title: Development and validation of the FRAGIRE tool for assessment an older person's risk for frailty.
abstract: Frailty is highly prevalent in elderly people. While significant progress has been made to understand its pathogenesis process, few validated questionnaire exist to assess the multidimensional concept of frailty and to detect people frail or at risk to become frail. The objectives of this study were to construct and validate a new frailty-screening instrument named Frailty Groupe Iso-Ressource Evaluation (FRAGIRE) that accurately predicts the risk for frailty in older adults.
  
  
  
  A prospective multicenter recruitment of the elderly patients was undertaken in France. The subjects were classified into financially-helped group (FH, with financial assistance) and non-financially helped group (NFH, without any financial assistance), considering FH subjects are more frail than the NFH group and thus representing an acceptable surrogate population for frailty. Psychometric properties of the FRAGIRE grid were assessed including discrimination between the FH and NFH groups. Items reduction was made according to statistical analyses and experts' point of view. The association between items response and tests with "help requested status" was assessed in univariate and multivariate unconditional logistic regression analyses and a prognostic score to become frail was finally proposed for each subject.
  
  
  
  Between May 2013 and July 2013, 385 subjects were included: 338 (88%) in the FH group and 47 (12%) in the NFH group. The initial FRAGIRE grid included 65 items. After conducting the item selection, the final grid of the FRAGIRE was reduced to 19 items. The final grid showed fair discrimination ability to predict frailty (area under the curve (AUC) = 0.85) and good calibration (Hosmer-Lemeshow P-value = 0.580), reflecting a good agreement between the prediction by the final model and actual observation. The Cronbach's alpha for the developed tool scored as high as 0.69 (95% Confidence Interval: 0.64 to 0.74). The final prognostic score was excellent, with an AUC of 0.756. Moreover, it facilitated significant separation of patients into individuals requesting for help from others (P-value < 0.0001), with sensitivity of 81%, specificity of 61%, positive predictive value of 93%, negative predictive value of 34%, and a global predictive value of 78%.
  
  
  
  The FRAGIRE seems to have considerable potential as a reliable and effective tool for identifying frail elderly individuals by a public health social worker without medical training.
authors.affiliation: Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France.
authors.forename: Dewi
authors.initials: D
authors.lastname: Vernerey
authors.affiliation: Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France.|National clinical research Platform for Quality of life in Oncology, Besançon, France.
authors.forename: Amelie
authors.initials: A
authors.lastname: Anota
authors.affiliation: Department of psychiatry, EA 481, University Hospital of Besançon, Besançon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Vandel
authors.affiliation: Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Paget-Bailly
authors.affiliation: Centre Georges Chevrier «Knowledge: norms and sensitivities», UMR CNRS 7366, University of Burgundy, Dijon, France.
authors.forename: Michele
authors.initials: M
authors.lastname: Dion
authors.affiliation: Interregional Gerontology Pole from Burgundy and Franche-Comté, Dijon, France.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Bailly
authors.affiliation: Interregional Gerontology Pole from Burgundy and Franche-Comté, Dijon, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Bonin
authors.affiliation: Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France.
authors.forename: Astrid
authors.initials: A
authors.lastname: Pozet
authors.affiliation: Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Foubert
authors.affiliation: GERCOR, Groupe Coopérateur Multidisciplinaire en Oncologie, Paris, France.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Benetkiewicz
authors.affiliation: Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.|Inserm/U1093 Cognition, Action and Sensorimotor Plasticity, University of Burgundy Franche-Comté, Dijon, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Manckoundia
authors.affiliation: Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France. franck.bonnetain@univ-fcomte.fr.|National clinical research Platform for Quality of life in Oncology, Besançon, France. franck.bonnetain@univ-fcomte.fr.
authors.forename: Franck
authors.initials: F
authors.lastname: Bonnetain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D005602:France; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Elderly; Evaluation tool; Frailty; Loss of autonomy