Reply to: Comment on: Measuring frailty in clinical practice: Overcoming challenges with implementation

Abstract

We thank Dr. Van Grootven for his interest in our article about measuring frailty in clinical practice.¹ We appreciated the engagement with the article as well as the constructive feedback. The discussion about frailty assessments and their utility in clinical practice is an important one. Dr. Van Grootven brings up several points that advance this discussion and will help inform future projects within the field.

We acknowledge the limitations of this work highlighted, namely the need for calibration of the predictions and classification statistics to understand misclassification as well as comparisons with the current standard of care (a geriatrician's clinical judgment).² These are excellent suggestions for future directions. Although these would expand the discussion and provide additional important information, they are also beyond the scope of this quality improvement project.

The study aimed to examine whether the predictive ability of frailty measures in routine practice was comparable to that in controlled research settings. Although it is useful to judge clinical utility in the context of outcomes, within the framework of this study, the term “utility” refers specifically to the measures' predictive consistency with findings from larger, standardized cohort studies, not to the immediate clinical impact on patient outcomes.

We appreciate your discussion of important next steps. This has provided an opportunity to consider future directions within the field. Although there are several studies that show frailty's predictive capacity,³ we agree that there is a need for larger-scale effectiveness studies to assess whether implementing frailty assessments in routine practice leads to improved patient outcomes. This would be crucial for determining the clinical utility of frailty measures in practice. We hope to have the opportunity to work on such a project in the future.

Our study showed that frailty assessments can be integrated into standard clinical practice and have predictive consistency. We hope that additional work can be done showing that frailty assessments can help improve outcomes. Further development of real-world evidence of frailty prevention, reversal, and management is crucial to advancing the field.

All listed authors had full access to all the data in the study, take responsibility for the integrity of the data and the accuracy of the data analysis, and had authority over manuscript preparation, the decision to submit the manuscript for publication, and approved its current contents. All authors meet the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals.

No personal or financial conflicts of interest.

Research reported in this publication was supported in part by the Duke Endowment and the University of North Carolina at Chapel Hill's Center for Aging and Health. The content is solely the authors' responsibility and does not necessarily represent the official views of Duke Endowment. This work was not sponsored by any other entities.