Perceived frailty and measured frailty among adults undergoing hemodialysis: a cross-sectional analysis

Megan L Salter; Natasha Gupta; Allan B Massie; Mara A McAdams-DeMarco; Andrew H Law; Reside Lorie Jacob; Luis F Gimenez; Bernard G Jaar; Jeremy D Walston; Dorry L Segev

doi:10.1186/s12877-015-0051-y

Perceived frailty and measured frailty among adults undergoing hemodialysis: a cross-sectional analysis

BMC Geriatr. 2015 Apr 24:15:52. doi: 10.1186/s12877-015-0051-y.

Authors

Megan L Salter^{1

2

3}, Natasha Gupta⁴, Allan B Massie^{5

6}, Mara A McAdams-DeMarco^{7

8}, Andrew H Law^{9

10}, Reside Lorie Jacob¹¹, Luis F Gimenez¹², Bernard G Jaar^{13

14

15

16}, Jeremy D Walston^{17

18

19}, Dorry L Segev^{20

21}

Affiliations

¹ Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. [email protected].
² Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA. [email protected].
³ Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. [email protected].
⁴ Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. [email protected].
⁵ Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. [email protected].
⁶ Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. [email protected].
⁷ Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. [email protected].
⁸ Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. [email protected].
⁹ Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. [email protected].
¹⁰ Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. [email protected].
¹¹ Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, USA. [email protected].
¹² Department of Medicine, Johns Hopkins University School of Medicine, 1830 Building Room 416 Nephrology, 600 North Wolfe Street, Baltimore, MD, 21287, USA. [email protected].
¹³ Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. [email protected].
¹⁴ Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA. [email protected].
¹⁵ Department of Medicine, Johns Hopkins University School of Medicine, 1830 Building Room 416 Nephrology, 600 North Wolfe Street, Baltimore, MD, 21287, USA. [email protected].
¹⁶ Nephrology Center of Maryland, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, 21239, USA. [email protected].
¹⁷ Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA. [email protected].
¹⁸ Department of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Room 1A.62, Baltimore, MD, 21224, USA. [email protected].
¹⁹ Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Cir, Baltimore, MD, 21224, US. [email protected].
²⁰ Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA. [email protected].
²¹ Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA. [email protected].

Abstract

Background: Frailty, a validated measure of physiologic reserve, predicts adverse health outcomes among adults with end-stage renal disease. Frailty typically is not measured clinically; instead, a surrogate-perceived frailty-is used to inform clinical decision-making. Because correlations between perceived and measured frailty remain unknown, the aim of this study was to assess their relationship.

Methods: 146 adults undergoing hemodialysis were recruited from a single dialysis center in Baltimore, Maryland. Patient characteristics associated with perceived (reported by nephrologists, nurse practitioners (NPs), or patients) or measured frailty (using the Fried criteria) were identified using ordered logistic regression. The relationship between perceived and measured frailty was assessed using percent agreement, kappa statistic, Pearson's correlation coefficient, and prevalence of misclassification of frailty. Patient characteristics associated with misclassification were determined using Fisher's exact tests, t-tests, or median tests.

Results: Older age (adjusted OR [aOR] = 1.36, 95%CI:1.11-1.68, P = 0.003 per 5-years older) and comorbidity (aOR = 1.49, 95%CI:1.27-1.75, P < 0.001 per additional comorbidity) were associated with greater likelihood of nephrologist-perceived frailty. Being non-African American was associated with greater likelihood of NP- (aOR = 5.51, 95%CI:3.21-9.48, P = 0.003) and patient- (aOR = 4.20, 95%CI:1.61-10.9, P = 0.003) perceived frailty. Percent agreement between perceived and measured frailty was poor (nephrologist, NP, and patient: 64.1%, 67.0%, and 55.5%). Among non-frail participants, 34.4%, 30.0%, and 31.6% were perceived as frail by a nephrologist, NP, or themselves. Older adults (P < 0.001) were more likely to be misclassified as frail by a nephrologist; women (P = 0.04) and non-African Americans (P = 0.02) were more likely to be misclassified by an NP. Neither age, sex, nor race was associated with patient misclassification.

Conclusions: Perceived frailty is an inadequate proxy for measured frailty among patients undergoing hemodialysis.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Comorbidity
Cross-Sectional Studies
Female
Health Status*
Humans
Kidney Failure, Chronic / psychology*
Kidney Failure, Chronic / therapy*
Logistic Models
Male
Middle Aged
Prevalence
Renal Dialysis*
Self Concept*

Abstract

Publication types

MeSH terms

Grants and funding