Value of the Safety Management System (VMS) frailty instrument as a frailty screener in care for older hospital patients: a systematic review

Abstract

Abstract Background Dutch hospitals are required to screen older patients for the risk of developing functional decline using the Safety Management System (VMS) which assesses four domains associated with functional decline; fall risk, risk of delirium, malnutrition, and physical impairment. Purpose The aim is twofold, first to compare the VMS frailty instrument as a frailty screener with existing frailty instruments and second to provide an overview of the available evidence. Methods We performed a literature search to identify studies that used the VMS instrument as frailty screener to asses frailty or to predict adverse health outcomes in older hospitalized patients. Pubmed, Cinahl, and Embase were searched from January 1st 2008 to December 11th 2023. Results Our search yielded 603 articles, of which 17 studies with heterogenous populations and settings were included. Using the VMS, frailty was scored in six different ways. The agreement between VMS and other frailty instruments ranged from 57 to 87%. The highest sensitivity and specificity of VMS for frailty were 90% and 67%, respectively. The association of the VMS with outcomes was studied in 14 studies, VMS was predictive for complications, delirium, falls, length of stay, and adverse events. Conflicting results were found for hospital (re)admission, complications, change in living situation, functional decline, and mortality. Conclusion The VMS frailty instrument were studied as a frailty screening instrument in various populations and settings. The value of the VMS instrument as a frailty screener looks promising. Our results suggest that the scoring method of the VMS could be adapted to specific requirements of settings or populations.