Comparing the PRISMA-7 and a Modified Version (PRISMA-6) for Frailty Screening: Addressing Sex Bias in Community-Dwelling Older Adults
<b>Background/Objectives:</b> Frailty screening facilitates the identification of older adults at risk of adverse health outcomes. The Program of Research to Integrate Services for the Maintenance of Autonomy 7 (PRISMA-7) is a widely utilised frailty tool; however, concerns regarding its...
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MDPI AG
2025-01-01
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| Series: | Geriatrics |
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| Online Access: | https://www.mdpi.com/2308-3417/10/1/9 |
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| author | Dietmar Ausserhofer Angelika Mahlknecht Verena Barbieri Adolf Engl Giuliano Piccoliori Christian J. Wiedermann |
| author_facet | Dietmar Ausserhofer Angelika Mahlknecht Verena Barbieri Adolf Engl Giuliano Piccoliori Christian J. Wiedermann |
| author_sort | Dietmar Ausserhofer |
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| description | <b>Background/Objectives:</b> Frailty screening facilitates the identification of older adults at risk of adverse health outcomes. The Program of Research to Integrate Services for the Maintenance of Autonomy 7 (PRISMA-7) is a widely utilised frailty tool; however, concerns regarding its potential sex bias persist due to item 2, which assigns a frailty point for male sex. This study compared the PRISMA-7 with a modified version, the PRISMA-6 (excluding item 2), to assess their suitability for frailty screening in South Tyrol, Italy. Objectives included evaluating the impact of item 2 on frailty classification and exploring the feasibility of the PRISMA-6 as a more equitable alternative. <b>Methods:</b> A cross-sectional survey of 1695 community-dwelling older adults aged ≥75 years was conducted in South Tyrol. Frailty was assessed using both the PRISMA-7 and PRISMA-6. Sociodemographic, health, and lifestyle data were collected to examine associations with frailty classifications. Logistic regression was applied to identify predictors of frailty for each tool. Agreement between the PRISMA-7 and PRISMA-6 was assessed, and internal consistency was evaluated using Cronbach’s alpha. <b>Results:</b> Frailty prevalence was 33.9% with the PRISMA-7 and 27.0% with the PRISMA-6. The PRISMA-7 classified men as frail more frequently than women (34.7% vs. 33.0%), while the PRISMA-6 reversed this trend (men, 21.4%; women, 33.0%). Excluding item 2 improved internal consistency (Cronbach’s alpha: PRISMA-7, 0.64; PRISMA-6, 0.75) and aligned frailty classifications with predictors such as age, health status, and physical activity. Logistic regression revealed significant sex differences with the PRISMA-7 but not with the PRISMA-6. <b>Conclusions:</b> The PRISMA-7 introduces sex bias by overestimating frailty in men, whereas the PRISMA-6 provides a more equitable and consistent alternative. The findings highlight the PRISMA-6’s potential as a reliable tool for unbiased frailty screening. Future research should validate the PRISMA-6 against established frailty tools to support its integration into primary care settings. |
| format | Article |
| id | doaj-art-7ac43902cfde4e9ea190449166110461 |
| institution | DOAJ |
| issn | 2308-3417 |
| language | English |
| publishDate | 2025-01-01 |
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| series | Geriatrics |
| spelling | doaj-art-7ac43902cfde4e9ea1904491661104612025-08-20T02:44:53ZengMDPI AGGeriatrics2308-34172025-01-01101910.3390/geriatrics10010009Comparing the PRISMA-7 and a Modified Version (PRISMA-6) for Frailty Screening: Addressing Sex Bias in Community-Dwelling Older AdultsDietmar Ausserhofer0Angelika Mahlknecht1Verena Barbieri2Adolf Engl3Giuliano Piccoliori4Christian J. Wiedermann5Institute 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 facilitates the identification of older adults at risk of adverse health outcomes. The Program of Research to Integrate Services for the Maintenance of Autonomy 7 (PRISMA-7) is a widely utilised frailty tool; however, concerns regarding its potential sex bias persist due to item 2, which assigns a frailty point for male sex. This study compared the PRISMA-7 with a modified version, the PRISMA-6 (excluding item 2), to assess their suitability for frailty screening in South Tyrol, Italy. Objectives included evaluating the impact of item 2 on frailty classification and exploring the feasibility of the PRISMA-6 as a more equitable alternative. <b>Methods:</b> A cross-sectional survey of 1695 community-dwelling older adults aged ≥75 years was conducted in South Tyrol. Frailty was assessed using both the PRISMA-7 and PRISMA-6. Sociodemographic, health, and lifestyle data were collected to examine associations with frailty classifications. Logistic regression was applied to identify predictors of frailty for each tool. Agreement between the PRISMA-7 and PRISMA-6 was assessed, and internal consistency was evaluated using Cronbach’s alpha. <b>Results:</b> Frailty prevalence was 33.9% with the PRISMA-7 and 27.0% with the PRISMA-6. The PRISMA-7 classified men as frail more frequently than women (34.7% vs. 33.0%), while the PRISMA-6 reversed this trend (men, 21.4%; women, 33.0%). Excluding item 2 improved internal consistency (Cronbach’s alpha: PRISMA-7, 0.64; PRISMA-6, 0.75) and aligned frailty classifications with predictors such as age, health status, and physical activity. Logistic regression revealed significant sex differences with the PRISMA-7 but not with the PRISMA-6. <b>Conclusions:</b> The PRISMA-7 introduces sex bias by overestimating frailty in men, whereas the PRISMA-6 provides a more equitable and consistent alternative. The findings highlight the PRISMA-6’s potential as a reliable tool for unbiased frailty screening. Future research should validate the PRISMA-6 against established frailty tools to support its integration into primary care settings.https://www.mdpi.com/2308-3417/10/1/9frailty screeningPRISMA-7sex biasSouth Tyrolpopulation-level screeningprimary care |
| spellingShingle | Dietmar Ausserhofer Angelika Mahlknecht Verena Barbieri Adolf Engl Giuliano Piccoliori Christian J. Wiedermann Comparing the PRISMA-7 and a Modified Version (PRISMA-6) for Frailty Screening: Addressing Sex Bias in Community-Dwelling Older Adults Geriatrics frailty screening PRISMA-7 sex bias South Tyrol population-level screening primary care |
| title | Comparing the PRISMA-7 and a Modified Version (PRISMA-6) for Frailty Screening: Addressing Sex Bias in Community-Dwelling Older Adults |
| title_full | Comparing the PRISMA-7 and a Modified Version (PRISMA-6) for Frailty Screening: Addressing Sex Bias in Community-Dwelling Older Adults |
| title_fullStr | Comparing the PRISMA-7 and a Modified Version (PRISMA-6) for Frailty Screening: Addressing Sex Bias in Community-Dwelling Older Adults |
| title_full_unstemmed | Comparing the PRISMA-7 and a Modified Version (PRISMA-6) for Frailty Screening: Addressing Sex Bias in Community-Dwelling Older Adults |
| title_short | Comparing the PRISMA-7 and a Modified Version (PRISMA-6) for Frailty Screening: Addressing Sex Bias in Community-Dwelling Older Adults |
| title_sort | comparing the prisma 7 and a modified version prisma 6 for frailty screening addressing sex bias in community dwelling older adults |
| topic | frailty screening PRISMA-7 sex bias South Tyrol population-level screening primary care |
| url | https://www.mdpi.com/2308-3417/10/1/9 |
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