Screening for intrinsic capacity and frailty in older adults with multimorbidity in the primary care setting: application of the ICOPE tool and two frailty instruments.

backgroundIntrinsic capacity (IC) co-exists with frailty and multimorbidity in primary care and guidelines recommend screening for IC and frailty to improve health outcomes. To inform effective implementation of such screening, this study aimed to understand the association between IC and frailty, and the discriminative ability of IC for frailty in older adults with multimorbidity.

methodA cross-sectional study was conducted across three primary care clinics from August to October 2022. The participants were multimorbid older adults who had the triad of diabetes mellitus, hypertension and hyperlipidemia and who could walk independently. Data collected included sociodemographic factors, Integrated Care Older People Screening Tool (ICOPE), social vulnerability, chronic conditions, functional impairment, modified Frailty Phenotype (mFP), and Clinical Frailty Scale (CFS). Multinomial logistic regression was used to assess the association between IC and frailty while area under the curve of the receiver operating characteristic (AUC-ROC), sensitivity, specificity, and false positive result were used to assess the discriminative ability of IC for frailty.

results411 participants were included in the study and the mean age was 69.9 (± 6.2) years. 11.9% of the participants were mFP frail while 7.5% were CFS frail, and almost all the participants (98.0%) had reduced IC. Higher composite IC score was associated with reduced odds of frailty (OR 0.39 (mFP) and OR 0.45 (CFS), p ≤ 0.05). The IC domains associated with frailty depended on the frailty measure used and socio-cultural factors. An IC cut-off score of 2 had AUC-ROC, sensitivities, specificities, and false positive results of 0.72, 59.2%, 77.9% and 22.1% respectively for mFP; and 0.74, 61.3%, 76.3% and 23.7% respectively for CFS.

conclusionsIn a primary care population with multimorbidity, IC screening inadequately discriminates for frailty and functional impairment with insufficient sensitivity and high false positive results. In view of the very high prevalence of IC losses, IC screening followed by frailty screening of selected patients with IC losses may not be feasible and other approaches should be considered to optimise screening.