The prevalence of frailty amongst acute stroke patients, and evaluation of method of assessment

Taylor-Rowan, M. , Cuthbertson, G., Keir, R., Shaw, R., Drozdowska, B. , Elliott, E., Stott, D. and Quinn, T. J. (2019) The prevalence of frailty amongst acute stroke patients, and evaluation of method of assessment. Clinical Rehabilitation, 33(10), pp. 1688-1696. (doi: 10.1177/0269215519841417) (PMID:30971115)

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Objective: We aimed to determine prevalence of pre-stroke frailty in acute stroke and describe validity of a Frailty Index–based assessment. Design: Cross-sectional. Setting: Single UK urban teaching hospital. Subjects: Consecutive acute stroke unit admissions, recruited in four waves (May 2016–August 2018). We performed the assessments within first week and attempted to include all admissions. Main measures: Our primary measure was a Frailty Index, based on cumulative disorders. A proportion of participants were also assessed with the ‘Frail non-disabled’ questionnaire. We evaluated concurrent validity of Frailty Index against variables associated with frailty in non-stroke populations. We described predictive validity of Frailty Index for stroke severity and delirium. We described convergent validity, quantifying agreement between frailty assessments and a measure of pre-stroke disability (modified Rankin Scale) using kappa statistics and correlations. Results: We included 546 patients. A Frailty Index–defined frailty syndrome was observed in 427 of 545 patients (78%), of whom, 151 (28%) had frank frailty and 276 (51%) were pre-frail. Phenotypic frailty was observed in 72 of 258 patients (28%). We demonstrated concurrent validity via significant associations with all variables (all p < 0.01). We demonstrated predictive validity for stroke severity and delirium (p < 0.01). Agreement between the frailty measures was poor (kappa = –0.06) and convergent validity was moderate (Frail non-disabled ‘Cramer’s V’ = 0.25; modified Rankin Scale ‘Cramer’s V’ = 0.47). Conclusion: Frailty is present in around one in four patients with acute stroke; if pre-frailty is included, then a frailty syndrome is seen in three out of four patients. The Frailty Index is a valid measure of frailty in stroke; however, there is little agreement between this scale and other measurements of frailty.

Item Type:Articles
Additional Information:MT is part funded by Chest Heart and Stroke Scotland; this work is part of the APPLE program of work funded by the Stroke Association and Chief Scientist Office Scotland. TQ is supported by a Stroke Association, Chief Scientist Office Senior Lectureship.
Glasgow Author(s) Enlighten ID:Taylor-Rowan, Mr Martin and Elliott, Emma and Stott J, Professor David and Drozdowska, Bogna and Shaw, Mr Robert and Quinn, Dr Terry
Authors: Taylor-Rowan, M., Cuthbertson, G., Keir, R., Shaw, R., Drozdowska, B., Elliott, E., Stott, D., and Quinn, T. J.
College/School:College of Medical Veterinary and Life Sciences
College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Clinical Rehabilitation
ISSN (Online):1477-0873
Published Online:10 April 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Clinical Rehabilitation 33(10):1688-1696
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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