Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red (CIBER) en Fragilidad y Envejecimiento Saludable, Spain.
Centro de Salud de San Juan, Pamplona, Spain.
J Am Med Dir Assoc. 2017 Oct 1;18(10):898.e1-898.e8. doi: 10.1016/j.jamda.2017.06.016. Epub 2017 Jul 27.
The identification of frail individuals has been recognized as a priority for the effective implementation of healthy aging strategies. Only a limited number of studies have examined frailty in nursing homes, and there is a big heterogeneity in the methods used. The primary objective of this study was to determine the prevalence and feasibility of different frailty screening tools in nursing homes as well as its relationship with multimorbidity and disability.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis from a concurrent cohort study, which included 110 participants aged over 65 years and with different degrees of disability at 2 nursing homes.
The study used 4 different frailty scales: The Fried frailty criteria, the imputed Fried frailty criteria, the Rockwood clinical frailty scale, and the frailty in nursing home scale, and we analyzed their relationship with disability and multimorbidity.
The mean age of the study population was 86.3 years (standard deviation 7.3), and 71.8% were female. Most residents had a high percentage of cognitive and functional impairment, multimorbidity, and risk of malnutrition. The following prevalence rates for frailty were determined: 71.8% (62.8, 79.4), 42.7% (33.9, 52.1), and 36.4% (23.8, 51.1) as per according to the Rockwood clinical frailty scale, frailty in nursing home scale, and Fried index (95% confidence interval), respectively. In the case of the Fried index, the prevalence of frailty is based on the percentage of patients meeting the criteria, which is 40% due to the large number of missing values. After the imputation of variables with the multivariate imputation by chained equation software, the prevalence of frailty increased to 66.4% (57.1, 74.5). We observed different statistically significant associations between the frailty scales and the clinical and demographic variables, and also with disability and multimorbidity.
Most residents of nursing homes are likely to be frail, but there is no single operational definition of frailty. Although all measures of frailty had similar associations with the clinical variables of the study, there are important conceptual differences that must be considered in addressing the relationships between frailty, disability, and multimorbidity. Further research is required, and homogeneous frailty criteria must be used so that studies and interventions can be compared.
识别虚弱个体已被认为是实施健康老龄化策略的重点。只有少数研究调查了养老院中的虚弱情况，而且使用的方法存在很大的异质性。本研究的主要目的是确定不同的虚弱筛查工具在养老院中的流行程度和可行性，以及其与多病共存和残疾的关系。
设计、设置和参与者：这是一项同期队列研究的横断面分析，纳入了 2 家养老院中年龄在 65 岁以上且残疾程度不同的 110 名参与者。
本研究使用了 4 种不同的虚弱量表：Fried 虚弱标准、推断的 Fried 虚弱标准、Rockwood 临床虚弱量表和养老院虚弱量表，并分析了它们与残疾和多病共存的关系。
研究人群的平均年龄为 86.3 岁（标准差为 7.3），71.8%为女性。大多数居民认知和功能受损、多病共存和营养不良风险较高。根据 Rockwood 临床虚弱量表、养老院虚弱量表和 Fried 指数（95%置信区间），虚弱的患病率分别为 71.8%（62.8，79.4）、42.7%（33.9，52.1）和 36.4%（23.8，51.1）。在 Fried 指数的情况下，虚弱的患病率基于符合标准的患者比例，由于大量缺失值，患病率为 40%。在使用多元链方程软件进行变量推断后，虚弱的患病率增加至 66.4%（57.1，74.5）。我们观察到虚弱量表与临床和人口统计学变量之间存在不同的统计学显著关联，也与残疾和多病共存之间存在关联。
养老院的大多数居民可能都处于虚弱状态，但虚弱尚无单一的操作性定义。虽然所有的虚弱测量方法与研究的临床变量都有类似的关联，但在解决虚弱、残疾和多病共存之间的关系时，必须考虑到重要的概念差异。需要进一步研究，并使用统一的虚弱标准，以便对研究和干预措施进行比较。
