Ausserhofer Dietmar, Mahlknecht Angelika, Barbieri Verena, Engl Adolf, Piccoliori Giuliano, Wiedermann Christian J
Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy.
Geriatrics (Basel). 2025 Jan 7;10(1):9. doi: 10.3390/geriatrics10010009.
Frailty screening facilitates the identification of older adults at risk of adverse health outcomes. The Program of Research to Integrate Services for the Maintenance of Autonomy 7 (PRISMA-7) is a widely utilised frailty tool; however, concerns regarding its potential sex bias persist due to item 2, which assigns a frailty point for male sex. This study compared the PRISMA-7 with a modified version, the PRISMA-6 (excluding item 2), to assess their suitability for frailty screening in South Tyrol, Italy. Objectives included evaluating the impact of item 2 on frailty classification and exploring the feasibility of the PRISMA-6 as a more equitable alternative. A cross-sectional survey of 1695 community-dwelling older adults aged ≥75 years was conducted in South Tyrol. Frailty was assessed using both the PRISMA-7 and PRISMA-6. Sociodemographic, health, and lifestyle data were collected to examine associations with frailty classifications. Logistic regression was applied to identify predictors of frailty for each tool. Agreement between the PRISMA-7 and PRISMA-6 was assessed, and internal consistency was evaluated using Cronbach's alpha. Frailty prevalence was 33.9% with the PRISMA-7 and 27.0% with the PRISMA-6. The PRISMA-7 classified men as frail more frequently than women (34.7% vs. 33.0%), while the PRISMA-6 reversed this trend (men, 21.4%; women, 33.0%). Excluding item 2 improved internal consistency (Cronbach's alpha: PRISMA-7, 0.64; PRISMA-6, 0.75) and aligned frailty classifications with predictors such as age, health status, and physical activity. Logistic regression revealed significant sex differences with the PRISMA-7 but not with the PRISMA-6. The PRISMA-7 introduces sex bias by overestimating frailty in men, whereas the PRISMA-6 provides a more equitable and consistent alternative. The findings highlight the PRISMA-6's potential as a reliable tool for unbiased frailty screening. Future research should validate the PRISMA-6 against established frailty tools to support its integration into primary care settings.
衰弱筛查有助于识别有不良健康结局风险的老年人。综合服务维持自主性研究项目7（PRISMA - 7）是一种广泛使用的衰弱评估工具；然而，由于第2项将男性性别列为一个衰弱评分点，对其潜在性别偏见的担忧依然存在。本研究将PRISMA - 7与一个修改版本PRISMA - 6（不包括第2项）进行比较，以评估它们在意大利南蒂罗尔用于衰弱筛查的适用性。目标包括评估第2项对衰弱分类的影响，并探索PRISMA - 6作为更公平替代方案的可行性。在南蒂罗尔对1695名年龄≥75岁的社区居住老年人进行了一项横断面调查。使用PRISMA - 7和PRISMA - 6评估衰弱情况。收集了社会人口学、健康和生活方式数据，以研究与衰弱分类的关联。应用逻辑回归来确定每种工具的衰弱预测因素。评估了PRISMA - 7和PRISMA - 6之间的一致性，并使用克朗巴赫α系数评估内部一致性。PRISMA - 7评估的衰弱患病率为33.9%，PRISMA - 6评估的为27.0%。PRISMA - 7将男性分类为衰弱的频率高于女性（34.7%对33.0%），而PRISMA - 6则扭转了这一趋势（男性为21.4%；女性为33.0%）。排除第2项提高了内部一致性（克朗巴赫α系数：PRISMA - 7为0.64；PRISMA - 6为0.75），并使衰弱分类与年龄、健康状况和身体活动等预测因素保持一致。逻辑回归显示，PRISMA - 7存在显著的性别差异，而PRISMA - 6则没有。PRISMA - 7通过高估男性的衰弱程度引入了性别偏见，而PRISMA - 6提供了一个更公平和一致的替代方案。研究结果突出了PRISMA - 6作为一种可靠的无偏倚衰弱筛查工具的潜力。未来的研究应将PRISMA - 6与已有的衰弱评估工具进行验证，以支持其纳入初级保健环境。
