# Comparative performance of ICOPE Step 1 and fried frailty criteria in detecting frailty phenotypes: A cross-sectional study

## TL;DR

This study compares two tools for detecting frailty in older adults and finds that one is better at identifying at-risk individuals but less precise.

## Contribution

The study provides a direct comparison of ICOPE Step 1 and Fried criteria for frailty detection in the same population.

## Key findings

- ICOPE Step 1 identified more individuals as frail compared to Fried criteria.
- ICOPE Step 1 showed high sensitivity but moderate specificity and discriminative ability.
- ICOPE Step 1 is recommended as a first-line screening tool but not a replacement for Fried criteria.

## Abstract

Frailty represents a significant public health challenge among aging populations. Early and accurate detection is vital for implementing timely interventions that may delay or prevent functional deterioration. Among the available assessment tools, The Fried frailty phenotype is widely recognized as a reference framework for assessing frailty. In parallel, the WHO’s ICOPE Step 1 has been developed as a tool to detect potential declines in intrinsic capacity. Considering its design and purpose, ICOPE Step 1 may be regarded as a feasible option for use as a screening tool in clinical and community settings; however, direct comparative analyses within the same population remain limited. This study aimed to evaluate the concordance between the ICOPE Step 1 tool and Fried criteria to inform and enhance frailty screening practices in both clinical and community-based settings.

This cross-sectional study included 202 community-dwelling older adults aged ≥60 years (mean age 85.0 ± 4.5; 160 [79.2 %] females), categorized as non-frail, pre-frail, or frail based on Fried’s frailty phenotype and the WHO ICOPE Step 1 screening tool. The diagnostic performance of the ICOPE tool was assessed in comparison to Fried’s criteria by calculating sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve.

Compared to the reference Fried criteria, the ICOPE Step 1 tool identified a higher proportion of individuals as frail (63 % vs. 29 %) and fewer as robust (2 % vs. 18 %). Diagnostic performance analysis showed a sensitivity of 83.9 % and a specificity of 43.8 %, with an area under the ROC curve (AUC) of 0.639, indicating moderate discriminative ability.

ICOPE Step 1 demonstrated high sensitivity as a rapid, community-based screening tool for identifying older adults at risk of frailty. While it cannot replace the diagnostic utility of the Fried phenotype due to its limited specificity, it serves as a valuable first-line instrument to guide further comprehensive geriatric assessment, particularly via ICOPE Step 2.