Diagnostic accuracy of the FRAIL scale plus functional measures for frailty screening: a cross-sectional study

We consider this article of great importance and want to clarify that the "Consensus document on frailty and falls prevention among the elderly" published by the Ministry of Health of Spain and referenced in the discussion, was updated in 2022 and is now also available in English (https://www.sanidad.gob.es/areas/promocionPrevencion/envejecimientoSalud...) [external link].
The update targets people aged 70 years and older, in the health care setting, especially in primary care.
As a first step, an initial assessment using the Barthel Index has been proposed in order to rule out the presence of established moderate–severe dependence, because people with this condition will benefit from other specific programmes.
This is followed by functional assessment with performance tests or the FRAIL scale and assessment of the risk of falls at the same time (the falls risk detection part is being updated). A positive result of the FRAIL scale or performance tests would indicate that the person has a high probability of being frail, in which case specific interventions are indicated within the framework of a Comprehensive Geriatric Assessment (CGA). As a result of this, an individualised intervention will be designed with the participation of the beneficiary, including at least an indication of multi-component physical exercise, nutritional recommendations and a review of medication.
This stepwise screening allows for better matching of care needs and resources. It was felt that it would elicit fewer referrals for CGA and would decrease the workload of primary care teams. The inclusion in its second step of the FRAIL scale is the result of the recommendation by ADVANTAGE JA (Rodriguez-Laso A, Caballero Mora MA, Garcia Sanchez I, et al. Updated state of the art report on the prevention and management of frailty. 2019; https://www.sanidad.gob.es/areas/promocionPrevencion/envejecimientoSalud... [external link] and the great benefits it provides, such as its short administration time (it can be completed in less than two minutes) and that it can be administered in person or by telephone.
This article confirms the appropriateness of including the cut-off point for the FRAIL scale at 1 or higher in the context of a three-step screening. We believe that this will have a positive impact on the care of older people in addressing frailty.