Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women
Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women
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DOI：
10.1001/archinternmed.2007.113
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发表时间：
2008-01-25
影响因子：
--
通讯作者：
Cummings, Steven R.
中科院分区：
文献类型：
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作者：
Ensrud, Kristine E.;Ewing, Susan K.;Cummings, Steven R.
背景：根据心血管健康研究(CHS指数)得出的指数所定义的虚弱，可以预测老年人不良结局的风险。方法：我们对6701名69岁或以上的女性进行了前瞻性队列研究，比较了简单的脆弱指数与CHS指数的预测有效性，其中包括体重减轻、不使用手臂就无法从椅子上站起5次、能量水平降低(研究骨质疏松性骨折[SOF指数])和CHS指数的预测有效性，这些因素包括无意体重减轻、握力差、能量水平降低、步行速度慢和体力活动水平低。使用每个指数，女性被归类为健壮、中等地位或虚弱。每4个月报告一次跌倒，持续1年。在41/2岁时确定残疾(=1个新的日常生活仪器性活动障碍)，并在9年的随访期中确定骨折和死亡。将包含CHS指数和SOF指数的模型的曲线下面积(AUC)统计数据和对数似然统计数据进行比较。结果：CHS指数或SOF指数定义的脆弱性证据的增加与不良结局的风险增加类似。经年龄调整后，体弱女性再次跌倒的风险更高(优势比，2.4)、残疾(优势比，2.2-2.8)、非脊柱骨折(风险比，1.4-1.5)、髋部骨折(风险比，1.7-1.8)和死亡(风险比，2.4-2.7)(P
Background: Frailty, as defined by the index derived from the Cardiovascular Health Study (CHS index), predicts risk of adverse outcomes in older adults. Use of this index, however, is impractical in clinical practice.Methods: We conducted a prospective cohort study in 6701 women 69 years or older to compare the predictive validity of a simple frailty index with the components of weight loss, inability to rise from a chair 5 times without using arms, and reduced energy level (Study of Osteoporotic Fractures [SOF index]) with that of the CHS index with the components of unintentional weight loss, poor grip strength, reduced energy level, slow walking speed, and low level of physical activity. Women were classified as robust, of intermediate status, or frail using each index. Falls were reported every 4 months for 1 year. Disability (>= 1 new impairment in performing instrumental activities of daily living) was ascertained at 41/2 years, and fractures and deaths were ascertained during 9 years of follow-up. Area under the curve (AUC) statistics from receiver operating characteristic curve analysis and -2 log likelihood statistics were compared for models containing the CHS index vs the SOF index.Results: Increasing evidence of frailty as defined by either the CHS index or the SOF index was similarly associated with an increased risk of adverse outcomes. Frail women had a higher age-adjusted risk of recurrent falls (odds ratio, 2.4), disability (odds ratio, 2.2-2.8), nonspine fracture (hazard ratio, 1.4-1.5), hip fracture (hazard ratio, 1.7-1.8), and death (hazard ratio, 2.4-2.7) (P