Cuili Wang, School of Nursing, Peking University, 100191 Beijing, China. Email:
J Nutr Health Aging. 2020;24(2):188-193. doi: 10.1007/s12603-019-1301-z.
To examine the diagnostic test accuracy (DTA) of the FRAIL-NH and four frailty screening instruments among institutionalized older adults.
Cross-sectional study.
Institutionalized setting, Jinan, China.
A total of 305 older adults (mean age 79.3 ± 8.4 years, 57.0% female) were enrolled from nursing homes.
Frailty was assessed by the FRAIL-NH, Physical Frailty Phenotype (PFP), FRAIL, Tilburg Frailty Indicator (TFI), and Groningen Frailty Indicator (GFI), respectively. The Comprehensive Geriatric Assessment (CGA) was used as a reference standard of frailty. The receiver operating characteristic (ROC) curve was plotted to examine the DTA of five frailty screening instruments against the CGA. The optimal cut-point was determined by the maximum value of the Youden index (YI, calculated as sensitivity + specificity - 1).
The prevalence of frailty ranged from 25.9% (FRAIL) to 56.4% (GFI). Areas under the curve (AUCs) against the CGA ranged from 0.80 [95% confidence interval (CI) 0.74 - 0.85: FRAIL] to 0.83 (95% CI 0.78 - 0.88: PFP). At their original cut-points, all five frailty screening instruments presented low sensitivity (32.9% - 69.3%) and high specificity (80.0% - 93.8%), as well as high positive predictive values (90.7% - 94.9%) and low negative predictive values (33.2% - 48.1%). At their optimal cut-points, the sensitivity and specificity of the FRAIL-NH, PFP, and FRAIL tended to be balanced, and their correctly classified rates (76.1% - 81.3%) and kappa values (0.465 - 0.523) increased a lot. ROC contrasts showed that all five frailty screening instruments had similarly good diagnostic accuracy (χ2: 0.0003 - 1.38, P > .05).
In the institutionalized setting, the specific FRAIL-NH, self-report FRAIL, TFI, and GFI as well as hybrid PFP, show similarly good diagnostic properties in identifying frailty against the CGA.
评估 FRAIL-NH 和四种虚弱筛查工具在机构化老年人中的诊断测试准确性（DTA）。
横断面研究。
机构化环境，中国济南。
共纳入 305 名来自养老院的老年患者（平均年龄 79.3±8.4 岁，57.0%为女性）。
分别采用 FRAIL-NH、身体虚弱表型（PFP）、FRAIL、蒂尔堡虚弱指标（TFI）和格罗宁根虚弱指标（GFI）评估虚弱。综合老年评估（CGA）作为虚弱的参考标准。绘制受试者工作特征（ROC）曲线，以评估五种虚弱筛查工具对 CGA 的 DTA。通过最大 Youden 指数（YI，计算方法为敏感性+特异性-1）值确定最佳截断值。
虚弱的患病率范围为 25.9%（FRAIL）至 56.4%（GFI）。与 CGA 相比，曲线下面积（AUC）范围为 0.80[95%置信区间（CI）0.74-0.85：FRAIL]至 0.83（95%CI 0.78-0.88：PFP）。在原始截断值下，五种虚弱筛查工具的敏感性均较低（32.9%-69.3%），特异性均较高（80.0%-93.8%），阳性预测值均较高（90.7%-94.9%），阴性预测值均较低（33.2%-48.1%）。在最佳截断值下，FRAIL-NH、PFP 和 FRAIL 的敏感性和特异性趋于平衡，其正确分类率（76.1%-81.3%）和kappa 值（0.465-0.523）显著提高。ROC 对比显示，五种虚弱筛查工具均具有相似的良好诊断准确性（χ2：0.0003-1.38，P＞0.05）。
在机构化环境中，特定的 FRAIL-NH、自我报告的 FRAIL、TFI 和 GFI 以及混合的 PFP，在识别 CGA 下的虚弱方面具有相似的良好诊断特性。
