A global clinical measure of fitness and frailty in elderly people
A global clinical measure of fitness and frailty in elderly people
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DOI：
10.1503/cmaj.050051
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发表时间：
2005-08-30
影响因子：
14.6
通讯作者：
Mitnitski, A
中科院分区：
文献类型：
--
作者：
Rockwood, K;Song, XW;Mitnitski, A
背景：虚弱没有一个普遍接受的临床定义。以前开发的评估虚弱的工具已被证明是预测死亡或需要进入机构设施尚未获得执业临床医生的接受。我们的目的是开发一种工具，这将是预测和易于使用的。方法：我们开发了7点临床虚弱量表和应用它和其他既定的工具，测量脆弱的2305老年患者参加了第二阶段的加拿大健康与老龄化研究（CSHA）。我们前瞻性地跟踪这一队列，5年后，我们确定了临床虚弱量表预测死亡或需要机构护理的能力，并将结果与从其他已建立的工具中获得的结果相关联。结果：CSHA临床虚弱量表与虚弱指数高度相关（r= 0.80）。在校正了年龄、性别和教育的多变量模型中，我们量表的每一个1类增量都显著增加了中期死亡风险（约70个月内21.2%，95%置信区间[ CI] 12.5% - 30.6%）和进入机构的风险（23.9%，95% CI 8.8% - 41.2%）。受试者工作特征曲线分析表明，我们的临床虚弱量表在评估死亡风险方面优于认知、功能或合并症（18个月死亡率曲线下面积为0.77，70个月死亡率曲线下面积为0.70）。对虚弱的临床判断可以产生有用的预测信息。
Background: There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use.Methods: We developed the 7- point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools.Results: The CSHA Clinical Frailty Scale was highly correlated ( r= 0.80) with the Frailty Index. Each 1- category increment of our scale significantly increased the medium- term risks of death ( 21.2% within about 70 mo, 95% confidence interval [ CI] 12.5% - 30.6%) and entry into an institution ( 23.9%, 95% CI 8.8% - 41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70- month mortality).Interpretation: Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.