Op Het Veld Linda P M, Beurskens Anna J H M, de Vet Henrica C W, van Kuijk Sander M J, Hajema KlaasJan, Kempen Gertrudis I J M, van Rossum Erik
1Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, The Netherlands.
2CAPHRI, Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
Eur J Ageing. 2019 Feb 19;16(3):387-394. doi: 10.1007/s10433-019-00502-4. eCollection 2019 Sep.
The aim of this study was to assess the predictive ability of the frailty phenotype (FP), Groningen Frailty Indicator (GFI), Tilburg Frailty Indicator (TFI) and frailty index (FI) for the outcomes mortality, hospitalization and increase in dependency in (instrumental) activities of daily living ((I)ADL) among older persons. This prospective cohort study with 2-year follow-up included 2420 Dutch community-dwelling older people (65+, mean age 76.3 ± 6.6 years, 39.5% male) who were pre-frail or frail according to the FP. Mortality data were obtained from Statistics Netherlands. All other data were self-reported. Area under the receiver operating characteristic curves (AUC) was calculated for each frailty instrument and outcome measure. The prevalence of frailty, sensitivity and specificity were calculated using cutoff values proposed by the developers and cutoff values one above and one below the proposed ones (0.05 for FI). All frailty instruments poorly predicted mortality, hospitalization and (I)ADL dependency (AUCs between 0.62-0.65, 0.59-0.63 and 0.60-0.64, respectively). Prevalence estimates of frailty in this population varied between 22.2% (FP) and 64.8% (TFI). The FP and FI showed higher levels of specificity, whereas sensitivity was higher for the GFI and TFI. Using a different cutoff point considerably changed the prevalence, sensitivity and specificity. In conclusion, the predictive ability of the FP, GFI, TFI and FI was poor for all outcomes in a population of pre-frail and frail community-dwelling older people. The FP and the FI showed higher values of specificity, whereas sensitivity was higher for the GFI and TFI.
本研究旨在评估衰弱表型（FP）、格罗宁根衰弱指标（GFI）、蒂尔堡衰弱指标（TFI）和衰弱指数（FI）对老年人死亡率、住院率以及日常生活（工具性）活动（（I）ADL）依赖性增加等结局的预测能力。这项为期2年随访的前瞻性队列研究纳入了2420名荷兰社区居住的老年人（65岁及以上，平均年龄76.3±6.6岁，男性占39.5%），这些老年人根据FP标准处于衰弱前期或衰弱状态。死亡率数据来自荷兰统计局。所有其他数据均为自我报告。计算了每种衰弱工具和结局指标的受试者工作特征曲线下面积（AUC）。使用开发者提出的临界值以及比提出的临界值高一个单位和低一个单位的临界值（FI为0.05）计算衰弱的患病率、敏感性和特异性。所有衰弱工具对死亡率、住院率和（I）ADL依赖性的预测能力都很差（AUC分别在0.62 - 0.65、0.59 - 0.63和0.60 - 0.64之间）。该人群中衰弱的患病率估计值在22.2%（FP）至64.8%（TFI）之间。FP和FI显示出较高的特异性水平，而GFI和TFI的敏感性较高。使用不同的临界值会显著改变患病率、敏感性和特异性。总之，在衰弱前期和衰弱的社区居住老年人人群中，FP、GFI、TFI和FI对所有结局的预测能力都很差。FP和FI显示出较高的特异性值，而GFI和TFI的敏感性较高。
