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Research ArticleOriginal Research

Diagnosis of Frailty after a Comprehensive Geriatric Assessment: Differences between Family Physicians and Geriatricians

Janneke A. L. van Kempen, René J. F. Melis, M. Perry, Henk J. Schers and Marcel G. M. Olde Rikkert
The Journal of the American Board of Family Medicine March 2015, 28 (2) 240-248; DOI: https://doi.org/10.3122/jabfm.2015.02.130081
Janneke A. L. van Kempen
From the Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (JALK, RJFM, MP, GMOR); Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (HJS).
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René J. F. Melis
From the Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (JALK, RJFM, MP, GMOR); Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (HJS).
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M. Perry
From the Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (JALK, RJFM, MP, GMOR); Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (HJS).
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Henk J. Schers
From the Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (JALK, RJFM, MP, GMOR); Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (HJS).
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Marcel G. M. Olde Rikkert
From the Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (JALK, RJFM, MP, GMOR); Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (HJS).
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    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-CGAG-CGA
    FrailNot FrailTotal
    Frail18330213
    31%5%36%
    Not frail111263374
    19%45%64%
    Total294293587
    50%50%100%
    • View popup
    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)
    CharacteristicTotal (n = 587)Frail FP-CGA (n = 213)Frail G-CGA (n = 294)
    Age (years) (mean ± SD)77 ± 579 ± 577 ± 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 ± 1.07.2 ± 1.07.2 ± 1.0
    Care use
        Days of hospitalization in the past year (mean ± SD)1.4 ± 5.22.4 ± 6.62.2 ± 6.6
        Hours/week home care (mean ± SD)1.0 ± 2.11.9 ± 2.91.6 ± 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 ± 0.110.34 ± 0.110.32 ± 0.10
    Number of domains with fair or poor rating according to family physicians (mean ± SD)2.0 ± 2.33.6 ± 1.93.3 ± 2.4
    Number of domains with fair or poor rating according to geriatrician (mean ± SD)3.1 ± 2.64.4 ± 1.75.0 ± 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.

    • View popup
    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 DomainFP-GCAC-GCA% Agreement (κ)
    GoodFairPoorTotal
    Physical62
    Good2641774445(0.36)
    Fair138628127
    Poor041115
    Total27726743587
    Medication55
    Good25222725504(0.17)
    Fair763878
    Poor0224
    Total25929235586*
    Cognition83
    Good437441482(0.53)
    Fair32421993
    Poor06612
    Total4699226587
    Sensory62
    Good2601390399(0.29)
    Fair6010011171
    Poor210517
    Total32224916587
    (Instrumental) activities of daily living84
    Good446303479(0.49)
    Fair464413103
    Poor0325
    Total4927718587
    Mobility78
    Good357651423(0.58)
    Fair348813135
    Poor0141529
    Total39116729587
    Mental75
    Good346882436(0.47)
    Fair378711135
    Poor26816
    Total38518121587
    Social82
    Good434390473(0.42)
    Fair56457108
    Poor1416
    Total491888587
    • ↵* One missing.

    • View popup
    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
    PredictorFPGeriatricianP Value for Interaction
    OR [95%-CI] for judging person as frailOR [95%-CI] for judging person as frail
    Domain reported as fair or poor functioning versus reported as good*
        Physical10.4 [4.4–24.4]11.5 [4.9–26.8].86
        Medication2.5 [1.13–5.6]2.4 [1.19–4.8].93
        Cognition9.3 [3.9–22.0]79.3 [18.4–341.2].005
        Sensory2.0 [1.1–3.6]7.6 [3.5–16.5].007
        (Instrumental) activities of daily living5.9 [2.0–16.8]Not estimable.98
        Mobility3.0 [1.5–6.0]25.0 [8.9–70.3]<.001
        Mental2.2 [1.1–4.4]18.0 [7.1–45.9]<.001
        Social4.1 [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.

  • Online Appendix Table 1.
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The Journal of the American Board of Family     Medicine: 28 (2)
The Journal of the American Board of Family Medicine
Vol. 28, Issue 2
March-April 2015
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Diagnosis of Frailty after a Comprehensive Geriatric Assessment: Differences between Family Physicians and Geriatricians
Janneke A. L. van Kempen, René J. F. Melis, M. Perry, Henk J. Schers, Marcel G. M. Olde Rikkert
The Journal of the American Board of Family Medicine Mar 2015, 28 (2) 240-248; DOI: 10.3122/jabfm.2015.02.130081

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Diagnosis of Frailty after a Comprehensive Geriatric Assessment: Differences between Family Physicians and Geriatricians
Janneke A. L. van Kempen, René J. F. Melis, M. Perry, Henk J. Schers, Marcel G. M. Olde Rikkert
The Journal of the American Board of Family Medicine Mar 2015, 28 (2) 240-248; DOI: 10.3122/jabfm.2015.02.130081
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