Age and Ageing Advance Access originally published online on May 31, 2008
Age and Ageing 2008 37(4):484-485; doi:10.1093/ageing/afn115
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Reply
SIR—We thank Dr De Lepeleire for his reflections on our paper [1], and we agree that general practitioners, due to limited consultation time, small office staff and cost constraints, may find it difficult to systematically administer test batteries. However, structured problem detection by means of multidimensional assessment instruments—the so-called Geriatric Comprehensive Assessment—although peculiar to the geriatrician's expertise, is actually crucial for an efficient evaluation and management of elderly patients at any level of medical care.Dr De Lepeleire states that assessment of nutritional and functional status and administration of Mini-Mental State Examination (MMSE) and geriatric depression scale (GDS) may be difficult to integrate into routine encounters in primary care. The observation, however, is not relevant to our score, as neither MMSE nor GDS were included among the final predictors, and assessment of nutrition was limited to calf measurement. With respect to the functional domain, our score measures it with four items from the instrumental activities of daily living (IADL) and the Tinetti's gait and balance test. IADLs are also included in one of the short frailty instruments proposed by Dr De Lepeleire himself [2] while the Tinetti test (the only structured assessment included in our score) just requires an armless chair and observation of how the subject sits and walks.
As underlined in the paper, and further discussed in the accompanying editorial [3], our score is still in its infancy and its real usefulness in any specific clinical setting is still to be investigated. However, we hope that our work will promote further research about frailty screening tests with a multidimensional ‘pragmatic’ approach, and the identification for any specific setting of the simplest parameters which best meets the needs of both patients and physicians.
1 Department of Internal Medicine, Cardioangiology and Hepatology, University of Bologna, Italy
2 Department of Medicine, McMaster University, Canada
* To whom correspondence should be addressed Email: ravaglia{at}med.unibo.it
References
- Ravaglia G, Forti P, Lucicesare A, et al. Development of an easy prognostic score for frailty outcomes in the aged. Age Ageing (2008) 37:161–6.
[Abstract/Free Full Text] - De Lepeleire J, Ylieff M, Stessens J, et al. The validity of the Frail instrument in general Practice. Arch Public Helath (2004) 62:185–96.
- Martin FC, Brighton P. Frailty: different tools for different purposes? Age Ageing (2008) 37:129–31.
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