Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
BMC Med. 2024 Jun 10;22(1):236. doi: 10.1186/s12916-024-03454-4.
As global aging accelerates, routinely assessing the functional status and morbidity burden of older patients becomes paramount. The aim of this study is to assess the validity of the comprehensive clinical and functional Health Assessment Tool (HAT) based on four cohorts of older adults (60 + years) from the Swedish National study on Aging and Care (SNAC) spanning urban, suburban, and rural areas.
The HAT integrates five health indicators (gait speed, global cognition, number of chronic diseases, and basic and instrumental activities of daily living), providing an individual-level score between 0 and 10. The tool was constructed using nominal response models, first separately for each cohort and then in a harmonized dataset. Outcomes included all-cause mortality over a maximum follow-up of 16 years and unplanned hospital admissions over a maximum of 3 years of follow-up. The predictive capacity was assessed through the area under the curve (AUC) using logistic regressions. For time to death, Cox regressions were performed, and Harrell's C-indices were reported. Results from the four cohorts were pooled using individual participant data meta-analysis and compared with those from the harmonized dataset.
The HAT demonstrated high predictive capacity across all cohorts as well as in the harmonized dataset. In the harmonized dataset, the AUC was 0.84 (95% CI 0.81-0.87) for 1-year mortality, 0.81 (95% CI 0.80-0.83) for 3-year mortality, 0.80 (95% CI 0.79-0.82) for 5-year mortality, 0.69 (95% CI 0.67-0.70) for 1-year unplanned admissions, and 0.69 (95% CI 0.68-0.70) for 3-year unplanned admissions. The Harrell's C for time-to-death throughout 16 years of follow-up was 0.75 (95% CI 0.74-0.75).
The HAT is a highly predictive, clinically intuitive, and externally valid instrument with potential for better addressing older adults' health needs and optimizing risk stratification at the population level.
随着全球老龄化的加速，定期评估老年患者的功能状态和发病负担变得至关重要。本研究旨在评估综合临床和功能健康评估工具（HAT）在四个来自瑞典老龄化和护理全国研究（SNAC）的老年人群体（60 岁以上）队列中的有效性，这些队列涵盖了城市、郊区和农村地区。
HAT 整合了五个健康指标（步态速度、整体认知、慢性疾病数量以及基本和工具性日常生活活动），提供了 0 到 10 之间的个体水平评分。该工具使用名义反应模型构建，首先分别针对每个队列，然后在协调数据集上进行。结果包括 16 年的最大随访期间的全因死亡率和 3 年的最大随访期间的非计划性住院。通过逻辑回归评估曲线下面积（AUC）来评估预测能力。对于死亡时间，进行了 Cox 回归，并报告了 Harrell 的 C 指数。使用个体参与者数据荟萃分析汇总了四个队列的结果，并将其与协调数据集的结果进行了比较。
HAT 在所有队列以及协调数据集中均表现出较高的预测能力。在协调数据集中，1 年死亡率的 AUC 为 0.84（95%CI 0.81-0.87），3 年死亡率为 0.81（95%CI 0.80-0.83），5 年死亡率为 0.80（95%CI 0.79-0.82），1 年非计划性住院的 AUC 为 0.69（95%CI 0.67-0.70），3 年非计划性住院的 AUC 为 0.69（95%CI 0.68-0.70）。16 年随访期间死亡时间的 Harrell 的 C 指数为 0.75（95%CI 0.74-0.75）。
HAT 是一种高度预测性、临床直观且具有外部有效性的工具，具有改善老年人群健康需求和优化人群水平风险分层的潜力。
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