S.J.LEE1, Y.R.LIM1, A.YEO2, L.ONG2, J.CHEW2, M.CHAN2, W.S.LIM2, O.BEAUCHET3
MOH Holdings Pte Ltd (MOHH)1, Tan Tock Seng Hospital2, Jewish General Hospital3
Subjective health measures are often used as frailty criteria, but the validity of self-administered online tools to identify frailty remains to be established. We aim to assess convergent, concurrent and predictive validity of the Centre of Excellence on Longevity Self-AdMinistered (CESAM) questionnaire for frailty identification in a geriatric clinic in Singapore.
We conducted cross-sectional analysis of 95 participants (mean age=80.4±6.2years) recruited consecutively from a tertiary geriatric clinic. Participants [61(64.2%)caregiver-assisted)] completed the CESAM questionnaire online, comprising 27 self-report items that encompass cognition, falls, mood and functional domains. Convergent validity was assessed using Spearman correlation with modified Barthel Index (MBI), modified version of the Chinese Mini-Mental State Examination (mCMMSE) and Geriatric Depression Scale (GDS). Concurrent validity was assessed by Area Under the Receiver Operating Characteristic curve (AUROC) against frailty [Frailty Index (FI)>/=0.25 from clinical interview and medical records]. Predictive validity for physician-diagnosed geriatric syndromes (cognitive impairment, unsteady gait with falls) and impaired proxy-rated quality-of-life [EuroQOL(EQ)-5D utility scores] were assessed using regression analyses adjusted for age and gender.
CESAM score significantly correlated with MBI (r=-0.65,P<0.001), mCMMSE (r=-0.53,P<0.001) and GDS (r=0.61,P<0.001). AUROC for CESAM was excellent for frailty [0.88(95%CI:0.81-0.95)]. Optimal CESAM cutoff of ≥ 8 for frailty (sensitivity75%;specificity82%) predicted physician-diagnosed cognitive impairment (OR3.5,95%CI:1.1-11.0), unsteady gait with falls (OR 5.3,95%CI 1.3-21.4) and lower EQ-5D (B=-0.07,95%CI:-0.09- -0.04).
We provide preliminary evidence for the validity of an online self-administered tool to identify frailty in an outpatient setting. The tool is potentially applicable to geriatricians conducting CGA remotely especially during the COVID-19 pandemic.