Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.
J Am Med Dir Assoc. 2018 Apr;19(4):310-314.e3. doi: 10.1016/j.jamda.2017.10.017. Epub 2017 Dec 27.
Comparison of frailty instruments in low-middle income countries, where the prevalence of frailty may be higher, is scarce. In addition, less complex diagnostic tools for frailty are important in these settings, especially in acutely ill patients, because of limited time and economic resources. We aimed to compare the performance of 3 frailty instruments for predicting adverse outcomes after 1 year of follow-up in older adults with an acute event or a chronic decompensated disease.
Prospective cohort study.
Geriatric day hospital (GDH) specializing in acute care.
A total of 534 patients (mean age 79.6 ± 8.4 years, 63% female, 64% white) admitted to the GDH.
Frailty was assessed using the Cardiovascular Health Study (CHS) criteria, the Study of Osteoporotic Fracture (SOF) criteria, and the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) questionnaire. Monthly phone contacts were performed over the course of the first year to detect the following outcomes: incident disability, hospitalization, fall, and death. Multivariable Cox proportional hazard regression models were performed to evaluate the association of the outcomes with frailty as defined by the 3 instruments. In addition, we compared the accuracy of these instruments for predicting the outcomes.
Prevalence of frailty ranged from 37% (using FRAIL) to 51% (using CHS). After 1 year of follow-up, disability occurred in 33% of the sample, hospitalization in 40%, fall in 44%, and death in 16%. Frailty, as defined by the 3 instruments was associated with all outcomes, whereas prefrailty was associated with disability, using the SOF and FRAIL instruments, and with hospitalization using the CHS and SOF instruments. The accuracy of frailty to predict different outcomes was poor to moderate with area under the curve varying from 0.57 (for fall, with frailty defined by SOF and FRAIL) to 0.69 (for disability, with frailty defined by CHS).
In acutely ill patients from a low-middle income country GDH acute care unit, the CHS, SOF, and FRAIL instruments showed similar performance in predicting adverse outcomes.
在中低收入国家，衰弱的流行率可能更高，因此比较衰弱工具的研究很少。此外，在这些环境中，衰弱的诊断工具越简单越好，尤其是在急性病患者中，因为时间和经济资源有限。我们旨在比较 3 种衰弱工具在预测急性事件或慢性失代偿性疾病后 1 年的不良结局方面的性能。
前瞻性队列研究。
专门从事急性护理的老年日医院（GDH）。
共纳入 534 名患者（平均年龄 79.6±8.4 岁，63%为女性，64%为白人），收入 GDH。
使用心血管健康研究（CHS）标准、骨质疏松性骨折研究（SOF）标准和衰弱（疲劳、抵抗力、活动、疾病和体重减轻）问卷评估衰弱。在第一年的过程中每月进行电话联系，以检测以下结果：残疾、住院、跌倒和死亡。使用多变量 Cox 比例风险回归模型评估 3 种工具定义的衰弱与结局的相关性。此外，我们比较了这些工具预测结局的准确性。
衰弱的患病率从 37%（使用 FRAIL）到 51%（使用 CHS）不等。在 1 年的随访后，33%的样本发生残疾，40%发生住院，44%发生跌倒，16%死亡。3 种工具定义的衰弱与所有结局相关，而前衰弱与 SOF 和 FRAIL 工具定义的残疾以及 CHS 和 SOF 工具定义的住院相关。衰弱预测不同结局的准确性较差到中等，曲线下面积从 0.57（SOF 和 FRAIL 定义的衰弱与跌倒相关）到 0.69（CHS 定义的衰弱与残疾相关）不等。
在来自中低收入国家 GDH 急性护理病房的急性病患者中，CHS、SOF 和 FRAIL 工具在预测不良结局方面表现相似。
