National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia.
Torrens University Australia, Adelaide, South Australia, Australia.
J Gerontol A Biol Sci Med Sci. 2020 May 22;75(6):1134-1142. doi: 10.1093/gerona/glz260.
Rapid frailty screening remains problematic in primary care. The diagnostic test accuracy (DTA) of several screening instruments has not been sufficiently established. We evaluated the DTA of several screening instruments against two reference standards: Fried's Frailty Phenotype [FP] and the Adelaide Frailty Index [AFI]), a self-reported questionnaire.
DTA study within three general practices in South Australia. We randomly recruited 243 general practice patients aged 75+ years. Eligible participants were 75+ years, proficient in English and community-dwelling. We excluded those who were receiving palliative care, hospitalized or living in a residential care facility.We calculated sensitivity, specificity, predictive values, likelihood ratios, Youden Index and area under the curve (AUC) for: Edmonton Frail Scale [EFS], FRAIL Scale Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC], Polypharmacy [POLY], PRISMA-7 [P7], Reported Edmonton Frail Scale [REFS], Self-Rated Health [SRH] and Timed Up and Go [TUG]) against FP [3+ criteria] and AFI [>0.21].
We obtained valid data for 228 participants, with missing scores for index tests multiply imputed. Frailty prevalence was 17.5% frail, 56.6% prefrail [FP], and 48.7% frail, 29.0% prefrail [AFI]. Of the index tests KC (Se: 85.0% [70.2-94.3]; Sp: 73.4% [66.5-79.6]) and REFS (Se: 87.5% [73.2-95.8]; Sp: 75.5% [68.8-81.5]), both against FP, showed sufficient diagnostic accuracy according to our prespecified criteria.
Two screening instruments-the KC and REFS, show the most promise for wider implementation within general practice, enabling a personalized approach to care for older people with frailty.
快速虚弱筛查在初级保健中仍然存在问题。几种筛查工具的诊断测试准确性（DTA）尚未得到充分证实。我们评估了几种筛查工具对两个参考标准的 DTA：弗里德的虚弱表型[FP]和阿德莱德虚弱指数[AFI]，这是一个自我报告的问卷。
在南澳大利亚的三个全科诊所进行的 DTA 研究。我们随机招募了 243 名 75 岁以上的全科诊所患者。合格的参与者年龄在 75 岁以上，精通英语，居住在社区。我们排除了正在接受姑息治疗、住院或居住在养老院的患者。我们计算了对 FP[3+标准]和 AFI[>0.21]的敏感性、特异性、预测值、似然比、Youden 指数和曲线下面积（AUC）：埃德蒙顿虚弱量表[EFS]、虚弱量表问卷[FQ]、步态速度测试[GST]、格罗宁根虚弱指标[GFI]、基本健康检查表[KC]、多种药物治疗[POLY]、PRISMA-7[P7]、报告的埃德蒙顿虚弱量表[REFS]、自我报告的健康状况[SRH]和计时起立行走测试[TUG]。
我们获得了 228 名参与者的有效数据，对指数测试的缺失分数进行了多次插补。虚弱患病率为 17.5%脆弱，56.6%衰弱前[FP]，48.7%脆弱，29.0%衰弱前[AFI]。在指数测试 KC（Se：85.0%[70.2-94.3]；Sp：73.4%[66.5-79.6]）和 REFS（Se：87.5%[73.2-95.8]；Sp：75.5%[68.8-81.5]）中，两种测试均针对 FP，根据我们预先指定的标准，显示出足够的诊断准确性。
两种筛查工具-KC 和 REFS，最有希望在全科实践中更广泛地实施，为虚弱老年人提供个性化的护理方法。
