Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore.
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
J Am Med Dir Assoc. 2022 Nov;23(11):1870.e1-1870.e7. doi: 10.1016/j.jamda.2022.04.046. Epub 2022 Jun 2.
We examined the construct validity of 2 self-reported frailty questionnaires, the Frailty Phenotype Questionnaire (FPQ) and FRAIL, against the Cardiovascular Health Study frailty phenotype (CHS-FP).
Cross-sectional data analysis of longitudinal prospective cohort study.
We included data from 230 older adults (mean age: 67.2 ± 7.4 years) from the "Longitudinal Assessment of Biomarkers for characterization of early Sarcopenia and Osteosarcopenic Obesity in predicting frailty and functional decline in community-dwelling Asian older adults Study" (GeriLABS 2) recruited between December 2017 and March 2019.
We compared area under receiver operating characteristic curves (AUC), agreement, correlation, and predictive validity against outcome measures [Short Physical Performance Battery, 5 times repeat chair stand (RCS-5), Frenchay activities index, International Physical Activity Questionnaire, life-space assessment, Social Functioning Scale 8 (SFS-8), EuroQol-5 dimensions (utility value)] using logistic regression adjusted for age, gender, and vascular risk factors. We examined concurrent validity across robust versus prefrail/frail for inflammatory blood biomarkers [tumor necrosis factor receptor 1 and C-reactive protein (CRP)] and dual-energy x-ray absorptiometry body composition [bone mineral density (BMD); appendicular lean mass index (ALMI), and fat mass index (FMI)].
Prevalence of prefrail/frail was 25.7%, 14.8%, and 48.3% for FPQ, FRAIL, and CHS-FP, respectively. Compared with FRAIL, FPQ had better diagnostic performance (AUC = 0.617 vs 0.531, P = .002; sensitivity = 37.8% vs 18.0%; specificity = 85.6% vs 88.2%) and agreement (AC1-Stat = 0.303 vs 0.197). FPQ showed good predictive validity [RCS-5: odds ratio (OR) 2.38; 95% CI: 1.17-4.86; International Physical Activity Questionnaire: OR 3.62; 95% CI:1.78-7.34; SFS-8: OR 2.11; 95% CI: 1.64-5.89 vs FRAIL: all P > .05]. Only FRAIL showed concurrent validity for CRP, compared with both FPQ and FRAIL for TNF-R1. FRAIL showed better concurrent validity for BMD, FMI, and possibly ALMI, unlike FPQ (all P > .05).
Our results support complementary validity of FPQ and FRAIL in independent community-dwelling older adults. FPQ has increased case detection sensitivity with good predictive validity, whereas FRAIL demonstrates concurrent validity for inflammation and body composition. With better diagnostic performance and validity for blood biomarkers and clinical outcomes, FPQ has utility for early frailty detection in the community setting.
我们研究了 2 种自我报告的衰弱问卷，即衰弱表型问卷（FPQ）和 FRAIL，与心血管健康研究衰弱表型（CHS-FP）的结构效度。
对纵向前瞻性队列研究进行横断面数据分析。
我们纳入了 2017 年 12 月至 2019 年 3 月期间招募的“亚洲社区居住的老年人早期肌少症和骨肌减少性肥胖生物标志物特征的纵向评估研究”（GeriLABS 2）中 230 名年龄在 67.2±7.4 岁的老年人的数据。
我们比较了受试者工作特征曲线下面积（AUC）、一致性、相关性和对结局指标（5 次重复椅站、法国活动指数、国际体力活动问卷、生活空间评估、社会功能量表 8、欧洲五维健康量表（效用值））的预测效度，采用逻辑回归校正年龄、性别和血管危险因素。我们使用 CRP 和双能 X 射线吸收法身体成分（骨密度、四肢瘦体重指数和脂肪量指数）对炎症性血液生物标志物（肿瘤坏死因子受体 1 和 CRP）和 FPQ 及 FRAIL 进行了同时效度检验。
FPQ、FRAIL 和 CHS-FP 分别为 25.7%、14.8%和 48.3%。与 FRAIL 相比，FPQ 具有更好的诊断性能（AUC=0.617 比 0.531，P=0.002；敏感性=37.8%比 18.0%；特异性=85.6%比 88.2%）和一致性（AC1-Stat=0.303 比 0.197）。FPQ 具有良好的预测效度[5 次重复椅站：比值比（OR）2.38；95%置信区间（CI）：1.17-4.86；国际体力活动问卷：OR 3.62；95%CI：1.78-7.34；社会功能量表 8：OR 2.11；95%CI：1.64-5.89 比 FRAIL：均 P > 0.05]。只有 FRAIL 对 CRP 具有同时效度，而 FPQ 和 FRAIL 对 TNF-R1 均具有同时效度。FRAIL 对 BMD、FMI 可能还有 ALMI 具有更好的同时效度，而 FPQ 则没有（均 P > 0.05）。
我们的结果支持 FPQ 和 FRAIL 在独立的社区居住老年人中具有补充性的有效性。FPQ 具有较高的病例检出敏感性和良好的预测效度，而 FRAIL 则对炎症和身体成分具有同时效度。FPQ 对血液生物标志物和临床结局具有更好的诊断性能和有效性，可用于社区环境下的早期衰弱检测。
