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Table 2 First Pilot: Selecting frail patients

From: 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]

Background: Measuring frailty is subject to debate and various operational definitions were proposed [15]. For our purpose we sought a valid easy administrable self-report instrument.
Objective: To determine the feasibility of multidimensional frailty screening instruments that could be sent by mail.
Methods: After a literature search three multidimensional screening instruments were selected and tested in one general practice among all 75+ patients: 1) VES-13, 2) Strawbridge's frailty screen, and 3) COOP-WONCA charts. Feasibility was expressed in percentage complete item response [20–22]. Our goal was to identify the worst quarter. This point of departure was based on studies by Fried and Rockwood who reported between 20–30% of 75+ people to be frail according to their measures [14,17].
Results: Of 116 patients 85 (81%) agreed to participate and 69 actually returned the questionnaire. The complete item response on the COOP-WONCA, Strawbridge screen, and VES-13 were 87%, 60% and 56% respectively. In order to identify a quarter of persons with the worst health on the COOP-WONCA, all persons were selected who scored in the worst quartile of at least two of the six charts (overall health ≥4; physical fitness ≥5; changes in health ≥4; daily activities ≥4; Feelings ≥3; social activities ≥3). This resulted in 23 persons who were further assessed at home by the RAI-HC. 90% had at least one chronic disease, two thirds had at least one ADL limitation, 60% had depressive symptoms (CESD>16) and 30% had cognitive impairment (MMSE<24) [37].
Conclusion: The COOP-WONCA was the most feasible screener. Our selection rule identified a frail group. The geriatric assessment identified new potentially treatable problems.
  1. COOP-WONCA = COOP functional health assessment charts – World Organization of Family Doctors
  2. VES-13 = Vulnerable Elders Survey-13
  3. RAI-HC = Resident Assessment Instrument – Home Care version
  4. MMSE = Mini Mental Screen Examination