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Frailty Screening Tools for Elderly Patients Incident to Dialysis.
Clin J Am Soc Nephrol. 2017 Sep 07; 12(9):1480-1488.CJ

Abstract

BACKGROUND AND OBJECTIVES

A geriatric assessment is an appropriate method for identifying frail elderly patients. In CKD, it may contribute to optimize personalized care. However, a geriatric assessment is time consuming. The purpose of our study was to compare easy to apply frailty screening tools with the geriatric assessment in patients eligible for dialysis.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

A total of 123 patients on incident dialysis ≥65 years old were included <3 weeks before to ≤2 weeks after dialysis initiation, and all underwent a geriatric assessment. Patients with impairment in two or more geriatric domains on the geriatric assessment were considered frail. The diagnostic abilities of six frailty screening tools were compared with the geriatric assessment: the Fried Frailty Index, the Groningen Frailty Indicator, Geriatric8, the Identification of Seniors at Risk, the Hospital Safety Program, and the clinical judgment of the nephrologist. Outcome measures were sensitivity, specificity, positive predictive value, and negative predictive value.

RESULTS

In total, 75% of patients were frail according to the geriatric assessment. Sensitivity of frailty screening tools ranged from 48% (Fried Frailty Index) to 88% (Geriatric8). The discriminating features of the clinical judgment were comparable with the other screening tools. The Identification of Seniors at Risk screening tool had the best discriminating abilities, with a sensitivity of 74%, a specificity of 80%, a positive predictive value of 91%, and a negative predictive value of 52%. The negative predictive value was poor for all tools, which means that almost one half of the patients screened as fit (nonfrail) had two or more geriatric impairments on the geriatric assessment.

CONCLUSIONS

All frailty screening tools are able to detect geriatric impairment in elderly patients eligible for dialysis. However, all applied screening tools, including the judgment of the nephrologist, lack the discriminating abilities to adequately rule out frailty compared with a geriatric assessment.

Authors+Show Affiliations

Dianet Dialysis Center, Utrecht, The Netherlands; i.vanloon@dianet.nl. Departments of Internal Medicine and. Departments of Nephrology and Hypertension and.Geriatrics and.Dianet Dialysis Center, Utrecht, The Netherlands. Departments of Internal Medicine and.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.Departments of Nephrology and Hypertension and.Geriatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands; and.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

28716855

Citation

van Loon, Ismay N., et al. "Frailty Screening Tools for Elderly Patients Incident to Dialysis." Clinical Journal of the American Society of Nephrology : CJASN, vol. 12, no. 9, 2017, pp. 1480-1488.
van Loon IN, Goto NA, Boereboom FTJ, et al. Frailty Screening Tools for Elderly Patients Incident to Dialysis. Clin J Am Soc Nephrol. 2017;12(9):1480-1488.
van Loon, I. N., Goto, N. A., Boereboom, F. T. J., Bots, M. L., Verhaar, M. C., & Hamaker, M. E. (2017). Frailty Screening Tools for Elderly Patients Incident to Dialysis. Clinical Journal of the American Society of Nephrology : CJASN, 12(9), 1480-1488. https://doi.org/10.2215/CJN.11801116
van Loon IN, et al. Frailty Screening Tools for Elderly Patients Incident to Dialysis. Clin J Am Soc Nephrol. 2017 Sep 7;12(9):1480-1488. PubMed PMID: 28716855.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty Screening Tools for Elderly Patients Incident to Dialysis. AU - van Loon,Ismay N, AU - Goto,Namiko A, AU - Boereboom,Franciscus T J, AU - Bots,Michiel L, AU - Verhaar,Marianne C, AU - Hamaker,Marije E, Y1 - 2017/07/17/ PY - 2016/11/16/received PY - 2017/05/30/accepted PY - 2017/7/19/pubmed PY - 2018/5/22/medline PY - 2017/7/19/entrez KW - Aged KW - Frail Elderly KW - Geriatric Assessment KW - Humans KW - Judgment KW - Nephrologists KW - Outcome Assessment (Health Care) KW - Renal Insufficiency, Chronic KW - Risk KW - Safety KW - Sensitivity KW - dialysis KW - elderly KW - frailty KW - geriatric assessment KW - renal dialysis KW - screening SP - 1480 EP - 1488 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 12 IS - 9 N2 - BACKGROUND AND OBJECTIVES: A geriatric assessment is an appropriate method for identifying frail elderly patients. In CKD, it may contribute to optimize personalized care. However, a geriatric assessment is time consuming. The purpose of our study was to compare easy to apply frailty screening tools with the geriatric assessment in patients eligible for dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 123 patients on incident dialysis ≥65 years old were included <3 weeks before to ≤2 weeks after dialysis initiation, and all underwent a geriatric assessment. Patients with impairment in two or more geriatric domains on the geriatric assessment were considered frail. The diagnostic abilities of six frailty screening tools were compared with the geriatric assessment: the Fried Frailty Index, the Groningen Frailty Indicator, Geriatric8, the Identification of Seniors at Risk, the Hospital Safety Program, and the clinical judgment of the nephrologist. Outcome measures were sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: In total, 75% of patients were frail according to the geriatric assessment. Sensitivity of frailty screening tools ranged from 48% (Fried Frailty Index) to 88% (Geriatric8). The discriminating features of the clinical judgment were comparable with the other screening tools. The Identification of Seniors at Risk screening tool had the best discriminating abilities, with a sensitivity of 74%, a specificity of 80%, a positive predictive value of 91%, and a negative predictive value of 52%. The negative predictive value was poor for all tools, which means that almost one half of the patients screened as fit (nonfrail) had two or more geriatric impairments on the geriatric assessment. CONCLUSIONS: All frailty screening tools are able to detect geriatric impairment in elderly patients eligible for dialysis. However, all applied screening tools, including the judgment of the nephrologist, lack the discriminating abilities to adequately rule out frailty compared with a geriatric assessment. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/28716855/Frailty_Screening_Tools_for_Elderly_Patients_Incident_to_Dialysis_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=28716855 DB - PRIME DP - Unbound Medicine ER -