What question did this study set out to answer?

This research aims to evaluate the feasibility, validity, and reliability of an electronic frailty index based on comprehensive geriatric assessment in primary care settings.

February 28, 2026Open Access

Electronic frailty index based on comprehensive geriatric assessment in primary care: feasibility, validity, and reliability

Key Points

This research aims to evaluate the feasibility, validity, and reliability of an electronic frailty index based on comprehensive geriatric assessment in primary care settings.
Developed electronic frailty index (eFI-CGA) through comprehensive geriatric assessment.
Measured completion rates and time required for assessments to determine feasibility.
Analyzed correlations with age and clinical frailty scale for validity.
Performed inter- and intra-rater reliability assessments with geriatricians and primary care providers.
eFI-CGA showed a four-factor structure: function/mobility, psychological/social, cognition, and physical/medical problems.
Moderate correlation (r = 0.65) with clinical frailty scale and modest correlation (r = 0.22) with age.
Each 0.01 increment in eFI-CGA increased the hazard ratio for three-year mortality by 4%.
eFI-CGA accurately discriminated individuals with adverse outcomes at 75% accuracy.
High inter-rater reliability (ICC = 0.91) and intra-rater reliability (ICC = 0.95) confirmed effectiveness.

Abstract

To aid frailty management in primary care we developed an electronic Frialty Index based on a Comprehensive Geriatric Assessment (eFI-CGA). Here we report the feasibility, validity, and reliability of the eFI-CGA when conducted in primary care. To assay feasibility, we measured assessment completion rate and time required. We tested validity by analyzing the content and characteristics of the eFI-CGA, its associations with age and the Clinical Frailty Scale (CFS), and prediction of three-year adverse outcomes. Reliability was evaluated by having primary care providers and geriatricians independently assess patients at baseline and at six months, yielding inter- and intra-rater estimates, as well as validity compared with a reference standard. Community-dwelling older adults from 27 clinics were enrolled (n = 281; 65% females). The eFI-CGA showed a four-factor structure, including function/mobility, psychological/social, cognition, and physical/medical problems. The eFI-CGA and CFS scores were moderately correlated: r = 0.65 (95% confidence intervals (CI): 0.56 − 0.72). The age − eFI-CGA correlation (r) was modest (r = 0.22; CI: 0.10 − 0.34). Each 0.01 eFI-CGA increment was associated with a Hazard Ratio (HR) of 1.04 for three-year mortality (CI: 1.02 − 1.06). The eFI-CGA discriminated individuals with an adverse outcome with 75% accuracy (CI: 68%−82%). The eFI-CGA conducted by geriatricians and primary care providers showed comparable characteristics and predictive capacities. Inter-rater intraclass correlation coefficients (ICCs) were high: 0.91 (CI: 0.84 − 0.94) baseline) and 0.87 (CI: 0.80 − 0.92) follow-up. Intra-rater ICCs were excellent 0.95 (CI: 0.92 − 0.97) for geriatricians and 0.93 (CI: 0.89 − 0.96) for primary care providers. Frailty assessment using the eFI-CGA is feasible, valid, and reliable in primary care settings. Larger studies are needed to evaluate its generalizability.

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