Self-administered RGA app captures functional status in older adults

A self-administered Rapid Geriatric Assessment (SA-RGA) app can reliably evaluate an older adult’s weight loss, falls, fatigue, and number of chronic illnesses, according to a recent Singapore study. Removing ambiguous words, such as ‘some’ or ‘a lot,’ could help further improve the accuracy of such self-assessment apps.

“SA-RGA has the potential to be incorporated in the eHEALTH platforms worldwide for early identifications of older adults at risk and to reduce health inequalities, at the same time building community resilience in the era of the coronavirus disease 2019 (COVID-19) pandemic,” the researchers said.

A total of 123 older adults (mean age 71±5.9 years) participated in the current prospective observational study. The SA-RGA was used to screen for frailty, sarcopoenia, anorexia of ageing, and cognition problems, and its diagnostic value was compared against the administered-RGA (A-RGA) conducted by healthcare professionals, set as the reference standard.

Compared with A-RGA, SA-RGA detected a higher prevalence prefrailty (32.5 percent vs 24.4 percent) and a much lower rate of frailty (1.6 percent vs 6.5 percent). “Some difficulty” with lifting 10 lbs (23.6 percent vs 14.6 percent), with walking across the room (4.9 percent vs 4.1 percent), with climbing a flight of stairs (23.6 percent vs 22.0 percent), and with transferring from chair to bed (13.0 percent vs 4.9 percent) were also more common when using the SA-RGA vs A-RGA. [J Nutr Health Aging 2021;25:1065-1069]

Moreover, the summed prevalence of ≥1 fall was likewise more frequently detected when using SA-RGA.

For the prediction of frailty, SA-RGA had a sensitivity and specificity value of 12.5 percent and 99.1 percent, respectively. Corresponding estimates were 70.0 percent and 79.6 percent for prefrailty, and 83.5 percent and 73.5 percent for robustness.

Sensitivity and specificity estimates were higher for no falls (94.3 percent and 100 percent, respectively), 1–3 falls (100 percent and 95.3 percent, respectively), and ≥4 falls (100 percent and 73.9 percent, respectively).

Notably, specific questions regarding fatigue, loss of weight, having ≥5 illnesses, and falls in the past year showed especially high sensitivity and specificity estimates, negative predictive values, and positive likelihood ratios, suggesting that self-responses to such items agreed well with the reference standard.

“RGA is a screening app, with the aim of identifying those at risk of functional decline and disability. It is not invasive, not dangerous, cost-effective, practical, fast with no physical discomfort, and meant to reduce long-term healthcare system demands,” the researchers said.

The present findings suggest that the RGA app, even when self-administered, could perform well in certain domains of frailty and sarcopoenia, including weight loss, falls, chronic illnesses, and fatigue. Since ambiguity in wording may impact the app’s reliability, the researchers recommend including rating scales, appropriate graphics, and audio to improve the app’s usability for older adults.

“With an ageing population and declining active workforce, the RGA app can be adopted by many countries for early identification of geriatric syndromes before the onset of disability,” they added.