age 65 years or older . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Scores on the 4 tests and retrospective falls histories . RESULTS Scores on the B-POMA and OLST showed significant differences between fallers and nonfallers ( P<.05 ) . An  OLST time of 1.02 seconds or less ( odds ratio [OR]=15.2 ; 95 % confidence interval [ CI ] , 1.72 - 133.95 ) and B-POMA score of 11 or less ( OR=18.5 ; 95 % CI , 2.05 - 167.79 ) were predictive of day hospital patients having a history of recurrent falls . CONCLUSIONS OLST and B-POMA both have potential as screening tools for risk of falls , but this observation requires confirmation in a prospect i ve study Background The intervention ; “ Continuum of Care for Frail Older People ” , was design ed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person ’s own home . The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living ( ADL ) . Methods The study is a non-blinded controlled trial with participants r and omised to either the intervention group or a control group with follow-ups at three- , six- and 12 months . The intervention involved collaboration between a nurse with geriatric competence at the emergency department , the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub . Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal , Sweden were asked to participate . Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL . Analyses were made on the basis of the intention-to-treat principle . Outcome measures were ADL independence and eight frailty indicators . These were analysed , using Chi-square and odds ratio ( OR ) . Results A total of 161 participated in the study , 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study . There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up . At both the three- and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control ( OR 2.37 , 95 % CI ; 1.20 – 4.68 ) and ( 2.04 , 95 % CI ; 1.03 – 4.06 ) respectively . At six months the intervention group had halved their odds for decreased ADL independence ( OR 0.52 , 95 % CI ; 0.27 – 0.98 ) compared to the control group . Conclusions The intervention has the potential to reduce dependency in ADLs , a valuable benefit both for the individual and for society . Trial registration Clinical Trials.gov : BACKGROUND The clinical syndrome of frailty identified through the assessment of weight loss , gait speed , grip strength , physical activity , and physical exhaustion has been used to identify patients with reduced reserves . We hypothesized that frailty is useful in predicting adverse outcomes in optimized elective elderly colorectal surgery patients . METHODS A prospect i ve study was conducted at 2 centers ( Singapore and Japan ) . All patients over 75 years of age undergoing colorectal resection were assessed for the presence of the syndrome of frailty .  All these patients had already had their comorbidities optimized for surgery . The outcome measure was postoperative major complications ( defined as Clavien-Dindo type II and above complications ) . RESULTS Eighty-three patients were studied from February 2008 to April 2010 . The mean age was 81.5 years ( range 75 - 93 years ) . The mean comorbidity index was 3.37 ( range 0 - 11 ) . Twenty-six ( 31.3 % ) patients were an American Society of Anesthesiologists ( ASA ) score of 3 and above . Chi-square analysis revealed that the odds ratio of postoperative major complications was 4.083 ( 95 % confidence interval , 1.433 - 11.638 ) when the patient satisfied the criteria for frailty . Albumin < 35 , ASA > 3 , comorbidity index > 5 , and Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity ( POSSUM ) scores were not predictive of postoperative major complications . CONCLUSIONS Preliminary findings show that frailty is a potent adjunctive tool of predicting postoperative morbidity . Frailty can be used to identify elderly patients needing further optimization before major surgery Background There is increasing evidence suggesting that cognition and physical frailty interact within a cycle of decline associated with aging which has been called cognitive frailty . Exercise programs have demonstrated to be an effective tool to prevent functional and cognitive decline during aging , but little is known about their potential to restore or maintain functionality in individuals that require long-term nursing care . Besides , WHO has recently highlighted the importance of introducing systematic musculoskeletal health programs for older people living in residential care , as they represent a particularly vulnerable group for the development of noncommunicable diseases . Methods This is a multicentre r and omized controlled trial . 114 participants will be r and omly allocated to a  usual care group or to an  intervention group .  Inclusion criteria are as follows : ≥ 70 years , ≥ 50 on the Barthel Index , ≥ 20 on MEC-35 who are capable to st and up and walk independently for 10 m. Subjects in the intervention group will add to the activities scheduled for the control group the participation in a 6 months long multicomponent exercise program design ed to improve strength , balance and walking retraining . Study assessment s will be conducted at baseline and at 3 and 6 months . The primary outcome is change in function assessed by Short Physical Performance Battery and secondary outcomes include other measurements to assess all together the condition of frailty , which includes functionality , sedentary behaviors , cognitive and emotional status and biological markers . The present study has been approved by the Committee on Ethics in Research of the University of the