Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
BMC Geriatr. 2023 Aug 7;23(1):474. doi: 10.1186/s12877-023-04160-1.
Early recognition of older people at risk of undesirable clinical outcomes is vital in preventing future disabling conditions. Here, we report the prognostic performance of an electronic frailty index (eFI) in comparison with traditional tools among nonfrail and prefrail community-dwelling older adults. The study is to investigate the predictive utility of a deficit-accumulation eFI in community elders without overt frailty.
Participants aged 65-80 years with a Clinical Frailty Scale of 1-3 points were recruited and followed for 2 years. The eFI score and Fried's frailty scale were determined by using a semiautomated platform of self-reported questionnaires and objective measurements which yielded cumulative deficits and physical phenotypes from 80 items of risk variables. Kaplan-Meier method and Cox proportional hazards regression were used to analyze the severity of frailty in relation to adverse outcomes of falls, emergency room (ER) visits and hospitalizations during 2 years' follow-up.
A total of 427 older adults were evaluated and dichotomized by the median FI score. Two hundred and sixty (60.9%) and 167 (39.1%) elders were stratified into the low- (eFI ≤ 0.075) and the high-risk (eFI > 0.075) groups, respectively. During the follow-up, 77 (47.0%) individuals developed adverse events in the high-risk group, compared with 79 (30.5%) in the low-risk group (x, p = 0.0006). In multivariable models adjusted for age and sex, the increased risk of all three events combined in the high- vs. low-risk group remained significant (adjusted hazard ratio (aHR) = 3.08, 95% confidence interval (CI): 1.87-5.07). For individual adverse event, the aHRs were 2.20 (CI: 1.44-3.36) for falls; 1.67 (CI: 1.03-2.70) for ER visits; and 2.84 (CI: 1.73-4.67) for hospitalizations. Compared with the traditional tools, the eFI stratification (high- vs. low-risk) showed better predictive performance than either CFS rating (managing well vs. fit to very fit; not discriminative in hospitalizations) or Fried's scale (prefrail to frail vs. nonfrail; not discriminative in ER visits).
The eFI system is a useful frailty tool which effectively predicts the risk of adverse healthcare outcomes in nonfrail and/or prefrail older adults over a period of 2 years.
早期识别有不良临床结局风险的老年人对于预防未来的失能状态至关重要。在这里，我们报告了电子虚弱指数 (eFI) 在与非虚弱和虚弱前期社区居住的老年人的传统工具相比的预后性能。该研究旨在调查无明显虚弱的社区老年人中累积缺陷 eFI 的预测效用。
招募年龄在 65-80 岁、临床虚弱量表评分为 1-3 分的参与者，并随访 2 年。eFI 评分和弗里德虚弱量表通过使用半自动化的自我报告问卷和客观测量平台确定，该平台从 80 个风险变量中产生累积缺陷和身体表型。采用 Kaplan-Meier 方法和 Cox 比例风险回归分析 2 年随访期间虚弱严重程度与跌倒、急诊室 (ER) 就诊和住院相关的不良结局。
共评估了 427 名老年人，并根据 FI 评分中位数进行了二分法。260（60.9%）和 167 名（39.1%）老年人分别分为低风险（eFI≤0.075）和高风险（eFI>0.075）组。在随访期间，高风险组有 77 人（47.0%）发生不良事件，而低风险组有 79 人（30.5%）（x，p=0.0006）。在调整年龄和性别后，多变量模型中高 vs. 低风险组的所有三种事件综合风险增加仍然显著（调整后的危险比（aHR）=3.08，95%置信区间（CI）：1.87-5.07）。对于个别不良事件，aHR 分别为跌倒 2.20（CI：1.44-3.36）；ER 就诊 1.67（CI：1.03-2.70）；住院 2.84（CI：1.73-4.67）。与传统工具相比，eFI 分层（高 vs. 低风险）比 CFS 评分（管理良好与适合非常适合；在住院方面无差异）或弗里德量表（虚弱前期与非虚弱；在 ER 就诊方面无差异）具有更好的预测性能。
eFI 系统是一种有用的虚弱工具，可有效预测 2 年内非虚弱和/或虚弱前期老年人不良医疗保健结局的风险。
