Comparison of 10 single and stepped methods to identify frail older persons in primary care: diagnostic and prognostic accuracy.
Comparison of 10 single and stepped methods to identify frail older persons in primary care: diagnostic and prognostic accuracy.
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DOI：
10.1186/s12875-016-0487-y
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发表时间：
2016-08-03
影响因子：
2.9
通讯作者：
van Hout HP
中科院分区：
文献类型：
--
作者：
Sutorius FL;Hoogendijk EO;Prins BA;van Hout HP
已经开发了许多工具来识别初级保健中的体弱老年人。对识别方法的准确性和普遍性进行直接比较的情况很少见，大多数研究都忽略了常规护理实践中通常采用的逐步选择。此外，还不清楚不同的方法是否会选择具有不同特征的人。我们的目的是评估 10 种单一和逐步方法的准确性，以识别老年人的虚弱状况并预测不良健康结果。此外，还对这些方法对已识别的体弱者的患病率和已识别的人的特征进行了比较。将格罗宁根衰弱指数 (GFI)、PRISMA-7、多药治疗、全科医生 (GP) 的临床判断、老年人健康自评、埃德蒙顿衰弱量表 (EFS)、高危老年人初级保健识别 (ISAR PC)、衰弱指数 (FI)、InterRAI 筛查仪和步态速度与三种测量进行比较：两个参考标准（多学科专家小组的临床判断和 Fried 的虚弱标准）和 6 年死亡率或长期护理入院。使用的数据来自荷兰体弱老年人识别研究，该研究由来自阿姆斯特丹一家初级保健机构的 102 名 65 岁及以上老人组成。体弱的老年人被过度采样。通过计算 ROC 曲线下的面积来估计每种仪器和几种逐步策略的准确性。虚弱患病率从 14.8% 到 52.9% 不等。建议截止值的准确性范围从差（AUC = 0.556 ISAR-PC）到良好（AUC = 0.865 步态速度）。 PRISMA-7 的表现优于两个参考标准，GP 对逆境的预测最好。阶梯式策略导致患病率和准确性较低。不同工具选择的人在年龄、IADL 依赖性、接受家庭护理和情绪方面差异很大。我们发现，识别体弱者的方法在患病率、准确性和所选择的人的特征方面存在巨大差异。下一步必要的步骤是在实施病例发现计划之前找出哪些体弱者可以从干预中受益。需要进一步的证据来指导这个新兴的临床领域。本文的在线版本 (doi:10.1186/s12875-016-0487-y) 包含补充材料，可供授权用户使用。
Many instruments have been developed to identify frail older adults in primary care. A direct comparison of the accuracy and prevalence of identification methods is rare and most studies ignore the stepped selection typically employed in routine care practice. Also it is unclear whether the various methods select persons with different characteristics. We aimed to estimate the accuracy of 10 single and stepped methods to identify frailty in older adults and to predict adverse health outcomes. In addition, the methods were compared on their prevalence of the identified frail persons and on the characteristics of persons identified. The Groningen Frailty Indicator (GFI), the PRISMA-7, polypharmacy, the clinical judgment of the general practitioner (GP), the self-rated health of the older adult, the Edmonton Frail Scale (EFS), the Identification Seniors At Risk Primary Care (ISAR PC), the Frailty Index (FI), the InterRAI screener and gait speed were compared to three measures: two reference standards (the clinical judgment of a multidisciplinary expert panel and Fried’s frailty criteria) and 6-years mortality or long term care admission. Data were used from the Dutch Identification of Frail Elderly Study, consisting of 102 people aged 65 and over from a primary care practice in Amsterdam. Frail older adults were oversampled. The accuracy of each instrument and several stepped strategies was estimated by calculating the area under the ROC-curve. Prevalence rates of frailty ranged from 14.8 to 52.9 %. The accuracy for recommended cut off values ranged from poor (AUC = 0.556 ISAR-PC) to good (AUC = 0.865 gait speed). PRISMA-7 performed best over two reference standards, GP predicted adversities best. Stepped strategies resulted in lower prevalence rates and accuracy. Persons selected by the different instruments varied greatly in age, IADL dependency, receiving homecare and mood. We found huge differences between methods to identify frail persons in prevalence, accuracy and in characteristics of persons they select. A necessary next step is to find out which frail persons can benefit from intervention before case finding programs are implemented. Further evidence is needed to guide this emerging clinical field. The online version of this article (doi:10.1186/s12875-016-0487-y) contains supplementary material, which is available to authorized users.