Department of General Medicine, Sengkang General Hospital, Singapore.
Ann Acad Med Singap. 2019 Jun;48(6):171-180.
Frailty begins in middle life and manifests as a decline in functional fitness. We described a model for community frailty screening and factors associated with prefrailty and frailty and fitness measures to distinguish prefrail/frail from robust older adults. We also compared the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (FRAIL) scale against Fried frailty phenotype and Frailty Index (FI).
Community-dwelling adults ≥55 years old were designated robust, prefrail or frail using FRAIL. The multidomain geriatric screen included social profiling and cognitive, psychological and nutritional assessments. Physical fitness assessments included flexibility, grip strength, upper limb dexterity, lower body strength and power, tandem and dynamic balance and cardiorespiratory endurance.
In 135 subjects, 99 (73.3%) were robust, 34 (25.2%) were prefrail and 2 (1.5%) were frail. After adjusting for age and sex, depression (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.05-7.90; = 0.040) and malnutrition (OR, 6.07; 95% CI, 2.52-14.64; <0.001) were independently associated with prefrailty/frailty. Prefrail/frail participants had significantly poorer performance in upper limb dexterity ( = 0.030), lower limb power ( = 0.003), tandem and dynamic balance ( = 0.031) and endurance ( = 0.006). Except for balance and flexibility, all fitness measures differentiated prefrail/frail from robust women. In men, only lower body strength was significantly associated with frailty. Area under receiver operating characteristic curves for FRAIL against FI and Fried were 0.808 (0.688-0.927, <0.001) and 0.645 (0.546-0.744, = 0.005), respectively.
Mood and nutrition are targets in frailty prevention. Physical fitness declines early in frailty and manifests differentially in both genders.
虚弱始于中年，表现为功能健康的下降。我们描述了一种社区虚弱筛查模型，以及与虚弱前期和虚弱相关的因素和与健康相关的测量指标，以区分虚弱前期/虚弱和健康的老年人。我们还比较了疲劳、抵抗、活动、疾病和体重减轻（FRAIL）量表与 Fried 虚弱表型和虚弱指数（FI）。
≥55 岁的社区居住成年人使用 FRAIL 被指定为强壮、虚弱前期或虚弱。多领域老年综合评估包括社会档案和认知、心理和营养评估。体能评估包括柔韧性、握力、上肢灵巧性、下肢力量和力量、双足和动态平衡以及心肺耐力。
在 135 名受试者中，99 名（73.3%）为强壮，34 名（25.2%）为虚弱前期，2 名（1.5%）为虚弱。调整年龄和性别后，抑郁（比值比 [OR]，2.90；95%置信区间 [CI]，1.05-7.90； = 0.040）和营养不良（OR，6.07；95% CI，2.52-14.64； <0.001）与虚弱前期/虚弱独立相关。虚弱前期/虚弱参与者在上肢灵巧性（ = 0.030）、下肢力量（ = 0.003）、双足和动态平衡（ = 0.031）和耐力（ = 0.006）方面表现明显较差。除了平衡和柔韧性，所有的健康测量指标都能区分虚弱前期/虚弱和强壮的女性。在男性中，只有下肢力量与虚弱显著相关。FRAIL 与 FI 和 Fried 的接受者操作特征曲线下面积分别为 0.808（0.688-0.927， <0.001）和 0.645（0.546-0.744， = 0.005）。
情绪和营养是虚弱预防的目标。虚弱前期的体能下降较早，并在两性中表现出不同的情况。
