Physical Function and Frailty for Predicting Adverse Outcomes in Older Primary Care Patients.
Sachi O'Hoski, Jonathan F Bean, Jinhui Ma and 5 others
PMID 31891711WHAT IT FOUND
Physical function tests predicted hospitalizations and self-rated health as well as frailty measures in older adults.
The patient-reported LLFDI was the only predictor of falls over two years, while the SPPB predicted emergency visits. Screening choice may depend on whether performance or patient-reported data is preferred.
Key findings
01All three measures (SPPB, LLFDI-function, frailty phenotype) significantly predicted hospitalizations and low self-rated health over 2 years.
02The patient-reported LLFDI-function score was the only measure that significantly predicted falls over 2 years.
03The performance-based SPPB score was the only measure that significantly predicted emergency department visits over 2 years.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The frailty phenotype was modified from the original Fried criteria due to available data (e.g., using BMI instead of weight loss history, and leg press instead of grip strength), which may affect generalizability. Participants were primarily English-speaking patients from a single health system in the Northeastern United States, limiting applicability to diverse populations. Adverse outcomes were tracked via phone calls, which may have resulted in underreporting if patients missed calls (false negatives). The study was a secondary analysis of a cohort not originally designed to compare these specific predictive tools. 34 participants had missing frailty data, though multiple imputation results were consistent with the main analysis.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institutes of Health.
The easy way to misread this
Do not interpret the LLFDI's prediction of falls as proof that patient-reported function causes falls. The study shows association, not causation, and the predictive accuracy (AUC) for most outcomes was modest, meaning these tests should not be used in isolation to rule out risk.