99. Use of recommended assessments of physical frailty and sarcopenia in hospitalised older people: is it feasible?

Ibrahim, Kinda, Howson, Fiona FA, Culliford, David, Aihie Sayer, Avan and Roberts, Helen (2019) 99. Use of recommended assessments of physical frailty and sarcopenia in hospitalised older people: is it feasible? British Geriatrics Society Communications to the Autumn Meeting, , London, United Kingdom. 14 - 16 Nov 2018. i27-i30 . (doi:10.1093/ageing/afy202.07).

Abstract

Background: frailty and sarcopenia are common among hospitalised older people and associated with poor healthcare outcomes. Recommended gold standard tools for their identification are the Fried Frailty Phenotype and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. We studied the feasibility of using these tools on acute wards for older people.

Methods: patients aged 70+ years admitted to acute wards at one UK hospital were prospectively recruited. The Fried Frailty Phenotype (unintentional weight loss; exhaustion; physical activity, gait speed and grip strength) and the 5-item self-reported FRAIL scale questionnaire covering the same domains were measured. Agreement between the two tools was reported using the Cohen kappa statistic. The EWGSOP criteria (gait speed, grip strength and muscle mass) were measured: grip strength using a dynamometer, gait speed timed over 4 metres, and muscle mass with a bedside bioelectrical-impedance machine.

Results: 233 participants (median age 80 years, 60% men) were recruited. Most (221, 95%) had their grip strength measured: 4 (2%) were unable and 8 (3%) had missing data. Only 70 (30%) completed the gait speed assessment: 153 (66%) were unable to walk with missing data on 10 (4%). Only 113 (50%) participants had the bioelectrical impedance assessment. The test was not feasible among 84 (38%): 25 patients declined, 21 were unavailable, 16 had clinical contra-indications, 22 results were technically invalid. Data on 26 (12%) were missing.

230 (99%) patients completed the FRAIL scale and frailty was identified among 77 (34%). Considering inability to complete grip strength or gait speed assessments as low values, data for the Fried Frailty Phenotype was available for 218 (89%) of participants and frailty was identified in 105 (48%). There was a moderate agreement between the two frailty tools (Kappa value of 0.46, 95%CI: 0.34 to 0.58). Complete data for the EWGOSP criteria were only available for 123 (53%) patients among whom 40 (33%) had sarcopenia.

Conclusion: it was feasible to measure grip strength and the FRAIL scale among older inpatients in hospital. Measuring gait speed and muscle mass using bio-impedance to identify sarcopenia was challenging in the acute setting.

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Contributors

Author: Kinda Ibrahim

Author: Helen Roberts

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