Department of Maternal and Child Health and Public Health, University of São Paulo, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto School of Nursing, Ribeirão Preto, Brazil.
Program in Health Promotion and Care in Hospital Care of the Medical School of the University of São Paulo, São Paulo, Brazil.
PLoS One. 2019 Apr 29;14(4):e0216166. doi: 10.1371/journal.pone.0216166. eCollection 2019.
Frailty is a dynamic process in which there is a reduction in the physical, psychological and/or social function associated with aging. The aim of this study was to identify instruments for the detection of frailty in older adults, characterizing their components, application scenarios, ability to identify pre-frailty and clinimetric properties evaluated. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), under registration number CRD42017039318. A total of 14 electronic sources were searched to identify studies that investigated instruments for the detection of frailty or that presented the construction and/or clinimetric evaluation of the instrument, according to criteria established by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 96 studies were included in the qualitative synthesis: 51 instruments for the detection of frailty were identified, with predominantly physical domains; 40 were constructed and/or validated for use in the older adult community population, 28 only highlighted the distinction between frail and non-frail individuals and 23 presented three or more levels of frailty. The FRAGIRE, FRAIL Scale, Edmonton Frail Scale and IVCF-20 instruments were the most frequently analyzed in relation to clinimetric properties. It was concluded that: (I) there is a large number of instruments for measuring the same construct, which makes it difficult for researchers and clinicians to choose the most appropriate; (II) the FRAGIRE and CFAI stand out due to their multidimensional aspects, including an environmental assessment; however, (III) the need for standardization of the scales was identified, since the use of different instruments in clinical trials may prevent the comparability of the results in systematic reviews and; (IV) considering the different instruments identified in this review, the choice of researchers/clinicians should be guided by the issues related to the translation and validation for their location and the suitability for their context.
衰弱是一个动态过程，在此过程中，与衰老相关的身体、心理和/或社会功能下降。本研究旨在确定用于检测老年人衰弱的工具，描述其组成部分、应用场景、识别虚弱前期的能力以及评估的临床计量学特性。研究按照系统评价和荟萃分析的首选报告项目（PRISMA）进行，注册编号为 CRD42017039318。共检索了 14 个电子来源，以确定研究衰弱检测工具的研究，或根据共识基础健康测量仪器选择标准（COSMIN）制定的标准，介绍工具的构建和/或临床计量学评估的研究。纳入了 96 项定性综合研究：确定了 51 种用于检测衰弱的工具，主要为身体领域；40 种工具是为老年社区人群构建和/或验证的，28 种仅强调了虚弱和非虚弱个体之间的区别，23 种则具有三个或更多的衰弱水平。FRAGIRE、FRAIL Scale、Edmonton Frail Scale 和 IVCF-20 等仪器在临床计量学特性方面分析得最多。得出的结论是：（I）有大量的工具用于测量相同的结构，这使得研究人员和临床医生难以选择最合适的工具；（II）FRAGIRE 和 CFAI 由于其多维性，包括环境评估，因此脱颖而出；然而，（III）需要对量表进行标准化，因为在临床试验中使用不同的工具可能会阻止系统评价中结果的可比性；（IV）考虑到本综述中确定的不同工具，研究人员/临床医生的选择应根据与翻译和验证相关的问题来指导，以适应他们的位置和适合他们的环境。