Basque Country ( Humans Committee Code M10/2016/105 ; Biological Sample s Committee Code M30/2016/106 ) . Discussion Results from this research will show if ageing related functional and cognitive deterioration can be effectively prevented by physical exercise in institutionalized elders . It is expected that the results of this research will guide clinical practice in nursing home setting s , so that clinicians and policymakers can provide more evidence -based practice for the management of institutionalized elder people . Trial registration The protocol has been registered under the Australian and New Zeal and Clinical Trials Registry ( ANZCTR ) with the identifier : ACTRN12616001044415 Abstract Background The objective of this article is to describe the design of an evaluation of the cost-effectiveness of systematic home visits by nurses to frail elderly primary care patients . Pilot objectives were : 1 . To determine the feasibility of postal multidimensional frailty screening instruments ; 2 . to identify the need for home visits to elderly . Methods Main study : The main study concerns a r and omized controlled in primary care practice s ( PCP ) with 18 months follow-up and blinded PCPs . Frail persons aged 75 years or older and living at home but neither terminally ill nor demented from 33 PCPs were eligible . Trained community nurses ( 1 ) visit patients at home and assess the care needs with the Resident Assessment Instrument-Home Care , a multidimensional computerized geriatric assessment instrument , enabling direct identification of problem areas ; ( 2 ) determine the care priorities together with the patient ; ( 3 ) design and execute interventions according to protocol s ; ( 4 ) and visit patients at least five times during a year in order to execute and monitor the care-plan . Controls receive usual care . Outcome measures are Quality of life , and Quality Adjusted Life Years ; time to nursing home admission ; mortality ; hospital admissions ; health care utilization . Pilot 1 : Three brief postal multidimensional screening measures to identify frail health among elderly persons were tested on percentage complete item response ( selected after a literature search ): 1 ) Vulnerable Elders Screen , 2 ) Strawbridge 's frailty screen , and 3 ) COOP-WONCA charts . Pilot 2 : Three nurses visited elderly frail patients as identified by PCPs in a health center of 5400 patients and used an assessment protocol to identify psychosocial and medical problems . The needs and experiences of all participants were gathered by semi-structured interviews . Discussion The design holds several unique elements such as early identification of frail persons combined with case-management by nurses . From two pilots we learned that of three potential postal frailty measures , the COOP-WONCA charts were completed best by elderly and that preventive home visits by nurses were positively evaluated to have potential for quality of care improvement Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Objective : To further assess the validity and inter-rater reliability of the  Elderly Mobility Scale ( EMS ) . Also whether the scale reflects elderly people 's perceptions regarding their mobility , and whether it can predict discharge destination , or likelihood of falling . Design : Question naire-based study completed on admission and weekly after this on all patients referred to physiotherapy for mobility problems over the course of one month . Setting : Care of the elderly wards in the Bristol General Hospital . Subjects : Sixty-six patients ( ages 66 - 69 years , 66 % female ) were included in the validity study . Nineteen patients ( ages 71 - 95 years , 47 % female ) were included in the inter-rater reliability study . Interventions : EMS , Barthel and patients ' perceptions of mobility were tested with routine physiotherapy treatment carried out as necessary . Main outcome measures : Concurrent validity was assessed by correlating EMS scores with Barthel scores using Spearman 's test . Inter-rater reliability was also tested using a Spearman 's correlation . EMS scores of patients were also evaluated in conjunction with whether or not they fell and their destination on discharge . Results : A significant correlation between EMS and Barthel scores indicated concurrent validity . Inter-rater reliability was demonstrated on 19 patients with a significant correlation between scores . No predictive validity could be ascribed to  EMS  in terms of discharge destination or likelihood of falling . Results do indicate a possible predictive validity of the functional reach component of the  EMS  regarding the risk of future falls . Conclusions : The EMS was found to be a valid scale with good inter-rater reliability that could be readily applied during daily clinical work . However , it was found to have no predictive validity in terms of falling or discharge destination Objective : To determine whether information about an older person 's physical functioning provided to the patient and his or her physician delays functional decline and improves health outcomes . Design : A r and omized controlled trial was undertaken ; the assessors were not blinded to the group allocation . Setting : The study took place in a clinic within a hospital setting . Participants : Two hundred and sixty-five community-dwelling people over 65 years were recruited from family practice units . Interventions : The intervention group received assessment s of physical function with feedback to the participant and the participant 's family physician or functional assessment s alone over 18 months .  