title: Identifying frailty: do the Frailty Index and Groningen Frailty Indicator cover different clinical perspectives? a cross-sectional study.
abstract: BACKGROUND
  Early identification of frailty is important for proactive primary care. Currently, however, there is no consensus on which measure to use. Therefore, we examined whether a Frailty Index (FI), based on ICPC-coded primary care data, and the Groningen Frailty Indicator (GFI) questionnaire identify the same older people as frail.
  
  
  METHODS
  We conducted a cross-sectional, observational study of 1,580 patients aged ≥ 60 years in a Dutch primary care center. Patients received a GFI questionnaire and were surveyed on their baseline characteristics. Frailty-screening software calculated their FI score. The GFI and FI scores were compared as continuous and dichotomised measures.
  
  
  RESULTS
  FI data were available for 1549 patients (98%). 663 patients (42%) returned their GFI questionnaire. Complete GFI and FI scores were available for 638 patients (40.4%), mean age 73.4 years, 52.8% female. There was a positive correlation between the GFI and the FI (Pearson's correlation coefficient 0.544). Using dichotomised scores, 84.3% of patients with a low FI score also had a low GFI score. In patients with a high FI score, 55.1% also had a high GFI score. A continuous FI score accurately predicted a dichotomised GFI score (AUC 0.78, 95% CI 0.74 to 0.82). Being widowed or divorced was an independent predictor of both a high GFI score in patients with a low FI score, and a high FI score in patients with a low GFI score.
  
  
  CONCLUSIONS
  The FI and the GFI moderately overlap in identifying frailty in community-dwelling older patients. To provide optimal proactive primary care, we suggest an initial FI screening in routine healthcare data, followed by a GFI questionnaire for patients with a high FI score or otherwise at high risk as the preferred two-step frailty screening process in primary care.
authors.affiliation: Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht 3584 CG, The Netherlands. i.drubbel@umcutrecht.nl
authors.forename: Irene
authors.initials: I
authors.lastname: Drubbel
authors.forename: Nienke
authors.initials: N
authors.lastname: Bleijenberg
authors.forename: Guido
authors.initials: G
authors.lastname: Kranenburg
authors.forename: René J C
authors.initials: RJ
authors.lastname: Eijkemans
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Schuurmans
authors.forename: Niek J
authors.initials: NJ
authors.lastname: de Wit
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D005260:Female; D016330:Frail Elderly / Q000523:psychology; D015577:Geriatric Assessment / Q000379:methods*; D006299:Health Services for the Aged / Q000458:organization & administration; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care; D012111:Residence Characteristics; D011795:Surveys and Questionnaires