Establishing Clinically Operational Domains of Multidimensional Frailty: A Consensus Approach to Improve Multidimensional Frailty Diagnosis at Point of Care

Abstract

Background and Objectives: Frailty is common among older patients; however, there is a lack of agreement on methods to diagnose and monitor frailty at point of care. The purpose of this study was to establish consensus on important, feasible, and usable domains for point-of-care frailty assessment within all conceptual models of frailty. Research Design and Methods: We reviewed instruments that assess frailty and extracted the domains measured by each tool. We developed 3 use cases for frailty assessment, which provided context for voters: (1) longitudinal tracking of frailty in the aging patient (>50 years), (2) preoperative evaluation of frailty before surgery in adults (>50 years), and (3) discharge disposition after hospital admission in adults (>50 years). We conducted a modified RAND Corporation/University of California Los Angeles Delphi with a panel of 11 experts. Panelists rated each domain for each use case on a scale from 1 to 9, where 1 is definitely not important/feasible/usable and 9 is definitely important/feasible/usable. Results: Panelists achieved agreement on the following domains for the respective clinical use cases: Physical Strength 1, 2, and 3; Balance 1 and 3; Cognition 1, 2, and 3; Nutrition 1; Physical Activity 1, 2, and 3; Depression 1; Disease 1, 2, and 3; and Social Environment 1 and 3. The remaining items were indeterminate. Discussion and Implications: We established consensus on 8 domains of frailty across 3 use cases. These results can inform the measurement of domains to diagnose, monitor, and inform the management of frailty within the defined use cases.