Sex Bias in Frailty Screening: A Cross-Sectional Analysis of PRISMA-7 and the Clinical Frailty Scale in Primary Care
<b>Background/Objectives</b>: Frailty screening is essential in primary care for the early identification of vulnerable older adults. PRISMA-7 is a widely used screening tool, but Item 2 (“Are you male?”) introduces potential sex bias and overestimates frailty in men. PRISMA-6, a modifie...
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MDPI AG
2025-04-01
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| author | Christian J. Wiedermann Verena Barbieri Dietmar Ausserhofer Adolf Engl Giuliano Piccoliori Angelika Mahlknecht |
| author_facet | Christian J. Wiedermann Verena Barbieri Dietmar Ausserhofer Adolf Engl Giuliano Piccoliori Angelika Mahlknecht |
| author_sort | Christian J. Wiedermann |
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| description | <b>Background/Objectives</b>: Frailty screening is essential in primary care for the early identification of vulnerable older adults. PRISMA-7 is a widely used screening tool, but Item 2 (“Are you male?”) introduces potential sex bias and overestimates frailty in men. PRISMA-6, a modified version that excludes Item 2, might provide a more equitable alternative. This study evaluates PRISMA-6’s alignment with the Clinical Frailty Scale (CFS) and its impact on sex-specific frailty classification. <b>Methods:</b> A cross-sectional study was conducted in 142 general practices across South Tyrol, including 9190 general practice patients aged ≥75 years. Frailty was assessed using PRISMA-7, PRISMA-6, and the CFS. Correlations between tools were calculated using Kendall’s Tau-b, whereas Fisher’s z-test was used to compare differences in alignment. The frailty prevalence and odds ratios were stratified according to sex and age. <b>Results:</b> PRISMA-6 showed a stronger correlation with the CFS (τ = 0.492) than PRISMA-7 (τ = 0.308, <i>z</i> = −10.2, <i>p</i> < 0.001). This effect was pronounced in men (<i>z</i> = −9.8, <i>p</i> < 0.001), whereas no difference was observed in women (<i>z</i> = 0.00, <i>p</i> = 1.000). PRISMA-6 reduced the frailty detection rate in men and was more closely aligned with the CFS. <b>Conclusions:</b> PRISMA-6 demonstrated improved alignment with the CFS and reduced sex bias compared to PRISMA-7. However, its use as a screening tool for men requires prospective validation in diverse settings. PRISMA-6 shows promise as a reliable and equitable frailty screening tool and should be considered for use in future studies, particularly in primary care settings, while awaiting further prospective validation. |
| format | Article |
| id | doaj-art-2e27ec1d06ed470e86abb4e596e1df19 |
| institution | OA Journals |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
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| series | Diagnostics |
| spelling | doaj-art-2e27ec1d06ed470e86abb4e596e1df192025-08-20T02:15:55ZengMDPI AGDiagnostics2075-44182025-04-0115791510.3390/diagnostics15070915Sex Bias in Frailty Screening: A Cross-Sectional Analysis of PRISMA-7 and the Clinical Frailty Scale in Primary CareChristian J. Wiedermann0Verena Barbieri1Dietmar Ausserhofer2Adolf Engl3Giuliano Piccoliori4Angelika Mahlknecht5Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, ItalyInstitute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, ItalyInstitute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, ItalyInstitute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, ItalyInstitute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, ItalyInstitute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy<b>Background/Objectives</b>: Frailty screening is essential in primary care for the early identification of vulnerable older adults. PRISMA-7 is a widely used screening tool, but Item 2 (“Are you male?”) introduces potential sex bias and overestimates frailty in men. PRISMA-6, a modified version that excludes Item 2, might provide a more equitable alternative. This study evaluates PRISMA-6’s alignment with the Clinical Frailty Scale (CFS) and its impact on sex-specific frailty classification. <b>Methods:</b> A cross-sectional study was conducted in 142 general practices across South Tyrol, including 9190 general practice patients aged ≥75 years. Frailty was assessed using PRISMA-7, PRISMA-6, and the CFS. Correlations between tools were calculated using Kendall’s Tau-b, whereas Fisher’s z-test was used to compare differences in alignment. The frailty prevalence and odds ratios were stratified according to sex and age. <b>Results:</b> PRISMA-6 showed a stronger correlation with the CFS (τ = 0.492) than PRISMA-7 (τ = 0.308, <i>z</i> = −10.2, <i>p</i> < 0.001). This effect was pronounced in men (<i>z</i> = −9.8, <i>p</i> < 0.001), whereas no difference was observed in women (<i>z</i> = 0.00, <i>p</i> = 1.000). PRISMA-6 reduced the frailty detection rate in men and was more closely aligned with the CFS. <b>Conclusions:</b> PRISMA-6 demonstrated improved alignment with the CFS and reduced sex bias compared to PRISMA-7. However, its use as a screening tool for men requires prospective validation in diverse settings. PRISMA-6 shows promise as a reliable and equitable frailty screening tool and should be considered for use in future studies, particularly in primary care settings, while awaiting further prospective validation.https://www.mdpi.com/2075-4418/15/7/915frailty screeningPRISMA-6PRISMA-7Clinical Frailty Scalesex biasprimary care |
| spellingShingle | Christian J. Wiedermann Verena Barbieri Dietmar Ausserhofer Adolf Engl Giuliano Piccoliori Angelika Mahlknecht Sex Bias in Frailty Screening: A Cross-Sectional Analysis of PRISMA-7 and the Clinical Frailty Scale in Primary Care Diagnostics frailty screening PRISMA-6 PRISMA-7 Clinical Frailty Scale sex bias primary care |
| title | Sex Bias in Frailty Screening: A Cross-Sectional Analysis of PRISMA-7 and the Clinical Frailty Scale in Primary Care |
| title_full | Sex Bias in Frailty Screening: A Cross-Sectional Analysis of PRISMA-7 and the Clinical Frailty Scale in Primary Care |
| title_fullStr | Sex Bias in Frailty Screening: A Cross-Sectional Analysis of PRISMA-7 and the Clinical Frailty Scale in Primary Care |
| title_full_unstemmed | Sex Bias in Frailty Screening: A Cross-Sectional Analysis of PRISMA-7 and the Clinical Frailty Scale in Primary Care |
| title_short | Sex Bias in Frailty Screening: A Cross-Sectional Analysis of PRISMA-7 and the Clinical Frailty Scale in Primary Care |
| title_sort | sex bias in frailty screening a cross sectional analysis of prisma 7 and the clinical frailty scale in primary care |
| topic | frailty screening PRISMA-6 PRISMA-7 Clinical Frailty Scale sex bias primary care |
| url | https://www.mdpi.com/2075-4418/15/7/915 |
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