Université Paris-Est Créteil, Inserm, IMRB U955, Créteil, France.
Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Service Santé Publique & Unité de Recherche clinique, Créteil, France.
Age Ageing. 2024 Oct 1;53(10). doi: 10.1093/ageing/afae222.
Automated frailty screening tools like the Hospital Frailty Risk Score (HFRS) are primarily validated for care consumption outcomes. We assessed the predictive ability of the HFRS regarding care consumption outcomes, frailty domain impairments and mortality among older adults with cancer, using the Geriatric 8 (G8) screening tool as a clinical benchmark.
This retrospective, linkage-based study included patients aged ≥70 years with solid tumor, enrolled in the Elderly Cancer Patients (ELCAPA) multicentre cohort study (2016-2020) and hospitalized in acute care within the Greater Paris University Hospitals. HFRS scores, which encompass hospital-acquired problems and frailty-related syndromes, were calculated using data from the index admission and the preceding 6 months. A multidomain geriatric assessment (GA), including cognition, nutrition, mood, functional status, mobility, comorbidities, polypharmacy, incontinence, and social environment, was conducted at ELCAPA inclusion, with computation of the G8 score. Logistic and Cox regressions measured associations between the G8, HFRS, altered GA domains, length of stay exceeding 10 days, 30-day readmission, and mortality.
Among 587 patients included (median age 82 years, metastatic cancer 47.0%), 237 (40.4%) were at increased frailty risk by the HFRS (HFRS>5) and 261 (47.5%) by the G8 (G8≤10). Both HFRS and G8 were significantly associated with cognitive and functional impairments, incontinence, comorbidities, prolonged length of stay, and 30-day mortality. The G8 was associated with polypharmacy, nutritional and mood impairment.
Although showing significant associations with short-term care consumption, the HFRS could not identify polypharmacy, nutritional, mood and social environment impairments and showed low discriminatory ability across all GA domains.
像医院衰弱风险评分（HFRS）这样的自动化衰弱筛查工具主要针对护理消费结果进行验证。我们使用老年 8 项筛查工具（G8）作为临床基准，评估 HFRS 对癌症老年患者的护理消费结果、衰弱域损伤和死亡率的预测能力。
这项回顾性的基于关联的研究包括年龄≥70 岁的患有实体肿瘤的患者，他们参加了老年癌症患者（ELCAPA）多中心队列研究（2016-2020 年），并在大巴黎大学医院的急性护理中住院。HFRS 评分涵盖了医院获得性问题和与衰弱相关的综合征，使用索引入院和之前 6 个月的数据进行计算。在 ELCAPA 纳入时进行了多领域老年评估（GA），包括认知、营养、情绪、功能状态、移动能力、合并症、多药治疗、尿失禁和社会环境，并计算了 G8 评分。逻辑和 Cox 回归测量了 G8、HFRS、改变的 GA 域、住院时间超过 10 天、30 天再入院和死亡率之间的关联。
在纳入的 587 名患者中（中位年龄 82 岁，转移性癌症 47.0%），237 名（40.4%）HFRS（HFRS>5）和 261 名（47.5%）G8（G8≤10）患者处于衰弱风险增加的状态。HFRS 和 G8 均与认知和功能障碍、尿失禁、合并症、住院时间延长和 30 天死亡率显著相关。G8 与多药治疗、营养和情绪障碍相关。
尽管与短期护理消费有显著关联，但 HFRS 无法识别多药治疗、营养、情绪和社会环境损伤，并且在所有 GA 域的区分能力都较低。
