title: Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments.
abstract: The medical syndrome of frailty is widely recognized, yet debate remains over how best to measure it in clinical and research settings. This study reviewed the frailty-related research literature by (a) comprehensively cataloging the wide array of instruments that have been utilized to measure frailty, and (b) systematically categorizing the different purposes and contexts of use for frailty instruments frequently cited in the research literature. We identified 67 frailty instruments total; of these, nine were highly-cited (≥ 200 citations). We randomly sampled and reviewed 545 English-language articles citing at least one highly-cited instrument. We estimated the total number of uses, and classified use into eight categories: risk assessment for adverse health outcomes (31% of all uses); etiological studies of frailty (22%); methodology studies (14%); biomarker studies (12%); inclusion/exclusion criteria (10%); estimating prevalence as primary goal (5%); clinical decision-making (2%); and interventional targeting (2%). The most common assessment context was observational studies of older community-dwelling adults. Physical Frailty Phenotype was the most used frailty instrument in the research literature, followed by the Deficit Accumulation Index and the Vulnerable Elders Survey. This study provides an empirical evaluation of the current uses of frailty instruments, which may be important to consider when selecting instruments for clinical or research purposes. We recommend careful consideration in the selection of a frailty instrument based on the intended purpose, domains captured, and how the instrument has been used in the past. Continued efforts are needed to study the validity and feasibility of these instruments.
authors.affiliation: Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States; School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Buta
authors.affiliation: Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States; School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Walston
authors.affiliation: Center for Wireless and Population Health Systems, University of CA, San Diego, United States; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Job G
authors.initials: JG
authors.lastname: Godino
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Minsun
authors.initials: M
authors.lastname: Park
authors.affiliation: Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States; School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Rita R
authors.initials: RR
authors.lastname: Kalyani
authors.affiliation: Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States; School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Qian-Li
authors.initials: QL
authors.lastname: Xue
authors.affiliation: Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Karen
authors.initials: K
authors.lastname: Bandeen-Roche
authors.affiliation: Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States; School of Medicine, Johns Hopkins University, Baltimore, MD, United States; Department of Oncology, Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States. Electronic address: ravi.varadhan@jhu.edu.
authors.forename: Ravi
authors.initials: R
authors.lastname: Varadhan
mesh_terms: D000369:Aged, 80 and over; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D015995:Prevalence; D062486:Public Health Surveillance / Q000379:methods; D018570:Risk Assessment / Q000379:methods
keywords: Frailty assessment; Instrument; Operational definition; Review