Fougère Bertrand, Sirois Marie-Josée, Carmichael Pierre-Hugues, Batomen-Kuimi Brice-Lionel, Chicoulaa Bruno, Escourrou Emile, Nourhashémi Fati, Oustric Stéphane, Vellas Bruno
Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France.
Centre d'Excellence sur le Vieillissement de Québec, Québec, Canada.
J Am Med Dir Assoc. 2017 Feb 1;18(2):193.e1-193.e5. doi: 10.1016/j.jamda.2016.11.008.
The progression of frailty is marked by an increased risk of adverse health outcomes in the elderly including falls, physical and/or cognitive disability, hospitalizations, and mortality. In primary care, the general practitioner's (GP's) clinical impression about their elderly patients' frailty state seems to be a key point in identifying frail individuals in their clinical practice. The aim of this article is to examine if GPs' clinical impressions regarding frailty concurs with objective measures of the gold standard frailty phenotype as described by Fried in community-dwelling older persons.
Cross-sectional study in 14 primary care GP offices in the Toulouse area from May 1st to October 31st, 2015.
Fourteen GPs screened their patients ≥70 years old.
GPs' "frailty impression" was based on the Gérontopôle Frailty Screening Tool. "Objective measures of the five Fried frailty criteria" were obtained by a geriatric nurse through standardized testing. The capacity of the GPs' clinical impression to detect participants objectively measured as frail was examined with diagnostic values of observed sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV).
A total of 268 participants were screened by GPs and assessed by a nurse. Mean age was 81 years and 62.3% were female. According to the objective measures of Fried's criteria, frailty (three to five criteria) and pre-frailty (one to two criteria) states were identified in 31% and 45.2% of participants, respectively. The Se of the GPs' impression was good (80.39%; 95% confidence interval [CI], 74.27%-85.61%), and the Sp was moderate (64.06%; 95% CI, 5.10%-75.68%). The overall PPV of the GPs' impression was 87.70% (95% CI, 82.12%-92.04%), and the NPV was 50.51% (95% CI, 39.27%-61.91%). Although the PPV increased with age reaching 93.33% (95% CI, 85.12%-97.80%) among patients ≥ 85 years old, the NPV decreased accordingly to a minimal 21.43% (95% CI, 4.66%-50.80%) in that subgroup.
The present study highlights the importance of the GPs' clinical impression on frailty as a fair means to identify this syndrome in community-dwelling older patients in primary care. This clinical impression may not be sufficient, however, and some objective tests could be added to improve the accuracy of frailty detection in older patients in primary care.
衰弱的进展以老年人不良健康结局风险增加为特征，这些不良结局包括跌倒、身体和/或认知残疾、住院和死亡。在初级保健中，全科医生（GP）对老年患者衰弱状态的临床印象似乎是其临床实践中识别衰弱个体的关键点。本文旨在研究全科医生对衰弱的临床印象是否与Fried所描述的社区居住老年人的金标准衰弱表型的客观测量结果一致。
2015年5月1日至10月31日在图卢兹地区14个初级保健全科医生办公室进行的横断面研究。
14名全科医生对其70岁及以上的患者进行了筛查。
全科医生的“衰弱印象”基于老年医学中心衰弱筛查工具。“Fried五项衰弱标准的客观测量”由一名老年护理护士通过标准化测试获得。通过观察到的敏感性（Se）、特异性（Sp）、阳性预测值（PPV）和阴性预测值（NPV）的诊断值，检验全科医生临床印象检测客观测量为衰弱的参与者的能力。
全科医生共筛查了268名参与者，并由一名护士进行了评估。平均年龄为81岁，62.3%为女性。根据Fried标准的客观测量，分别在31%和45.2%的参与者中识别出衰弱（三至五项标准）和衰弱前期（一至两项标准）状态。全科医生印象的Se良好（80.39%；95%置信区间[CI]，74.27%-85.61%），Sp中等（64.06%；95%CI，5.10%-75.68%）。全科医生印象的总体PPV为87.70%（95%CI，82.12%-92.04%），NPV为50.51%（95%CI，39.27%-61.91%）。尽管PPV随年龄增长而增加，在85岁及以上患者中达到93.33%（95%CI，85.12%-97.80%），但该亚组中的NPV相应下降至最低21.43%（95%CI，4.66%-50.80%）。
本研究强调了全科医生对衰弱的临床印象作为在初级保健中识别社区居住老年患者中这种综合征的合理手段的重要性。然而，这种临床印象可能并不充分，可以增加一些客观测试以提高初级保健中老年患者衰弱检测的准确性。
