Lee Linda, Patel Tejal, Costa Andrew, Bryce Erin, Hillier Loretta M, Slonim Karen, Hunter Susan W, Heckman George, Molnar Frank
Family physician with the Centre for Family Medicine Family Health Team (CFFM FHT) in Kitchener, Ont, Schlegel Research Chair in Primary Care for Elders at the Schlegel-UW Research Institute for Aging, and Associate Clinical Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont.
Pharmacist with the CFFM FHT and Assistant Clinical Professor at the University of Waterloo School of Pharmacy.
Can Fam Physician. 2017 Jan;63(1):e51-e57.
To examine the accuracy of individual Fried frailty phenotype measures in identifying the Fried frailty phenotype in primary care.
Retrospective chart review.
A community-based primary care practice in Kitchener, Ont.
A total of 516 patients 75 years of age and older who underwent frailty screening.
Using modified Fried frailty phenotype measures, frailty criteria included gait speed, hand-grip strength as measured by a dynamometer, and self-reported exhaustion, low physical activity, and unintended weight loss. Sensitivity, specificity, accuracy, and precision were calculated for single-trait and dual-trait markers.
Complete frailty screening data were available for 383 patients. The overall prevalence of frailty based on the presence of 3 or more frailty criteria was 6.5%. The overall prevalence of individual Fried frailty phenotype markers ranged from 2.1% to 19.6%. The individual criteria all showed sensitivity and specificity of more than 80%, with the exception of weight loss (8.3% and 97.4%, respectively). The positive predictive value of the single-item criteria in predicting the Fried frailty phenotype ranged from 12.5% to 52.5%. When gait speed and hand-grip strength were combined as a dual measure, the positive predictive value increased to 87.5%.
There is a need for frailty measures that are psychometrically sound and feasible to administer in primary care. While use of gait speed or grip strength alone was found to be sensitive and specific as a proxy for the Fried frailty phenotype, use of both measures together was found to be accurate, precise, specific, and more sensitive than other possible combinations. Assessing both measures is feasible within primary care.
检验个体Fried衰弱表型测量在基层医疗中识别Fried衰弱表型的准确性。
回顾性病历审查。
安大略省基奇纳市的一个社区基层医疗诊所。
共有516名75岁及以上接受衰弱筛查的患者。
采用改良的Fried衰弱表型测量方法，衰弱标准包括步速、用握力计测量的握力，以及自我报告的疲惫、低体力活动和非故意体重减轻。计算单性状和双性状标志物的敏感性、特异性、准确性和精确性。
383名患者有完整的衰弱筛查数据。基于3项或更多衰弱标准的衰弱总体患病率为6.5%。个体Fried衰弱表型标志物的总体患病率在2.1%至19.6%之间。除体重减轻外（分别为8.3%和97.4%），各单项标准的敏感性和特异性均超过80%。单项标准预测Fried衰弱表型的阳性预测值在12.5%至52.5%之间。当步速和握力作为双指标联合使用时，阳性预测值增至87.5%。
需要在基层医疗中采用心理测量合理且可行的衰弱测量方法。虽然单独使用步速或握力作为Fried衰弱表型的替代指标具有敏感性和特异性，但发现两者联合使用比其他可能的组合更准确、精确、特异且更敏感。在基层医疗中同时评估这两项指标是可行的。
