Ability of Self-Reported Frailty Components to Predict Incident Disability, Falls, and All-Cause Mortality: Results From a Population-Based Study of Older British Men.
Ability of Self-Reported Frailty Components to Predict Incident Disability, Falls, and All-Cause Mortality: Results From a Population-Based Study of Older British Men.
复制标题
自我报告的脆弱成分预测事件残疾，跌倒和全因死亡率的能力：基于人群的大英国男性的研究结果。
DOI：
10.1016/j.jamda.2016.08.020
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发表时间：
2017-02-01
影响因子：
7.6
通讯作者：
Ramsay SE
中科院分区：
文献类型：
--
作者：
Papachristou E;Wannamethee SG;Lennon LT;Papacosta O;Whincup PH;Iliffe S;Ramsay SE
虚弱是一种易患残疾、跌倒和死亡的状态。弗里德虚弱表型包括握力和步态速度的评估，这是复杂的或需要客观的测量，在常规的初级保健实践中具有挑战性。在这项研究中，我们的目的是开发一种简单的评估工具，基于自我报告的5个Fried脆弱性组成部分的信息，以识别有意外残疾、跌倒和死亡风险的老年人。分析是基于2010-2012年一组包括71-92岁英国老年男性的前瞻性队列。随访问卷于2014年完成。采用受者工作特征曲线下面积（ROC-AUC）对偶发性残疾和跌倒的区分力与Fried脆弱表型进行比较；对于意外跌倒，还将其与虚弱量表（疲劳、抵抗、行走、疾病和体重减轻）进行比较。使用年龄校正Cox比例风险模型评估死亡率的预测能力。与Fried虚弱表型相比，包括缓慢步行速度、低体力活动和疲惫的自我报告测量的模型在偶发性残疾方面的ROC-AUC[0.68, 95%可信区间（CI） 0.63 - 0.72]显著增加（0.63,95% CI 0.59-0.68； P值ΔAUC = 0.003）。与Fried虚弱表型（0.57,95% CI 0.53-0.61； P值ΔAUC < .001）和虚弱量表（0.56,95% CI 0.52-0.61； P值ΔAUC = .001）相比，第二种模型包括自我报告的缓慢行走速度、低体力活动和体重减轻的ROC-AUC （0.64, 95% CI 0.59-0.68）对于意外跌倒具有更高的ROC-AUC （0.64, 95% CI 0.59-0.68）。与Fried表型（Harrell's C = 0.71, Somer's D = 0.42，线性趋势P < 0.001）和虚弱量表（Harrell's C = 0.71, Somer's D = 0.42，线性趋势P < 0.001）相比，该模型还与死亡风险增加相关（Harrell's C = 0.73, Somer's D = 0.45，线性趋势P < 0.001）。与Fried衰弱表型相比，对于所有考虑到的不良结果和对于意外跌倒和死亡率的虚弱量表，Fried衰弱成分的自我报告信息具有优越的歧视性和预测性。这些发现对于制定干预措施和卫生保健政策具有重要意义，因为它们提供了一种简单的方法来识别有与虚弱相关的不良后果风险的老年人。
Frailty is a state of increased vulnerability to disability, falls, and mortality. The Fried frailty phenotype includes assessments of grip strength and gait speed, which are complex or require objective measurements and are challenging in routine primary care practice. In this study, we aimed to develop a simple assessment tool based on self-reported information on the 5 Fried frailty components to identify older people at risk of incident disability, falls, and mortality. Analyses are based on a prospective cohort comprising older British men aged 71–92 years in 2010–2012. A follow-up questionnaire was completed in 2014. The discriminatory power for incident disability and falls was compared with the Fried frailty phenotype using receiver operating characteristic-area under the curve (ROC-AUC); for incident falls it was additionally compared with the FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight). Predictive ability for mortality was assessed using age-adjusted Cox proportional hazard models. A model including self-reported measures of slow walking speed, low physical activity, and exhaustion had a significantly increased ROC-AUC [0.68, 95% confidence interval (CI) 0.63–0.72] for incident disability compared with the Fried frailty phenotype (0.63, 95% CI 0.59–0.68; P value of ΔAUC = .003). A second model including self-reported measures of slow walking speed, low physical activity, and weight loss had a higher ROC-AUC (0.64, 95% CI 0.59–0.68) for incident falls compared with the Fried frailty phenotype (0.57, 95% CI 0.53–0.61; P value of ΔAUC < .001) and the FRAIL scale (0.56, 95% CI 0.52–0.61; P value of ΔAUC = .001). This model was also associated with an increased risk of mortality (Harrell's C = 0.73, Somer's D = 0.45; linear trend P < .001) compared with the Fried phenotype (Harrell's C = 0.71; Somer's D = 0.42; linear trend P < .001) and the FRAIL scale (Harrell's C = 0.71, Somer's D = 0.42; linear trend P < .001). Self-reported information on the Fried frailty components had superior discriminatory and predictive ability compared with the Fried frailty phenotype for all the adverse outcomes considered and with the FRAIL scale for incident falls and mortality. These findings have important implications for developing interventions and health care policies as they offer a simple way to identify older people at risk of adverse outcomes associated with frailty.