Kim Hidong, Higgins Patricia A, Canaday David H, Burant Chris J, Hornick Thomas R
School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Geriatr Gerontol Int. 2014 Jan;14(1):78-83. doi: 10.1111/ggi.12057. Epub 2013 Mar 26.
Frailty is a common phenomenon in geriatric patients. In the present translational research study, we assessed two frailty instruments (Fried 2001; Gill 2002), comparing the usefulness and scoring classifications for frailty screening in an academically affiliated geriatrics clinic.
Assessment was completed on 162 male veterans (mean age 83.7 years, 57% African American) enrolled in a geriatric clinic. The instruments' component criteria, which are well known to gerontological clinicians, were administered in a standard order and scoring was identical to original instruments.
The five-item Fried frailty instrument required 15-20 min to complete; the two-item Gill frailty instrument required less than 2 min. Of the 162 participants assessed, 72 were determined to be frail by at least one of the instruments, but just 33 were frail by both instruments. Correlations between the instruments were Spearman = 0.55 (P < 0.001) and kappa = 0.25, (P < 0.001). There were no differences in frailty scores based on race, and there were equivocal results based on age, even though this was an older sample, with almost 17% ≥90 years. A total of 63% (103/162) of the sample met the criterion for weak grip strength, and decreasing grip strength correlated with increasing age (r = -0.238, P = 0.002).
Expedient identification of the frailty syndrome remains an unmet necessity for clinical practice. The different results by the Fried and Gill frailty instruments are likely due to differences in component domains and testing methods. The present results support previous findings that showed that grip strength might be an important indicator of increasing frailty.
衰弱是老年患者中的常见现象。在本转化研究中，我们评估了两种衰弱评估工具（Fried，2001年；Gill，2002年），比较了它们在一家学术附属老年病诊所中用于衰弱筛查的实用性和评分分类。
对162名参加老年病诊所的男性退伍军人（平均年龄83.7岁，57%为非裔美国人）进行了评估。这些工具的组成标准对老年病临床医生来说是熟知的，按照标准顺序进行评估，评分与原始工具相同。
五项Fried衰弱评估工具需要15 - 20分钟完成；两项Gill衰弱评估工具需要不到2分钟。在评估的162名参与者中，至少有一种工具判定72人衰弱，但两种工具都判定衰弱的只有33人。工具之间的相关性为Spearman = 0.55（P < 0.001），kappa = （P < 0.001）。基于种族的衰弱评分没有差异，基于年龄的结果不明确，尽管这是一个年龄较大的样本，近17%的人年龄≥90岁。样本中共有63%（103/162）符合握力弱的标准，握力下降与年龄增长相关（r = -0.238，P = 0.002）。
临床实践中仍迫切需要快速识别衰弱综合征。Fried和Gill衰弱评估工具结果不同可能是由于组成领域和测试方法的差异。目前的结果支持了先前的研究发现，即握力可能是衰弱加剧的一个重要指标。
