Call to action: frailty assessment in primary care

We thank Dr Lee and colleagues for their very interesting study in the January 2017 issue of Canadian Family Physician.¹ It is to be hoped that many medical organizations will follow this feasible “call to action” on dual-trait measurement of gait speed and hand-grip strength for frailty screening and implement it permanently in daily primary care practice.

The authors have included the study by Auyeung et al in their references, but unfortunately it was not mentioned that this study also examined the sensitivity and specificity of each of the 5 Fried criteria in the identification of frailty in 4000 Chinese older adults (mean age was 72.5 years).² Auyeung et al also concluded gait speed and grip strength were key indicators of frailty in the primary care setting. For gait speed, the sensitivity and specificity were 91.9% and 84.5% in women (area under the receiver operating curve [AUC] = 0.88) and 82.7% and 83.1% in men (AUC = 0.83), respectively. For grip strength, the sensitivity and specificity were 84.5% and 81.9% in women (AUC = 0.84) and 89.5% and 80.6% in men (AUC = 0.86), respectively.

General practitioners’ clinical impression of frailty is important but alone it is not sufficient.³ We agree with the authors that objective, simple, quick, and inexpensive screening tests such as gait speed and grip strength are necessary to improve the accuracy of frailty detection in elderly patients in primary care.^3,4 This is also supported by other current studies to identify the Fried frailty phenotype in the primary care setting.⁵

To Dr Lee and colleagues: Very well written, correct results, and appropriate references. Congratulations!