Abstract
Background
Intrinsic capacity (IC) co-exists with frailty and multimorbidity in primary care. To improve health outcomes, guidelines recommend IC and frailty screening and it is thought that IC screening can support the concurrent and subsequent evaluation of frailty. For feasible implementation of such screening, it is important to understand the association between IC and frailty, including the discriminative ability of IC against frailty in a primary care population with multimorbidity.
Method
A cross-sectional study was conducted across three primary care clinics. Participants were elderly and had the multimorbidity triad of diabetes mellitus, hypertension, and hyperlipidemia. Data collected included sociodemographic variables, IC (Integrated Care Older People Screening Tool), social vulnerability, chronic conditions, functional disability, modified Frailty Phenotype (mFP), and Clinical Frailty Scale (CFS). Logistic regression was used to assess the association between IC and the two measurements of frailty while area under the curve of the receiver operating characteristic (AUC-ROC) was used to assess the discriminative ability of IC against frailty.
Results
411 participants were included. Mean age was 69.9 (± 6.2) years and almost all (98.0%) the participants had reduced IC on screening, of which the most affected domains were the sensory (90.0%), locomotion (44.0%), and cognition (30.9%) domains. 12.4% were mFP frail while 7.4% were CFS frail. While higher IC was associated with reduced odds of frailty regardless of the frailty measure (p ≤ 0.001), the IC domains associated with frailty depended on the frailty measure used. Vitality and locomotion were associated with being mFP frail while the sensory and locomotion domains were associated with being CFS frail. An IC cut-off score of 3 was able to discriminate moderately against the mFP and CFS (AUC 0.72 and 0.74, respectively), but with a high false-positive rate 85.4% and 81.9%, respectively.
Conclusions
In a primary care population with multimorbidity, IC screening discriminates moderately against frailty. In view of the very high prevalence of IC losses, the high false-positive rate of frailty in this population and limited healthcare resources, IC screening followed by frailty screening of selected patients with IC losses may not be feasible and other approaches should be considered.