A brief frailty screening tool in Tanzania: external validation and refinement of the B-FIT screen
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ORIGINAL ARTICLE
A brief frailty screening tool in Tanzania: external validation and refinement of the B‑FIT screen Emma Grace Lewis1,2 · Louise A. Whitton3 · Harry Collin3 · Sarah Urasa4 · Kate Howorth1,2 · Richard W. Walker1,2 · Catherine Dotchin1 · Louise Mulligan5 · Bhavini Shah6 · Ali Mohamed4 · Debora Mdegella4 · Joyce Mkodo4 · Francis Zerd4 · William K. Gray1,7 Received: 21 October 2019 / Accepted: 30 October 2019 © Springer Nature Switzerland AG 2019
Abstract Background Identifying older people who are most vulnerable to adverse outcomes is important. This is particularly so in low-resource settings, such as those in sub-Saharan Africa (SSA), where access to social and healthcare services is often limited. Aim To validate and further refine a frailty screening tool for SSA. Methods Phase I screening of people aged 60 years and over was conducted using the Brief Frailty Instrument for Tanzania (B-FIT). In phase II, a stratified, frailty-weighed sample was assessed across a range of variables covering cognition, physical function (including continence, mobility, weakness and exhaustion) nutrition, mood, co-morbidity, sensory impairment, polypharmacy, social support and self-rated health. The frailty-weighted sample was also assessed for frailty according to the comprehensive geriatric assessment (CGA), which we used as our ‘gold standard’ diagnosis. Results Of 235 people in the frailty-weighted sample, 91 (38.7%) were frail according to CGA, the median age was 73 years and 136 (57.9%) were female. In multivariable modelling, physical disability (Barthel index), cognitive impairment (IDEA cognitive screen), calf circumference, poor distance vision and problems engaging in social activities were found to be associated with frailty. After developing a scoring system, based on regression coefficients, a modified B-FIT screen (B-FIT 2) had an area under the receiver operating characteristic curve of 0.925, a sensitivity of 86.2% and a specificity of 88.8%. Discussion The inclusion of items assessing nutrition, social support and sensory impairment improved the performance of the B-FIT. Conclusions The B-FIT 2 should be externally validated. Keywords Frailty · Screening · Tanzania · Sub-Saharan Africa · Low- and middle-income countries
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40520-019-01406-0) contains supplementary material, which is available to authorized users. * William K. Gray [email protected] 1
Frailty has been defined by Clegg et al. [1] as a state of vulnerability to poor resolution of homeostasis following stress, which increases the risk of adverse outcomes. It is a consequence of cumulative decline in the physiological 4
Kilimanjaro Christian Medical Centre, Moshi, Tanzania
5
South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch, WA, Australia
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
6
Institute of Health and Society, Newcas
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