ArticleBMC geriatrics2026
A cross-sectional study of the relationship between community dwelling older adults' self-perceived frailty and their electronic frailty index score.
Article in BMC geriatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundQualitative studies suggest discrepancies between older adults’ self-perceived and measured frailty. Quantification of this is limited. This study investigated the relationship between older adults’ self-perceived frailty and a measure of frailty derived from electronic heath record data (electronic Frailty Index [eFI] score). The eFI is derived routinely from available primary care electronic health record data and is based on the cumulative deficit model of frailty.
methodsOne thousand people (≥ 70 years), randomly selected from a GP practice, were sent a survey, asking them to rate their frailty (ordinal and binary scale), and complete self-rated health (SRH) and PRISMA-7 questionnaires. We analysed (a) agreement between self-perceived frailty (ordinal scale) and eFI categorised frailty; (b) discrimination of self-report measures for eFI defined frailty (threshold ≥ 0.12); and (c) predictors of self-perceived frailty (logistic regressions).
results375 people were analysed (median age 76, 51% female). Agreement was ‘fair’ between self-perceived frailty and eFI (linear weighted Kappa 0.25, quadratic weighted Kappa 0.37). Agreement was higher with linear and quadratic weighted Gwet’s second order agreement co-efficient [AC2]), (0.65 and 0.81 respectively). As eFI increased, agreement with self-perceived frailty decreased. Disagreements commonly reflected self-perceived frailty reported as less severe than eFI. Self-perceived frailty poorly discriminated eFI defined frailty (AUC 0.59, 95%CI 0.55-0.63) as did SRH, while PRISMA-7 reached moderate discrimination (AUC 0.71, 95%CI 0.66-0.76). The optimal eFI cut-point for discriminating self-perceived frailty was 0.17. A multivariable regression model revealed increasing age (OR 1.10 per year, 95%CI 1.02-1.18) and depression (OR 1.51, 95%CI 1.31-1.74) were associated with self-perceived frailty, however, sex, anxiety, eFI score and deprivation were not.
conclusionsThe mismatch between self-perceived and eFI categorised frailty has implications for the social acceptability of screening and for meaningful engagement with frailty interventions including advance care planning.
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