Self-report measures for health status using the Short Form-36 ( SF-36 ) and pre clinical disability were used together with performance measures which included the lower extremity performance test and muscle strength . Results : There were small , statistically significant group/time interactions which included disability scores , F=4.78 , P ≤0.05 ) , and the vitality subscale of the SF-36 , F=7.47 , P ≤0.01 ) . Conclusion : Providing information about the results of detailed assessment of physical functioning to older adults and their physicians did not show significant differences in function scores between the intervention and control groups Background : There is no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information Older adults represent the fastest-growing population of drivers with a valid driver 's licence . Also common in this age group are multiple chronic medical conditions that may have an effect on physical function and driving ability . Determining the reliability of physical measures used to assess older drivers ' functional ability is important to identifying those who are safe to continue driving . Most previous reliability studies of clinical physical measures of health used test-retest intervals shorter than those between patient visits with a clinician . In the present study we examined a more clinical ly representative interval of 1 year to determine the stability of commonly used physical measures collected during the C and rive II prospect i ve cohort study of older drivers .  Reliability statistics indicate that the  sequential finger-thumb opposition , rapid pace walk  and the  Pelli-Robson contrast sensitivity tests  have adequate stability over 1 year . Poor stability was observed for the one-legged stance and Snellen visual acuity test . Several assessment s with nominal data ( Marottoli method [ functional neck range of motion ] , whispered voice test , range of motion and strength testing ) lacked sufficient variability to conduct reliability analyses ; however , a lack of variability between test days suggests consistency over a 1-year time frame . Our results provide evidence that specific physical measures are stable in monitoring functional ability over the course of a year BACKGROUND admission to a Geriatric Evaluation and Management Unit ( GEMU ) can optimise a patient 's chance of functional recovery . OBJECTIVE to evaluate the ability of several commonly used frailty and functional decline indices to predict GEMU outcomes , both at discharge and at 6 months . DESIGN prospect i ve , observational study . SETTING AND PARTICIPANTS consecutive GEMU patients aged ≥70 years . METHODS patients were classified as ' frail ' or ' at high risk of functional decline ' using several frailty and functional decline instruments . Predictive ability was evaulated using logistic regression and area under receiver operator characteristic ( ROC ) curves ( auROC ) . RESULTS a total of 172 patients were included . Frailty prevalence varied from 24 to 94 % depending on the instrument used . Several instruments predicted patients at risk of poor outcome , including the Frailty Index of Accumulative Deficits ( FI-CD ) , Fried 's Cardiovascular Health Study index , the Study of Osteoporotic Fractures index , an adapted Katz score of activities of daily living ( ADL ) , Instrumental ADL , the Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie ( SHERPA ) and grip strength [ odds ratio ( OR ) range of 2.06 - 6.47 ] . Adequate discriminatory power for discharge outcome was achieved by the FI-CD ( auROC = 0.735 , P < 0.001 ) and an adapted Katz score ( auROC = 0.704 , P = < 0.001 ) . The FI-CD also showed adequate discriminatory power for a poor 6-month outcome ( auROC = 0.702 , P < 0.001 ) . CONCLUSION frailty and functional decline instruments can predict older patients at risk of poor outcome . However , only the FI-CD showed adequate discriminatory power for outcome prediction at both follow-up time-points OBJECTIVE To verify the efficacy of a multidimensional preventive programme on functional decline of older people .  DESIGN R and omized controlled trial . SETTING Community of Sherbrooke City , Quebec , Canada . SUBJECTS A representative sample of individuals aged over 75 living at home and identified to be at risk of functional decline by postal question naire ( n = 503 ) . INTERVENTION Subjects r and omized to the study group ( n = 250 ) were assessed at home by a nurse on 12 dimensions ( including medication , depressive mood , risk of falls , hearing ) . A report of the assessment was sent to the general practitioner with recommendations for interventions . A monthly telephone contact was carried out by the nurse for surveillance and to verify if the recommendations had been applied . METHODS The primary outcome --functional decline -- was defined as either death , admission to an institution or increase of > or = 5 points on the disability score of the Functional Autonomy Measurement System ( SMAF ) scale during the reference year . Secondary outcomes were functional autonomy ( on the SMAF ) , well-being ( General Well-being Schedule ) , perceived social support ( Social Provisions Scale ) and use of health care services . RESULTS Of the 494 subjects who completed the study , 48 ( 19.6 % ) of 245 in the study group and 49 ( 19.7 % ) of 249 in the control group had functional decline ( relative risk 1.00 ; 95 % confidence interval 0.82 - 1.23 ) . There were no differences between the groups in all secondary outcomes . CONCLUSIONS This study confirms the inefficacy of multidimensional programmes for preventing functional decline in the older population . More effort should be devoted to improving the efficacy of specific interventions for conditions causing functional decline Background Physical performance tests are important for assessing the effect of physical activity interventions in older people with dementia , but their psychometric properties have not been systematic ally established within this specific population . Objective The purpose of this study was to determine the relative and absolute test-retest reliability of the  6-m walk test  , the  Figure-of-Eight Walk Test ( F8W ) , the  Timed “ Up & Go ” Test ( TUG )  , the  Frailty and Injuries : Cooperative Studies of Intervention Techniques–4  ( FICSIT–4 ) Balance Test , the  Chair Rise Test ( CRT )  , and the  Jamar dynamometer .  