Article Figures & Data
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Tables
- Table 1. Overall frailty judgment: Comprehensive Geriatric Assessment by Family Physicians (FP-CGA) compared with Comprehensive Geriatric Assessment by Geriatricians (G-CGA) in Community-Dwelling Elderly (n = 587)
FP-CGA G-CGA Frail Not Frail Total Frail 183 30 213 31% 5% 36% Not frail 111 263 374 19% 45% 64% Total 294 293 587 50% 50% 100% - Table 2. Characteristics of the Total Study Population, Frail according to Comprehensive Geriatric Assessment by Family Physician (FP-CGA) and Frail according to Comprehensive Geriatric Assessment by Geriatricians (G-CGA)
Characteristic Total (n = 587) Frail FP-CGA (n = 213) Frail G-CGA (n = 294) Age (years) (mean ± SD) 77 ± 5 79 ± 5 77 ± 5 Sex, women (%) 330 (56) 120 (56) 165 (56) Multimorbidity ≥2 diseases (%) 396 (68) 191 (90) 253 (86) Polypharmacy ≥4 Medications (%) 362 (62) 156 (73) 204 (69) Disability Activities of Daily Living Scale (ADL) disability (≥1 disability on Katz ADL scale) (%) 140 (24) 84 (39) 104 (35) Instrumental activities of daily living (IADL) disability (≥1 disability on Katz IADL scale) (%) 317 (54) 164 (77) 225 (77) Cognition Mini Mental State Examination (MMSE) ≤24* (%) 63 (11) 50 (23) 58 (20) Mobility Short Physical Performance Battery (SPPB) <9† (%) 163 (28) 113 (53) 138 (47) Poor hearing (%) 266 (45) 110 (52) 158 (54) Poor vision (%) 270 (46) 127 (60) 167 (57) Mental wellbeing Depression: Geriatric Depression Scale (GDS)-15 ≥6‡ (%) 46 (8) 35 (17) 44 (15) Anxiety: Hospital Anxiety and Depression Scale-A ≥7‖ (%) 45 (7) 34 (16) 41 (14) Social context Loneliness Sometimes (%) 141 (24) 72 (34) 90 (31) Often (%) 19 (3) 11 (5) 12 (4) Nobody to help in case of an emergency (%) 49 (8) 24 (11) 31 (11) Self-perceived health Excellent (%) 29 (5) 2 (1) 7 (2) Very good (%) 56 (10) 2 (1) 8 (3) Good (%) 295 (50) 90 (42) 117 (40) Reasonable (%) 187 (32) 101 (47) 142 (48) Poor (%) 20 (3) 18 (8) 20 (7) Quality of life (range, 0–10) (mean ± SD) 7.5 ± 1.0 7.2 ± 1.0 7.2 ± 1.0 Care use Days of hospitalization in the past year (mean ± SD) 1.4 ± 5.2 2.4 ± 6.6 2.2 ± 6.6 Hours/week home care (mean ± SD) 1.0 ± 2.1 1.9 ± 2.9 1.6 ± 2.6 Number of professional caregivers 1–3 (%) 329 (56) 145 (68) 178 (61) ≥4 (%) 47 (8) 31 (15) 39 (13) Informal care (%) 89 (15) 64 (30) 69 (24) Frailty Index ¶ (mean ± SD) 0.25 ± 0.11 0.34 ± 0.11 0.32 ± 0.10 Number of domains with fair or poor rating according to family physicians (mean ± SD) 2.0 ± 2.3 3.6 ± 1.9 3.3 ± 2.4 Number of domains with fair or poor rating according to geriatrician (mean ± SD) 3.1 ± 2.6 4.4 ± 1.7 5.0 ± 2.2 ↵* MMSE score of ≤24 is indicative of cognitive problems (range, 0–30).
↵† SPPB score of <9 is indicative of a high risk for loss of mobility (range, 0–12).
↵‡ GDS-15 score of ≥6 is indicative of depression (range, 0–15).
↵‖ HADS-A score of ≥7 is indicative of anxiety symptoms (range, 0–21).
↵¶ Frailty Index27 where higher scores are indicative of being frailer (range, 0–1).
SD, standard deviation.
- Table 3. Judgments on Eight Frailty Domains, Comprehensive Geriatric Assessment by Family Physicians (FP-CGA; in the columns) Compared with Comprehensive Geriatric Assessment by Geriatricians (G-CGA; in the rows) (n = 587)
Frailty Domain FP-GCA C-GCA % Agreement (κ) Good Fair Poor Total Physical 62 Good 264 177 4 445 (0.36) Fair 13 86 28 127 Poor 0 4 11 15 Total 277 267 43 587 Medication 55 Good 252 227 25 504 (0.17) Fair 7 63 8 78 Poor 0 2 2 4 Total 259 292 35 586* Cognition 83 Good 437 44 1 482 (0.53) Fair 32 42 19 93 Poor 0 6 6 12 Total 469 92 26 587 Sensory 62 Good 260 139 0 399 (0.29) Fair 60 100 11 171 Poor 2 10 5 17 Total 322 249 16 587 (Instrumental) activities of daily living 84 Good 446 30 3 479 (0.49) Fair 46 44 13 103 Poor 0 3 2 5 Total 492 77 18 587 Mobility 78 Good 357 65 1 423 (0.58) Fair 34 88 13 135 Poor 0 14 15 29 Total 391 167 29 587 Mental 75 Good 346 88 2 436 (0.47) Fair 37 87 11 135 Poor 2 6 8 16 Total 385 181 21 587 Social 82 Good 434 39 0 473 (0.42) Fair 56 45 7 108 Poor 1 4 1 6 Total 491 88 8 587 ↵* One missing.
- Table 4. Odd Ratios (OR) for the Association of Frailty Domain Scores (Good versus Fair/Poor) and Number of Frailty Domains Rated as Fair/Poor with Judgment of the Absence or Presence of Frailty According to Family Physicians (FP) and Geriatrician
Predictor FP Geriatrician P Value for Interaction OR [95%-CI] for judging person as frail OR [95%-CI] for judging person as frail Domain reported as fair or poor functioning versus reported as good* Physical 10.4 [4.4–24.4] 11.5 [4.9–26.8] .86 Medication 2.5 [1.13–5.6] 2.4 [1.19–4.8] .93 Cognition 9.3 [3.9–22.0] 79.3 [18.4–341.2] .005 Sensory 2.0 [1.1–3.6] 7.6 [3.5–16.5] .007 (Instrumental) activities of daily living 5.9 [2.0–16.8] Not estimable .98 Mobility 3.0 [1.5–6.0] 25.0 [8.9–70.3] <.001 Mental 2.2 [1.1–4.4] 18.0 [7.1–45.9] <.001 Social 4.1 [1.9–8.7] 3.1 [1.0–9.3] .67 Increase in number of health domains reported as fair or poor; +1† 3.8 [2.9–5.0] 7.7 [5.1–11.5] <.001 ↵* Results (OR [95% CI]) taken from a logistic mixed-model regressing profession of evaluator (FP versus geriatrician), all frailty domain scores (fair/poor versus good) simultaneously, and terms for the interaction between domain scores and profession with a random intercept to allow the dependence at participant level.
↵† Results (OR [95% CI]) taken from a logistic mixed-model regressing profession of evaluator (FP versus geriatrician), the number of frailty domains (0–8) rated as fair/poor and terms for the interaction between the number of impaired domains and profession with a random intercept to allow the dependence at participant level.
In this issue
Diagnosis of Frailty after a Comprehensive Geriatric Assessment: Differences between Family Physicians and Geriatricians
