Testing the Validity of a Construct of Geriatric Frailty

测试老年衰弱结构的有效性

• 批准号: 7388857
• 负责人: CATHERINE A SARKISIAN
• 金额: $ 18.62万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-01 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7388857
• 关键词: Address; Adult; Age; Aging; Anorexia; Behavioral; Biology; Body Weight decreased; Cardiovascular system; Characteristics; Clinical; Cognitive; Cohort Studies; Comorbidity; Complex; Condition; Data; Data Set; Depth; Development; Elderly; Equation; Functional disorder; Gait; Geriatrics; Health; Hospitalization; Impaired cognition; Inflammation; Inflammatory; Institutes; Intervention; Investigation; Knowledge; Lead; Light; Link; Literature; Measures; Medical; Mental disorders; Modeling; Morbidity - disease rate; Muscle; Neurosecretory Systems; Numbers; Outcome; Paper; Pattern; Phenotype; Physical activity; Physiological; Process; Publishing; Range; Research; Research Personnel; Research Project Grants; Resistance; Risk; Role; Sampling; Self Efficacy; Serum Markers; Social support; Syndrome; System; Techniques; Testing; Urine; Work; allostatic load; cognitive function; concept; cost; cost effective; design; disability; exhaustion; frailty; insight; long term hospitalization; mortality; multidisciplinary; novel; older patient; prevent; programs; psychosocial; social; stressor; wasting

DESCRIPTION (provided by applicant): The investigators seek support for an exploratory/developmental research project that will offer new insights into the complex biology and pathophysiology underlying the geriatric syndrome of frailty. Frailty is a topic of great clinical importance to geriatric medicine, but research has been hampered by a lack of an agreed-upon definition of frailty. Valid operational definitions of frailty could greatly enhance research on the causes and consequences of frailty. Though numerous definitions of "frailty" have been proposed in the published literature, the term has usually been used clinically as a global concept to describe a condition, common in the very old, of impaired strength and endurance, increased vulnerability to stressors, and increased risk for morbidity, disability and mortality. In a landmark paper in 2001, Fried and colleagues used data from the Cardiovascular Health Study (CHS) and defined a phenotype of frailty to include 3 or more of the following: unintentional weight loss, weakness, exhaustion, slow gait, and low physical activity level. Older adults found to be frail using this definition were at increased risk for adverse health outcomes, independent of their sociodemographic characteristics, medical comorbidities, and level of disability. This definition provides a useful operational starting point in the quest towards understanding and ultimately preventing and treating frailty, but empiric support of its construct validity is incomplete. This multidisciplinary team proposes to use data previously-collected in the MacArthur Study of Successful Aging (MSSA), a longitudinal cohort study of 1189 older adults, to: 1) use structural equation modeling to test the construct validity of the selected CHS criteria; 2) empirically explore whether the CHS definition of frailty could be enhanced by expanding the definition to include differing criteria that have been hypothesized to be part of frailty (such as cognitive impairment); 3) test whether geriatric frailty is represented by correlated sub-phenotypes (physical, cognitive, behavioral and inflammatory) with different characteristic patterns; and 5) examine the potential role of neuroendocrine, psychosocial and sociodemographic characteristics in predicting frailty. The MSSA offers an extraordinary opportunity to gain new insights into the geriatric syndrome of frailty because this rich dataset includes measures of all 5 of the criteria used in CHS to define frailty, and it also includes rigorous measures of disability and comorbidity, serum markers of inflammation, urine markers of neuroendocrine dysregulation, detailed measures of cognitive function, long-term hospitalization and mortality data, as well as measures of many psychosocial constructs that may be associated with frailty. In summary, this exploratory investigation offers a unique and cost-effective means to break new ground in our understanding of the geriatric syndrome of frailty.

描述(由申请人提供)：研究人员寻求对探索性/发展性研究项目的支持，该项目将为老年虚弱综合征潜在的复杂生物学和病理生理学提供新的见解。对于老年医学来说，虚弱是一个非常重要的临床主题，但由于缺乏对虚弱的一致定义，研究一直受到阻碍。有效的脆弱性操作定义可以极大地加强对脆弱性原因和后果的研究。尽管在已发表的文献中提出了许多对“脆弱”的定义，但该术语通常被用作临床上的一个全球概念，描述一种在很老的时候常见的情况，即力量和耐力受损，对应激源的易感性增加，以及发病率、残疾和死亡风险的增加。在2001年的一篇里程碑式的论文中，Fry和他的同事使用了心血管健康研究(CHS)的数据，并将虚弱的表型定义为包括以下三种或三种以上：无意中的体重减轻、虚弱、疲惫、步态缓慢和低体力活动水平。根据这一定义，被发现虚弱的老年人出现不良健康结果的风险增加，与他们的社会人口学特征、医学合并症和残疾水平无关。这一定义在寻求理解并最终预防和治疗脆弱性方面提供了一个有用的操作起点，但对其结构有效性的经验支持是不完整的。这个多学科团队建议使用之前在麦克阿瑟成功老龄化研究(MSSA)中收集的数据，这是一项对1189名老年人的纵向队列研究，以：1)使用结构方程模型来测试选定的CHS标准的结构有效性；2)实证探索是否可以通过扩展定义来增强CHS对脆弱的定义，包括已被假设为脆弱的不同标准(如认知障碍)；3)测试具有不同特征模式的相关亚表型(身体、认知、行为和炎症)是否代表老年脆弱；以及5)研究神经内分泌、心理社会和社会人口特征在预测脆弱中的潜在作用。MSSA提供了一个非同寻常的机会，以获得对老年虚弱综合征的新见解，因为这个丰富的数据集包括CHS中用来定义虚弱的所有5个标准的测量，它还包括对残疾和共病的严格测量，血清炎症标记物，神经内分泌失调的尿标记物，认知功能的详细测量，长期住院和死亡率数据，以及许多可能与虚弱相关的心理社会结构的测量。总而言之，这项探索性调查提供了一种独特且具有成本效益的方法，为我们对老年虚弱综合征的理解开辟了新的天地。