Geriatric Unit, Campus Bio-Medico University, Rome, Italy.
Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy; Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
J Am Med Dir Assoc. 2019 Aug;20(8):1026-1031. doi: 10.1016/j.jamda.2018.12.018. Epub 2019 Feb 13.
Frailty phenotype (FP) has low sensitivity toward the identification of older people who will lose 1 or more activities of daily living. Nevertheless, the definition of disability in terms of activities of daily living may not resemble the pattern of functional impairment occurring during aging. The aim of this study was to examine the discriminative capacity of the FP toward the identification of patterns of disabilities in an extended list of tasks, identified among community-dwelling older people.
Longitudinal cohort study.
We included 997 persons age 65 years and older selected from the Invecchiare in Chianti (InCHIANTI) Study population.
Using latent class analysis, we assessed the pattern of 3-year changes in 24 functional tasks. Then, we calculated the discriminative capacity of the FP for each pattern of disability. Analyses were stratified by sex.
In both men and women, we recognized 3 classes: stable function; disability in complex tasks; and global functional disability. Among women, ability of FP to identify persons in global functional disability showed sensitivity = 0.42, specificity = 0.98, positive and negative predictive values 0.75 and 0.91; the corresponding values for prediction of disability in complex tasks were 0.13, 0.98, 0.68, and 0.75. Similar results were obtained among men.
CONCLUSIONS/IMPLICATIONS: Over 3 years, older people of the InCHIANTI population remained largely functional stable, some persons developed deficiency in complex tasks, and a minority developed global functional disability. Trying to predict these 3 patterns may be useful for the care of older people in order to promote individualized interventions to reduce the burden of disabilities and their consequences. To this purpose, FP showed a fairly good capacity to identify people at risk of functional decline, but further studies are needed to identify instruments with better prognostic capacity.
虚弱表型（FP）对识别可能丧失 1 项或多项日常生活活动能力的老年人的敏感性较低。然而，根据日常生活活动来定义残疾的方式可能与老年人发生的功能障碍模式不同。本研究旨在检验 FP 对社区居住的老年人中确定的一系列扩展任务的残疾模式的识别能力。
纵向队列研究。
我们纳入了 997 名年龄在 65 岁及以上的 Invecchiare in Chianti（InCHIANTI）研究人群中的个体。
我们使用潜在类别分析评估了 3 年 24 项功能任务变化的模式。然后，我们计算了 FP 对每种残疾模式的识别能力。分析按性别分层。
在男性和女性中，我们都识别出了 3 种类型：功能稳定；复杂任务的残疾；以及全面功能障碍。在女性中，FP 识别处于全面功能障碍的个体的能力具有敏感性=0.42、特异性=0.98、阳性和阴性预测值分别为 0.75 和 0.91；预测复杂任务残疾的相应值分别为 0.13、0.98、0.68 和 0.75。男性也得到了类似的结果。
结论/意义：在 3 年期间，InCHIANTI 人群中的老年人在很大程度上保持功能稳定，一些人出现了复杂任务的缺陷，少数人出现了全面的功能障碍。尝试预测这 3 种模式可能有助于老年人的护理，以促进个体化干预措施来减轻残疾负担及其后果。为此，FP 对识别功能下降风险的个体具有相当好的能力，但需要进一步研究来确定具有更好预后能力的工具。
