Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, MD, 21205, Baltimore, USA.
Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, USA.
BMC Geriatr. 2022 Aug 25;22(1):705. doi: 10.1186/s12877-022-03376-x.
The ability to identify frail older adults using a self-reported version of the physical frailty phenotype (PFP) that has been validated with the standard PFP could facilitate physical frailty detection in clinical settings.
We collected data from volunteers (N = 182), ages 65 years and older, in an aging research registry in Baltimore, Maryland. Measurements included: standard PFP (walking speed, grip strength, weight loss, activity, exhaustion); and self-reported questions about walking and handgrip strength. We compared objectively-measured gait speed and grip strength to self-reported questions using Cohen's Kappa and diagnostic accuracy tests. We used these measures to compare the standard PFP with self-reported versions of the PFP, focusing on a dichotomized identification of frail versus pre- or non-frail participants.
Self-reported slowness had fair-to-moderate agreement (Kappa(k) = 0.34-0.56) with measured slowness; self-reported and objective weakness had slight-to-borderline-fair agreement (k = 0.10-0.21). Combining three self-reported slowness questions had highest sensitivity (81%) and negative predictive value (NPV; 91%). For weakness, three questions combined had highest sensitivity (72%), while all combinations had comparable NPV. Follow-up questions on level of difficulty led to minimal changes in agreement and decreased sensitivity. Substituting subjective for objective measures in our PFP model dichotomized by frail versus non/pre-frail, we found substantial (k = 0.76-0.78) agreement between standard and self-reported PFPs. We found highest sensitivity (86.4%) and NPV (98.7%) when comparing the dichotomized standard PFP to a self-reported version combining all slowness and weakness questions. Substitutions in a three-level model (frail, vs pre-frail, vs. non-frail) resulted in fair-to-moderate agreement (k = 0.33-0.50) with the standard PFP.
Our results show potential utility as well as challenges of using certain self-reported questions in a modified frailty phenotype. A self-reported PFP with high agreement to the standard phenotype could be a valuable frailty screening assessment in clinical settings.
使用经过标准体格虚弱表型（PFP）验证的自我报告版本识别虚弱的老年人的能力，可以促进临床环境中的体格虚弱检测。
我们从马里兰州巴尔的摩的老龄化研究登记处的志愿者（N=182）中收集了数据，年龄在 65 岁及以上。测量包括：标准 PFP（步行速度、握力、体重减轻、活动、疲惫）；以及关于步行和握力的自我报告问题。我们使用 Cohen 的 Kappa 和诊断准确性测试比较了客观测量的步态速度和握力与自我报告的问题。我们使用这些措施来比较标准 PFP 与 PFP 的自我报告版本，重点关注虚弱与预先或非虚弱参与者的二分识别。
自我报告的缓慢与测量的缓慢有适度至中度一致性（Kappa(k)=0.34-0.56）；自我报告的虚弱与客观的虚弱有轻微至边缘公平的一致性（k=0.10-0.21）。结合三个自我报告的缓慢问题具有最高的敏感性（81%）和阴性预测值（NPV；91%）。对于虚弱，三个问题的结合具有最高的敏感性（72%），而所有组合的 NPV 都相当。对难度水平的后续问题导致一致性略有变化，并降低了敏感性。在我们的 PFP 模型中用虚弱与非/预虚弱的二分法代替主观测量的客观测量，我们发现标准和自我报告的 PFP 之间有实质性的（k=0.76-0.78）一致性。当比较标准 PFP 与结合所有缓慢和虚弱问题的自我报告版本时，我们发现最高的敏感性（86.4%）和 NPV（98.7%）。在三级模型（虚弱、预虚弱、非虚弱）中的替代产生了与标准 PFP 的适度至中度一致性（k=0.33-0.50）。
我们的研究结果表明，在修改后的体格虚弱表型中使用某些自我报告问题具有潜在的效用和挑战。与标准表型高度一致的自我报告的 PFP 可以成为临床环境中一种有价值的虚弱筛查评估。
