Shi Sandra M, McCarthy Ellen P, Mitchell Susan L, Kim Dae Hyun
Hinda and Arthur Marcus Institute for Aging, Hebrew Senior Life, Boston, MA, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Gen Intern Med. 2020 May;35(5):1516-1522. doi: 10.1007/s11606-020-05700-w. Epub 2020 Feb 18.
Mortality prediction models are useful to guide clinical decision-making based on prognosis. The frailty index, which allows prognostication and personalized care planning, has not been directly compared with validated prognostic models.
To compare the discrimination of mortality, disability, falls, and hospitalization between a frailty index and validated prognostic indices.
Secondary Analysis of the National Health and Aging Trends Study.
Seven thousand thirty-three Medicare beneficiaries 65 years or older.
We measured a deficit-accumulation frailty index, Schonberg index, and Lee index at the 2011 baseline assessment. Primary outcome was mortality at 5 years. Secondary outcomes were decline in activities of daily living (ADL), decline in instrumental activities of daily living (IADL), fall, and hospitalization at 1 year. We used C-statistics to compare discrimination between indices, adjusting for age and sex.
The study population included 4146 (44.8%) with age ≥ 75 years, with a median frailty index of 0.15 (interquartile range 0.09-0.25). A total of 1385 participants died (14.7%) and 2386 (35.2%) were lost to follow-up. Frailty, Schonberg, and Lee indices predicted mortality similarly: C-statistics (95% confidence interval) were 0.78 (0.77-0.80) for frailty index; 0.79 (0.78-0.81) for Schonberg index; and 0.78 (0.77-0.80) for Lee index. The frailty index had higher C-statistics for decline in ADL function (frailty index, 0.80 [0.78-0.83]; Schonberg, 0.74 [0.72-0.76]; Lee, 0.74 [0.71-0.77]) and falls (frailty index, 0.66 [0.65-0.68]; Schonberg, 0.61 [0.58-0.63]; Lee, 0.61 [0.59-0.63]). C-statistics were similar for decline in IADL function (frailty index, 0.61 [0.59-0.63]; Schonberg, 0.60 [0.59-0.62]; Lee, 0.60 [0.58-0.62]) and hospitalizations (frailty index, 0.68 [0.66-0.70]; Schonberg, 0.68 [0.66-0.69]; Lee, 0.65 [0.63-0.67]).
A deficit-accumulation frailty index performs as well as prognostic indices for mortality prediction, and better predicts ADL disability and falls in community-dwelling older adults. Frailty assessment offers a unifying approach to risk stratification for key health outcomes relevant to older adults.
死亡率预测模型有助于基于预后指导临床决策。衰弱指数可用于预后评估和个性化护理规划，但尚未与经过验证的预后模型进行直接比较。
比较衰弱指数与经过验证的预后指数在死亡率、残疾、跌倒和住院方面的辨别能力。
对国家健康与老龄化趋势研究进行二次分析。
7033名65岁及以上的医疗保险受益人。
在2011年基线评估时，我们测量了缺陷积累衰弱指数、舍恩伯格指数和李指数。主要结局是5年时的死亡率。次要结局是1年时日常生活活动（ADL）能力下降、工具性日常生活活动（IADL）能力下降、跌倒和住院情况。我们使用C统计量来比较各指数之间的辨别能力，并对年龄和性别进行了调整。
研究人群包括4146名（44.8%）年龄≥75岁的参与者，衰弱指数中位数为0.15（四分位间距0.09 - 0.25）。共有1385名参与者死亡（14.7%），2386名（35.2%）失访。衰弱指数、舍恩伯格指数和李指数对死亡率的预测能力相似：衰弱指数的C统计量（95%置信区间）为0.78（0.77 - 0.80）；舍恩伯格指数为0.79（0.78 - 0.81）；李指数为0.78（0.77 - 0.80）。衰弱指数在ADL功能下降方面的C统计量更高（衰弱指数为0.80[0.78 - 0.83]；舍恩伯格指数为0.74[0.72 - 0.76]；李指数为0.74[0.71 - 0.77]）以及跌倒方面（衰弱指数为0.66[0.65 - 0.68]；舍恩伯格指数为0.61[0.58 - 0.63]；李指数为0.61[0.59 - 0.63]）。IADL功能下降（衰弱指数为0.61[0.59 - 0.63]；舍恩伯格指数为0.60[0.59 - 0.62]；李指数为0.60[0.58 - 0.62]）和住院情况（衰弱指数为0.68[0.66 - 0.70]；舍恩伯格指数为0.68[0.66 - 0.69]；李指数为0.65[0.63 - 0.67]）的C统计量相似。
缺陷积累衰弱指数在死亡率预测方面与预后指数表现相当，并且能更好地预测社区居住老年人的ADL残疾和跌倒情况。衰弱评估为与老年人相关的关键健康结局的风险分层提供了一种统一方法。