These tests are used to assess gait speed , dynamic balance , functional mobility , static balance , lower-limb strength , and grip strength , respectively . Design This investigation was a prospect i ve , nonexperimental study . Methods Older people with dementia ( n=58 , age range=70–92 years ) performed each test at baseline and again after 1 week . Intraclass correlation coefficients ( ICC ) , st and ard error of measurement ( SEM ) , minimal detectable change ( MDC ) , and log-transferred limits of agreement of Bl and -Altman plots were calculated . Results The relative reliability of the F8W , TUG , and Jamar dynamometer was excellent ( ICC=.90–.95 ) and good for the 6-m walk test , FICSIT–4 , and CRT ( ICC=.79–.86 ) . The SEMs and MDCs were large for all tests . The absolute reliability of the TUG and CRT was significantly influenced by the level of cognitive functioning ( as assessed with the Mini-Mental State Examination [ MMSE ] ) . Limitations The specific etiology of dementia was not obtained . Conclusions The physical performance tests evaluated are useful for detecting differences in performance between older people with mild to moderate dementia and , therefore , are suitable for cross-sectional or controlled intervention studies . They appear less suitable to monitor clinical ly relevant intra-individual performance changes . Future studies should focus on the development of more sensitive tests and the identification of criteria for clinical ly relevant changes in this rapidly growing population Objectives Cognitive decline is related to frailty . Frailty can be operationalized in different ways , which have an unknown impact on the estimation of risk . Here , we compared 3 frailty measures in relation to cognitive changes and mortality in the Canadian Study of Health and Aging ( CSHA ) . Design Prospect i ve population -based study , with 5 year follow up . Participants / Setting 2,305 subjects aged 70 + years . Methods For each participant , cognitive status was measured by the errors in the Modified Mini-Mental State Examination ( 3MS ) score .  Three frailty measures were used : a Frailty Index based on the Comprehensive Geriatric Assessment ( FI-CGA ) evaluated from 47 potential deficits , a Clinical Frailty Score and the Fried frailty phenotype . Multivariate Poisson regression and multivariate logistic regression were used to examine the association between baseline cognitive errors and frailty and death , respectively , while controlling for possible confounders ( age , sex , education , and baseline cognitive status ) . Results Changes in cognitive status were strongly associated with baseline cognition and frailty , however defined . In multivariate models adjusted for age , sex and education , each frailty measure was associated with cognitive decline and with mortality . The frailest people ( from the highest FI-CGA tertile ) rarely showed cognitive improvement or stabilization ( 1.5 % , 95 % CI=0.002%–2.8 % ) compared with non-frail people ( from the lowest tertile of the FI-CGA ) , of whom 27.8 % ( 95 % CI=24.5%–31.1 % ) did not deteriorate . Conclusions Frail elderly people have an increased risk of cognitive decline . All frailty measures allowed quantification of individual vulnerability and predict both cognitive changes and mortality
The Frailty Index was examined in almost all these dimensions , with the exception of reliability , and its diagnostic and predictive characteristics were shown to be satisfactory .
Gait speed showed high sensitivity , but only moderate specificity , and excellent predictive ability for future disability in activities of daily living .
The Tilburg Frailty Indicator was shown to be a reliable and valid measure for frailty screening , but its diagnostic accuracy was not evaluated .
Screening Letter , Timed-up- and -go test and PRISMA 7 ( Preferred Reporting Items for Systematic Review s and Meta-Analyses ) demonstrated high sensitivity and moderate specificity for identifying frailty .
In general , low physical activity , variously measured , was one of the most powerful predictors of future decline in activities of daily living .
Conclusion Only a few frailty measures seem to be demonstrably valid , reliable and diagnostically accurate , and have good predictive ability .
Nevertheless , it was clear that no suitable tool for assessing frailty appropriately in emergency departments was identified
Background A scoping search identified systematic review s on diagnostic accuracy and predictive ability of frailty measures in older adults .
In most cases , research was confined to specific assessment measures related to a specific clinical model .
Objectives To summarize the best available evidence from systematic review s in relation to reliability , validity , diagnostic accuracy and predictive ability of frailty measures in older adults .