Xiao hong Liu, No. 1 Shuai fu yuan, Dong cheng District, Beijing, 100730, China, e-mail:
J Nutr Health Aging. 2021;25(4):419-424. doi: 10.1007/s12603-020-1534-x.
OBJECTIVES: To compare the ability of Frailty Phenotype (FP), FRAIL and Frailty Index (FI) to predict adverse outcomes. DESIGN: A prospective cohort study. SETTING: A senior community in Beijing, China. PARTICIPANTS: A total of 188 older adults aged 65 years or older (mean age 84.0 ± 4.4 years, 58.5% female). MEASUREMENTS: Frailty was evaluated by FP, FRAIL and FI. The agreement between scales was assessed by Cohen kappa coefficient. The predictive value of the three scales for adverse outcomes during one-year follow-up period were analyzed using decision curve analysis(DCA) and receiver operating characteristic curve (ROC) analysis. RESULTS: Frailty ranged from 25% (FRAIL) to 42.6% (FI). The agreement between scales was moderate to good (Cohen's kappa coefficient 0.44~0.61). DCA showed though the curves of the scales overlapped across all relevant risk thresholds, clinical treating had a higher net benefit than "treat all" and "treat none" when risk of unplanned hospital visits ≥30%, risk of functional decline or falls ≥15%. The three scales had similar predictive value for unplanned hospital visits (area under ROC, AUC 0.63, 0.64 and 0.69). FRAIL and FI had similar predictive value for functional decline (AUC 0.63,0.65). FI had predictive value for falls (AUC 0.65). CONCLUSIONS: All three scales showed clinical utility but FRAIL may be best in practice because it is simple. Multidimensional measures of frailty are better than unidimensional for prediction of adverse outcomes among older adults.
目的:比较衰弱表型(FP)、衰弱评估工具(FRAIL)和衰弱指数(FI)预测不良结局的能力。 设计:前瞻性队列研究。 地点:中国北京的一个高级社区。 参与者:共纳入 188 名 65 岁及以上的老年人(平均年龄 84.0±4.4 岁,58.5%为女性)。 测量方法:采用 FP、FRAIL 和 FI 评估衰弱。采用 Cohen κ 系数评估量表间的一致性。采用决策曲线分析(DCA)和受试者工作特征曲线(ROC)分析评估三种量表在一年随访期间预测不良结局的价值。 结果:衰弱的发生率为 25%(FRAIL)至 42.6%(FI)。量表间的一致性为中等至良好(Cohen κ 系数 0.44~0.61)。DCA 显示,虽然曲线在所有相关风险阈值上都有重叠,但当非计划性就诊风险≥30%、功能下降或跌倒风险≥15%时,临床治疗比“治疗所有”和“不治疗所有”具有更高的净获益。三种量表对非计划性就诊的预测价值相似(ROC 曲线下面积,AUC 为 0.63、0.64 和 0.69)。FRAIL 和 FI 对功能下降的预测价值相似(AUC 为 0.63、0.65)。FI 对跌倒的预测价值较高(AUC 为 0.65)。 结论:三种量表均具有临床应用价值,但 FRAIL 可能在实践中最佳,因为它简单。多维衰弱指标比单一维度指标更能预测老年人的不良结局。
J Am Med Dir Assoc. 2017-6-3
J Am Geriatr Soc. 2014-3-17
Diabetol Metab Syndr. 2025-6-23