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Research Paper:
Vidya Perera, Beata V. Bajorek, Slade Matthews, and Sarah N. Hilmer
The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation
Age Ageing 2009; 0: afn293v1-293 [Abstract] [Full text] [PDF]
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[Read eLetter] Assigning "frailty"
Stephen C W Chalcroft   (26 October 2009)

Assigning "frailty" 26 October 2009
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Stephen C W Chalcroft,
Geriatrician
Otago District Health Board, 210 Great king Street, Dunedin 9016

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Re: Assigning "frailty"

Dear Sir I read the paper by Perera et al and the accompanying editorial with interest as there is a need for geriatricians to recognise the treatments and outcomes for frail adults.

I have, however great difficulty in determining what cut score for the Edmonton Frail Scale (EFS) was used. It is not described in the article's methods section.

There are two relevant references. Wolfson et al have measured the correlation of the EFS against a Geriatrician's Clinical Impression of Frailty (GCIF) questionnaire. Whilst they demonstrate a modest relationship (Pearson's r = 0.64) they do not identify a cut point in the EFS above, or below which a classification of "frailty" can reasonably be ruled in or out. Dasgupta et al have found that EFS score ranges (3 and below, or above 7) have a reasonable relationship to the ability to predict which, of an elderly cohort would not, or would have post- operative surgical complications. But, this is scarcely a reference against a "gold-standard" for identifying frailty and again, the statistical power of the association is poor with Receiver Operator Curve "Area under curve" data of 0.69 for all complications and 0.65 for cardiac complications.

So, while there is an association for the EFS with other measures of frailty I cannot apply these data to any other population of elderly because the key defining criterion is not given.

Yours faithfully

Stephen Chalcroft

References

1)Vidya Perera, Beata V. Bajorek, Slade Matthews, Sarah N. Hilmer.The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation. Age and Ageing 2009; 38: 162–167

2) Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing 2006; 35: 526–9.

3)Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr 2009; 48: 78–83.

Conflict of Interest:

None declared