January 11, 2019
2 min read

Frailty associated with psychiatric disorders, multicomponent assessment tools needed

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Although evidence suggests that adults with psychiatric disorders have an increased risk for becoming frail, there is currently a lack of tools designed specifically to evaluate frailty in this population, according to a study published in the Journal of the American Geriatrics Society.

In addition, construct overlap exists between indicators of frailty in the assessment tools and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnostic criteria for common psychiatric disorders, like major depressive episode and generalized anxiety disorder, which can make frailty assessment results less reliable.

“As frail older adults with a diagnosis of psychiatric disorder are particularly vulnerable to adverse outcomes in late life, being able to accurately assess and treat frailty is paramount,” Jennifer L. Sutton, MSc, PhD candidate and research occupational therapist in the department of old age psychiatry at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, told Healio Family Medicine. “This review provides an overview of all construct overlap identified between the assessment domains of existing frailty assessment tools and DSM-5 diagnostic criteria for seven common psychiatric disorders in older adults.”

To determine what, if any, multicomponent frailty assessment tools exist specifically for patients with psychiatric disorders, researchers conducted a systematic literature review of 95 studies focusing on adults aged 60 years or older and describing multicomponent tools that assess two or more indicators of frailty.

After extracting data related to study characteristics, the population each tool was developed for and validated in and the content of each frailty assessment tool, researchers compared the assessment items of each tool with the DSM-5 diagnostic criteria for major depressive disorder, bipolar affective disorder, schizophrenia, generalized anxiety disorder, social anxiety disorder, specific phobia and panic disorder to assess construct overlap. Researchers defined construct overlap as when the tool item and diagnostic criteria were conceptually similar.

In total, researchers identified 48 multicomponent frailty assessment tools and found that no tool was developed for, or validated in, older adult populations with a psychiatric disorder.

They also found that 20 of these tools had a psychological assessment domain and 17 considered the presence of depression and/or anxiety as a frailty indicator.

Researchers observed that weight loss (29 of 48) and fatigue (21 of 48) were the most common areas of construct overlap between frailty assessment tools and DSM-5 diagnostic criteria.

The researchers hope that this information will help clinicians to select the most appropriate assessment methodology available in the absence of a published tool that has been developed for and validated in older adult psychiatric populations, according to Sutton.

“The results highlighted a clear need to develop a frailty assessment tool specifically for older adult psychiatric populations, minimizing where possible the construct overlap identified,” Sutton said. “To address this gap, we have developed a tool specifically to assess frailty in older adults with a diagnosis of psychiatric disorder. The reliability and validity of this novel tool are being explored.” – by Melissa J. Webb

For more information:

Jennifer L. Sutton, MSc, can be reached at jennifer.1.sutton@kcl.ac.uk.

Disclosures: The authors report no relevant financial disclosures.