P1274 The Astur-Frailty-IBD Study: Assessment of Frailty in elderly IBD patients and comparison of four frailty scores.
Authors: Carballo-Folgoso L , Duque Alcorta J M , Varela P , De Francisco García R , Armesto González E , Mancebo Mata A , Pérez-Martínez I , Rodríguez López P , De Jorge Turrión M A , Castaño-García A , García-Pérez C , Martínez Martín G , Fernández-González E , Chiminazzo V , Díaz-Simal A , Suarez A , Riestra S 
Published: January 2025

Abstract

Background
The prevalence of older adults with inflammatory bowel diseases (IBD) is increasing. The European Crohn's and Colitis Organization recommends that frailty should be considered in management decision-making in elderly IBD patients rather than just chronological age. However, there is no “gold standard” tool for the assessment of frailty in IBD. The aim of this study is to assess the prevalence of frailty using 4 frailty scales in IBD and to evaluate the agreement between them.

Methods
Astur-Frailty-IBD study, a multicentre prospective study of elderly IBD patients attended at three hospitals in Asturias. We recruited all consecutive IBD patients ≥ 60 years during outpatient visits between March 1 and June 30, 2024. Four frailty scales were used: Fried Frailty Phenotype, FRAIL Scale, Rockwood Clinical Frailty Scale (CFS) and SHARE Frailty Instrument (SHARE-FI). The classification criteria were: Fried and FRAIL (0: non-frail; 1-2: prefrail; ≥ 3: frail); CFS (1-3: non-frail; 4: prefrail; ≥ 5: frail). In SHARE-FI, we used a validated calculator that provides a continuous frailty score and enables automatic classification into the same frailty categories. All the patients were surveyed by face-to-face questionaries. Handgrip strength was measured using the same dynamometer. The agreement between the four scales was measured with weighted Kappa.

Results
A total of 612 IBD patients (median age 68.8 years, 50.2% females, 56.4% Crohn’s disease) were included. Depending on the scale, the prevalence of frailty varied from 4.4% (FRAIL), 4.6% (CFS), 12.4% (SHARE-FI) up to 16.8% (Fried) (figure 1). Twenty-seven patients were classified as frail by at least one scale. The agreement between frailty scales was showed in table 1. SHARE-FI and Fried showed the highest agreement in classifying into three categories (0.45 Kappa - moderate), followed by FRAIL and Fried (0.42 kappa). The agreement between all the scales used was 0.25 Fleiss' Kappa (fair). Subsequently, we assess the agreement of the scales considering two categories: non-frail and risk of frailty (prefrail + frail). The kappa coefficient ranged from 0.47 (moderate) for FRAIL and Fried to 0.2 for CFS and Fried. Taking the Fried scale as a reference, we found that both SHARE-FI and FRAIL have a high specificity (94.7% and 92.7%), without good sensibility (53.5% and 62% respectively).

Conclusion
Elderly IBD patients are characterized by a high prevalence of frailty, although it differs depending on the frailty scale used. Our study shows at least a moderate level of agreement between Fried Frailty Phenotype and SHARE-FI. Further studies are needed to identify diagnostic criteria for frailty in IBD, as well as prospective studies focused on the impact of frailty in elderly IBD patients.