Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; The Chinese University of Hong Kong Jockey Club Institute of Ageing, Shatin, Hong Kong.
Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; The Chinese University of Hong Kong Jockey Club Institute of Ageing, Shatin, Hong Kong.
J Am Med Dir Assoc. 2018 May;19(5):444-449. doi: 10.1016/j.jamda.2017.11.006. Epub 2017 Dec 16.
To examine the ability of each item of the Fried phenotype of frailty to predict physical limitation and physical performance measures after 4 years, walking speed and hospitalization after 7 years, and mortality after 12 years.
Prospective cohort study.
Community-living older people in Hong Kong SAR, China.
4000 community-living Chinese men and women aged 65 and older were recruited using stratified sampling so that approximately 33% each would be aged 65-69, 70-74, and 75 and older. Those who were unable to walk independently, had had bilateral hip replacement, or were not competent to give informed consent were excluded.
Information was collected from questionnaire to include sociodemographic and lifestyle data, medical history, cognition, mood, and ability to carry out daily functional tasks. Frailty was assessed using the 5-item Fried phenotype, or Cardiovascular Health Study (CHS) scale. Measurements include grip strength, 6-m walking speed, and chair stand. Length of hospital stay was obtained from the hospital records. Death was ascertained from the Death Registry.
Logistic regression was used to analyze the association between individual items and health outcomes, adjusting for age, education, chronic obstructive pulmonary disease, diabetes mellitus, hypertension, heart disease, current smoker, Mini-Mental State Examination score, and depression. The predictive ability of each item was examined using the area under the curve (AUC), and stepwise models were applied to assess the incremental predictive validity.
In men, all items of the CHS scale predicted increased risk of physical limitation after 4 years with similar AUC values. The lowest quintile of walking speed and grip strength predicted increased risk of walking speed <0.8 m/s at 4 and 7 years. The other items had variable predictive ability for outcomes. For women, low walking speed and grip strength were the only 2 items that predicted all the adverse outcomes except mortality. When each item was entered into a stepwise model to predict adverse outcomes, low walking speed predicted nearly as well as the combined 5-item CHS.
The 5-item Fried phenotype in frailty screening in clinical management may be replaced by a single physical performance measure such as walking speed or grip strength, but cut-off values derived from individual populations need to be applied.
探究衰弱的 Fried 表型的各个条目在 4 年后预测身体受限和身体表现测量、7 年后预测步行速度和住院情况、12 年后预测死亡率的能力。
前瞻性队列研究。
中国香港特别行政区的社区居住的老年人。
招募了 4000 名年龄在 65 岁及以上的社区居住的中国男女，采用分层抽样，以便每个年龄组（65-69 岁、70-74 岁和 75 岁及以上）各占约 33%。那些无法独立行走、双侧髋关节置换或没有能力提供知情同意的人被排除在外。
通过问卷收集信息，包括社会人口统计学和生活方式数据、病史、认知、情绪和日常功能任务的完成能力。使用 5 项 Fried 表型或心血管健康研究（CHS）量表评估衰弱。测量包括握力、6 米步行速度和椅子站立。住院时间从医院记录中获得。从死亡登记处确定死亡情况。
使用逻辑回归分析单个条目与健康结果之间的关联，调整年龄、教育、慢性阻塞性肺疾病、糖尿病、高血压、心脏病、当前吸烟者、简易精神状态检查评分和抑郁情况。使用曲线下面积（AUC）检查每个条目的预测能力，并应用逐步模型评估增量预测有效性。
在男性中，CHS 量表的所有条目都预测了 4 年后身体受限的风险增加，AUC 值相似。步行速度和握力最低五分位数预测了 4 年和 7 年后步行速度<0.8m/s 的风险增加。其他条目对结果的预测能力各不相同。对于女性，低步行速度和握力是唯一 2 个预测除死亡率以外所有不良结局的条目。当每个条目被输入逐步模型来预测不良结局时，低步行速度的预测效果几乎与 CHS 的 5 个条目组合相当。
衰弱的 Fried 表型在临床管理中的筛查可能会被单一的身体表现测量（如步行速度或握力）所取代，但需要应用从不同人群中得出的截断值。
Zotero 插件