Division of Geriatric Medicine, Faculty of Medicine, University of Calgary, HSC 3330 Hospital Drive NW, Calgary, AB, Canada.
BMC Geriatr. 2012 Sep 14;12:56. doi: 10.1186/1471-2318-12-56.
Few studies have directly compared the competing approaches to identifying frailty in more vulnerable older populations. We examined the ability of two versions of a frailty index (43 vs. 83 items), the Cardiovascular Health Study (CHS) frailty criteria, and the CHESS scale to accurately predict the occurrence of three outcomes among Assisted Living (AL) residents followed over one year.
The three frailty measures and the CHESS scale were derived from assessment items completed among 1,066 AL residents (aged 65+) participating in the Alberta Continuing Care Epidemiological Studies (ACCES). Adjusted risks of one-year mortality, hospitalization and long-term care placement were estimated for those categorized as frail or pre-frail compared with non-frail (or at high/intermediate vs. low risk on CHESS). The area under the ROC curve (AUC) was calculated for select models to assess the predictive accuracy of the different frailty measures and CHESS scale in relation to the three outcomes examined.
Frail subjects defined by the three approaches and those at high risk for decline on CHESS showed a statistically significant increased risk for death and long-term care placement compared with those categorized as either not frail or at low risk for decline. The risk estimates for hospitalization associated with the frailty measures and CHESS were generally weaker with one of the frailty indices (43 items) showing no significant association. For death and long-term care placement, the addition of frailty (however derived) or CHESS significantly improved on the AUC obtained with a model including only age, sex and co-morbidity, though the magnitude of improvement was sometimes small. The different frailty/risk models did not differ significantly from each other in predicting mortality or hospitalization; however, one of the frailty indices (83 items) showed significantly better performance over the other measures in predicting long-term care placement.
Using different approaches, varying degrees of frailty were detected within the AL population. The various approaches to defining frailty were generally more similar than dissimilar with regard to predictive accuracy with some exceptions. The clinical implications and opportunities of detecting frailty in more vulnerable older adults require further investigation.
很少有研究直接比较在更脆弱的老年人群中识别衰弱的竞争方法。我们研究了两种版本的衰弱指数（43 项与 83 项）、心血管健康研究（CHS）衰弱标准和 CHESS 量表，以准确预测在一年中接受辅助生活（AL）的居民中发生三种结果的能力。
三种衰弱测量方法和 CHESS 量表源自在参加阿尔伯塔省持续护理流行病学研究（ACCES）的 1066 名 AL 居民（年龄在 65 岁以上）中完成的评估项目。与非虚弱（或 CHESS 量表上的高/中风险与低风险）相比，对归类为虚弱或虚弱前期的人进行了一年死亡率、住院和长期护理安置的调整风险估计。计算了选择模型的 ROC 曲线下面积（AUC），以评估不同衰弱测量方法和 CHESS 量表与三种研究结果相关的预测准确性。
三种方法定义的虚弱受试者和 CHESS 上高风险下降的受试者与归类为非虚弱或低风险下降的受试者相比，死亡和长期护理安置的风险显著增加。与衰弱和 CHESS 相关的住院风险估计通常较弱，其中一种衰弱指数（43 项）没有显示出显著关联。对于死亡和长期护理安置，无论衰弱（无论如何定义）或 CHESS 的加入，都显著提高了仅包括年龄、性别和合并症的模型的 AUC，但改善幅度有时很小。不同的衰弱/风险模型在预测死亡率或住院率方面没有显著差异；然而，其中一种衰弱指数（83 项）在预测长期护理安置方面的表现明显优于其他措施。
使用不同的方法，在 AL 人群中检测到不同程度的衰弱。在预测准确性方面，各种定义衰弱的方法通常更为相似，尽管存在一些例外。在更脆弱的老年人中检测衰弱的临床意义和机会需要进一步研究。
