Schoufour Josje D, Echteld Michael A, Evenhuis Heleen M
Intellectual Disability Medicine, Department of General Practice, Erasmus Medical Center, PO box 2040, 3000 CA Rotterdam, The Netherlands.
Department of Epidemiology, Erasmus Medical Center, PO box 2040, 3000 CA Rotterdam, The Netherlands.
Eur J Ageing. 2017;14(1):63-79. doi: 10.1007/s10433-016-0388-x. Epub 2016 Jun 24.
In general, disabilities are considered a consequence of frailty rather than a cause of frailty, whereas in people with intellectual disabilities (ID), disabilities are often lifelong, which could have consequences for the feasibility and validity of frailty instruments. To better understand frailty in people with ID, we compared two broadly used concepts: the frailty phenotype (FP) and the frailty index (FI) taking into account their feasibility (e.g., percentage of participants able to complete the frailty assessments), agreement, validity (based on 5-year mortality risk), influence of motor disability, and the relation between single frailty variables and mortality. The FI and an adapted version of the FP were applied to a representative dataset of 1050 people with ID, aged 50 years and over. The FI was feasible in a larger part of the dataset (94 %) than the adapted FP: 29 % for all five items, and 81 % for at least three items. There was a slight agreement between the approaches ( = 0.3). However defined, frailty was related with mortality, but the FI showed higher discriminative ability and a stronger relation with mortality, especially when adjusted for motor disabilities. Concluding, these results imply that the used FI is a stronger predictor for mortality and has higher feasibility than our adaptation of the FP, in older people with ID. Possible explanations of our findings are that we did not use the exact FP variables or that the FI includes multiple health domains, and the variables of the FI have lower sensitivity to lifelong disabilities and are less determined by mobility.
一般来说，残疾被认为是虚弱的结果而非原因，而在智力残疾（ID）人群中，残疾往往是终身的，这可能会影响虚弱评估工具的可行性和有效性。为了更好地理解ID人群中的虚弱情况，我们比较了两个广泛使用的概念：虚弱表型（FP）和虚弱指数（FI），同时考虑了它们的可行性（例如，能够完成虚弱评估的参与者百分比）、一致性、有效性（基于5年死亡风险）、运动残疾的影响以及单个虚弱变量与死亡率之间的关系。FI和一个经过改编的FP版本被应用于一个包含1050名年龄在50岁及以上的ID人群的代表性数据集。FI在数据集中的可行部分（94%）比改编后的FP更大：所有五项指标的可行率为29%，至少三项指标的可行率为81%。两种方法之间存在轻微的一致性（=0.3）。无论如何定义，虚弱都与死亡率相关，但FI显示出更高的辨别能力以及与死亡率更强的相关性，尤其是在对运动残疾进行调整之后。总之，这些结果表明，在老年ID人群中，所使用的FI是更强的死亡率预测指标，并且比我们改编的FP具有更高的可行性。我们研究结果的可能解释是，我们没有使用确切的FP变量，或者FI包含多个健康领域，并且FI的变量对终身残疾的敏感性较低，受 mobility 的影响较小。 （注：最后一句中“mobility”在原文语境中不太明确准确含义，可能影响翻译的精准度）
