Vernerey Dewi, Anota Amelie, Vandel Pierre, Paget-Bailly Sophie, Dion Michele, Bailly Vanessa, Bonin Marie, Pozet Astrid, Foubert Audrey, Benetkiewicz Magdalena, Manckoundia Patrick, Bonnetain Franck
Methodological and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France.
National clinical research Platform for Quality of life in Oncology, Besançon, France.
BMC Geriatr. 2016 Nov 17;16(1):187. doi: 10.1186/s12877-016-0360-9.
Frailty is highly prevalent in elderly people. While significant progress has been made to understand its pathogenesis process, few validated questionnaire exist to assess the multidimensional concept of frailty and to detect people frail or at risk to become frail. The objectives of this study were to construct and validate a new frailty-screening instrument named Frailty Groupe Iso-Ressource Evaluation (FRAGIRE) that accurately predicts the risk for frailty in older adults.
A prospective multicenter recruitment of the elderly patients was undertaken in France. The subjects were classified into financially-helped group (FH, with financial assistance) and non-financially helped group (NFH, without any financial assistance), considering FH subjects are more frail than the NFH group and thus representing an acceptable surrogate population for frailty. Psychometric properties of the FRAGIRE grid were assessed including discrimination between the FH and NFH groups. Items reduction was made according to statistical analyses and experts' point of view. The association between items response and tests with "help requested status" was assessed in univariate and multivariate unconditional logistic regression analyses and a prognostic score to become frail was finally proposed for each subject.
Between May 2013 and July 2013, 385 subjects were included: 338 (88%) in the FH group and 47 (12%) in the NFH group. The initial FRAGIRE grid included 65 items. After conducting the item selection, the final grid of the FRAGIRE was reduced to 19 items. The final grid showed fair discrimination ability to predict frailty (area under the curve (AUC) = 0.85) and good calibration (Hosmer-Lemeshow P-value = 0.580), reflecting a good agreement between the prediction by the final model and actual observation. The Cronbach's alpha for the developed tool scored as high as 0.69 (95% Confidence Interval: 0.64 to 0.74). The final prognostic score was excellent, with an AUC of 0.756. Moreover, it facilitated significant separation of patients into individuals requesting for help from others (P-value < 0.0001), with sensitivity of 81%, specificity of 61%, positive predictive value of 93%, negative predictive value of 34%, and a global predictive value of 78%.
The FRAGIRE seems to have considerable potential as a reliable and effective tool for identifying frail elderly individuals by a public health social worker without medical training.
衰弱在老年人中极为普遍。尽管在了解其发病机制方面已取得重大进展，但用于评估衰弱这一多维度概念以及检测衰弱或有衰弱风险人群的经过验证的问卷却很少。本研究的目的是构建并验证一种名为“衰弱群体等资源评估（FRAGIRE）”的新型衰弱筛查工具，该工具能准确预测老年人的衰弱风险。
在法国对老年患者进行了一项前瞻性多中心招募。考虑到接受经济援助的人群（FH）比未接受经济援助的人群（NFH）更衰弱，因此将受试者分为经济援助组（FH，有经济援助）和非经济援助组（NFH，无任何经济援助），NFH组可作为可接受的衰弱替代人群。评估了FRAGIRE量表的心理测量特性，包括FH组和NFH组之间的区分度。根据统计分析和专家意见进行项目精简。在单变量和多变量无条件逻辑回归分析中评估项目反应与“请求帮助状态”测试之间的关联，最终为每个受试者提出了一个衰弱预后评分。
2013年5月至2013年7月，共纳入385名受试者：FH组338名（88%），NFH组47名（12%）。最初的FRAGIRE量表包含65个项目。经过项目筛选后，FRAGIRE的最终量表减少至19个项目。最终量表显示出较好的预测衰弱的区分能力（曲线下面积（AUC）=0.85）和良好的校准度（Hosmer-Lemeshow P值=0.580），这反映了最终模型的预测与实际观察之间的良好一致性。所开发工具的Cronbach's alpha高达0.69（95%置信区间：0.64至0.74）。最终的预后评分出色，AUC为0.756。此外，它有助于将患者显著分为需要他人帮助的个体（P值<0.0001），敏感性为81%，特异性为61%，阳性预测值为93%，阴性预测值为34%，总体预测值为78%。
FRAGIRE似乎有相当大的潜力，可作为一种可靠且有效的工具，供未经医学培训的公共卫生社会工作者识别衰弱老年人。
