评估住院老年人衰弱和肌少症的可行性：常用工具的比较。
The feasibility of assessing frailty and sarcopenia in hospitalised older people: a comparison of commonly used tools.
机构信息
Academic Geriatric Medicine, University of Southampton, Southampton, UK.
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, UK.
出版信息
BMC Geriatr. 2019 Feb 15;19(1):42. doi: 10.1186/s12877-019-1053-y.
BACKGROUND
Frailty and sarcopenia are common amongst hospitalised older people and associated with poor healthcare outcomes. Widely recognised tools for their identification are the Fried Frailty Phenotype, its self-report version the FRAIL Scale, and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. We studied the feasibility of using these tools in a hospital setting of acute wards for older people.
METHODS
Patients aged 70+ years admitted to acute wards at one English hospital were prospectively recruited. The Fried Frailty Phenotype was assessed through measured grip strength, gait speed and questions on unintentional weight loss, exhaustion and physical activity. The 5-item self-reported FRAIL scale questionnaire covering the same domains was completed. Agreement between the two tools was reported using the Cohen kappa statistic. The EWGSOP criteria (gait speed, grip strength and muscle mass) were assessed by additional bedside measurement of muscle mass with bioelectrical impedance.
RESULTS
Two hundred thirty three participants (median age 80 years, 60% men) were recruited. Most (221, 95%) had their grip strength measured: 4 (2%) were unable and data were missing for 8 (3%). Only 70 (30%) completed the gait speed assessment: 153 (66%) were unable with missing data on 10 (4%). 113 (49%) participants had the bioelectrical impedance assessment. Muscle mass measurement was not possible for 84 (36%) participants: 25 patients declined, 21 patients were unavailable, 22 results were technically invalid, and 16 had clinical contra-indications. Data on 36 (15%) were missing. Considering inability to complete grip strength or gait speed assessments as low values, data for the Fried Frailty Phenotype was available for 218 (94%) of participants; frailty was identified in 105 (48%). 230 (99%) patients completed the FRAIL scale; frailty was identified among 77 (34%). There was moderate agreement between the two frailty tools (Kappa value of 0.46, 95%CI: 0.34 to 0.58). Complete data for the EWGOSP criteria were only available for 124 (53%) patients of whom 40 (32%) had sarcopenia.
CONCLUSION
It was feasible to measure grip strength and complete the FRAIL scale among older inpatients in hospital. Measuring gait speed and muscle mass to identify sarcopenia was challenging in the acute setting.
TRIAL REGISTRATION
ISRCTN registry (ID ISRCTN16391145 ) on 30.12.14.
背景
衰弱和肌少症在住院老年人群中很常见，与不良的医疗保健结果相关。广泛认可的识别工具是 Fried 衰弱表型、其自我报告版本 FRAIL 量表以及欧洲老年人肌少症工作组（EWGSOP）标准。我们研究了在一家医院的急性病房中使用这些工具的可行性。
方法
前瞻性招募了一家英国医院急性病房中 70 岁以上的患者。通过测量握力、步态速度和非故意体重减轻、疲劳和身体活动问题评估 Fried 衰弱表型。完成了涵盖相同领域的 5 项自我报告 FRAIL 量表问卷。使用 Cohen kappa 统计量报告两种工具之间的一致性。通过生物电阻抗法对肌肉质量进行额外的床边测量，评估 EWGSOP 标准（步态速度、握力和肌肉质量）。
结果
共招募了 233 名参与者（中位年龄 80 岁，60%为男性）。大多数（221 名，95%）进行了握力测量：4 名（2%）无法进行，8 名（3%）数据缺失。只有 70 名（30%）完成了步态速度评估：153 名（66%）无法进行，10 名（4%）数据缺失。113 名（49%）参与者接受了生物电阻抗评估。84 名（36%）参与者无法进行肌肉质量测量：25 名患者拒绝，21 名患者无法参加，22 名结果技术无效，16 名患者存在临床禁忌症。有 36 名（15%）数据缺失。考虑到无法完成握力或步态速度评估视为低值，218 名（94%）参与者可获得 Fried 衰弱表型数据；105 名（48%）参与者被确定为衰弱。230 名（99%）患者完成了 FRAIL 量表；77 名（34%）参与者被确定为衰弱。两种衰弱工具之间存在中度一致性（Kappa 值为 0.46，95%CI：0.34 至 0.58）。仅 124 名（53%）患者可获得 EWGOSP 标准的完整数据，其中 40 名（32%）患有肌少症。
结论
在医院住院老年患者中测量握力和完成 FRAIL 量表是可行的。在急性环境中测量步态速度和肌肉质量以识别肌少症具有挑战性。
试验注册
ISRCTN 注册（ID ISRCTN16391145）于 2014 年 12 月 30 日。
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