Campitelli Michael A, Bronskill Susan E, Hogan David B, Diong Christina, Amuah Joseph E, Gill Sudeep, Seitz Dallas, Thavorn Kednapa, Wodchis Walter P, Maxwell Colleen J
Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada.
Division of Geriatric Medicine, University of Calgary, HSC-3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
BMC Geriatr. 2016 Jul 7;16:133. doi: 10.1186/s12877-016-0309-z.
Evaluating different approaches to identifying frail home care clients at heightened risk for adverse health outcomes is an important but understudied area. Our objectives were to determine the prevalence and correlates of frailty (as operationally defined by three measures) in a home care cohort, the agreement between these measures, and their predictive validity for several outcomes assessed over one year.
We conducted a retrospective cohort study with linked population-based administrative and clinical (Resident Assessment Instrument [RAI]) data for all long-stay home care clients (aged 66+) assessed between April 2010-2013 in Ontario, Canada (n = 234,552). We examined two versions of a frailty index (FI), a full and modified FI, and the CHESS scale, compared their baseline characteristics and their predictive accuracy (by calculating the area under the ROC curve [AUC]) for death, long-term care (LTC) admission, and hospitalization endpoints in models adjusted for age, sex and comorbidity.
Frailty prevalence varied by measure (19.5, 24.4 and 44.1 %, for full FI, modified FI and CHESS, respectively) and was similar among female and male clients. All three measures were associated with a significantly increased risk of death, LTC admission and hospitalization endpoints in adjusted analyses but their addition to base models resulted in modest improvement for most AUC estimates. There were significant differences between measures in predictive accuracy, with the full FI demonstrating a higher AUC for LTC admission and CHESS a higher AUC for hospitalization - although none of the measures performed well for the hospitalization endpoints.
The different approaches to detecting vulnerability resulted in different estimates of frailty prevalence among home care clients in Ontario. Although all three measures were significant predictors of the health outcomes examined, the gains in predictive accuracy were often modest with the exception of the full FI in predicting LTC admission. Our findings provide some support for the clinical utility of a comprehensive FI measure and also illustrate that it is feasible to derive such a measure at the population level using routinely collected data. This may facilitate further research on frailty in this setting, including the development and evaluation of interventions for frailty.
评估识别健康结局不良风险较高的居家护理体弱客户的不同方法是一个重要但研究不足的领域。我们的目标是确定居家护理队列中衰弱（根据三种测量方法进行操作性定义）的患病率及其相关因素、这些测量方法之间的一致性，以及它们对一年中评估的几种结局的预测效度。
我们进行了一项回顾性队列研究，将基于人群的行政数据和临床数据（居民评估工具[RAI]）相链接，纳入2010年4月至2013年在加拿大安大略省接受评估的所有长期居家护理客户（年龄66岁及以上，n = 234,552）。我们研究了衰弱指数（FI）的两个版本，即完整FI和改良FI，以及CHESS量表，比较了它们的基线特征及其在根据年龄、性别和合并症进行调整的模型中对死亡、长期护理（LTC）入院和住院终点的预测准确性（通过计算ROC曲线下面积[AUC]）。
衰弱患病率因测量方法而异（完整FI为19.5%，改良FI为24.4%，CHESS为44.1%），在女性和男性客户中相似。在调整分析中，所有三种测量方法都与死亡、LTC入院和住院终点的风险显著增加相关，但将它们添加到基础模型中对大多数AUC估计值的改善不大。测量方法在预测准确性方面存在显著差异，完整FI在LTC入院方面显示出较高的AUC，CHESS在住院方面显示出较高的AUC——尽管没有一种测量方法在住院终点方面表现良好。
检测脆弱性的不同方法导致安大略省居家护理客户中衰弱患病率的估计值不同。虽然所有三种测量方法都是所检查的健康结局的重要预测指标，但除完整FI预测LTC入院外，预测准确性的提高通常不大。我们的研究结果为综合FI测量方法的临床实用性提供了一些支持，也表明使用常规收集的数据在人群层面得出这样的测量方法是可行的。这可能有助于在这种情况下对衰弱进行进一步研究，包括衰弱干预措施的开发和评估。
