A cross-sectional study of the relationship between community dwelling older adults’ self-perceived frailty and their electronic frailty index score

Qualitative 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. One 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). 375 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. The 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.