Department of Medical Gerontology, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.
Geriatr Gerontol Int. 2013 Apr;13(2):497-504. doi: 10.1111/j.1447-0594.2012.00948.x. Epub 2012 Sep 19.
Frailty is an emerging concept in primary care, which potentially can provide healthcare commissioners with a clinical focus for targeting resources at an aging population. However, primary care practitioners need valid instruments that are easy to use. With that purpose in mind, we created a Frailty Instrument (FIt) for primary care based on the Survey of Health, Aging and Retirement in Europe (SHARE). The aim of the present study was to compare the mortality prediction of the five-item SHARE-FIt with that of a 40-item Frailty Index (FIx) based on comprehensive geriatric assessment (CGA).
The participants were 15,578 women and 12,783 men from the first wave of SHARE. A correspondence analysis was used to assess the degree of agreement between phenotypic classifications. The ability of the continuous frailty measures (FIt score and FIx) to predict mortality (mean follow up of 2.4 years) was compared using receiver-operating characteristic (ROC) plots and areas under the curve (AUC).
In both sexes, there was significant correspondence between phenotypic categories. The two continuous measures performed equally well as mortality predictors (women: AUC-FIx = 0.79, 95% CI 0.75-0.82, P < 0.001; AUC-FIt = 0.77, 95% CI 0.73-0.81, P < 0.001; men: AUC-FIx = 0.77, 95% CI 0.74-0.79, P < 0.001; AUC-FIt = 0.76, 95% CI 0.74-0.79, P < 0.001). Their equivalent performance was confirmed by statistical comparisons of the AUC.
SHARE-FIt is simpler and more usable, and predicts mortality similarly to a more complex FIx based on CGA.
衰弱是初级保健中的一个新兴概念，它有可能为医疗保健专员提供一个针对老龄化人口的临床重点。然而，初级保健医生需要易于使用的有效工具。有鉴于此，我们基于欧洲健康、老龄化和退休调查（SHARE）创建了一个适用于初级保健的衰弱量表（FIt）。本研究的目的是比较基于全面老年评估（CGA）的五分量表 SHARE-FIt 与四十分量表衰弱指数（FIx）对死亡率的预测能力。
参与者为 SHARE 第一波的 15578 名女性和 12783 名男性。采用对应分析评估表型分类的一致性程度。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）比较连续衰弱测量值（FIt 评分和 FIx）预测死亡率（平均随访 2.4 年）的能力。
在男性和女性中，表型类别之间均存在显著的一致性。两种连续测量方法作为死亡率预测指标的性能相当（女性：AUC-FIx=0.79，95%CI 0.75-0.82，P<0.001；AUC-FIt=0.77，95%CI 0.73-0.81，P<0.001；男性：AUC-FIx=0.77，95%CI 0.74-0.79，P<0.001；AUC-FIt=0.76，95%CI 0.74-0.79，P<0.001）。通过 AUC 的统计学比较，证实了它们的等效性能。
SHARE-FIt 更简单易用，与基于 CGA 的更复杂的 FIx 相比，对死亡率的预测能力相当。
