Frailty Assessment: Matching Simplification Efforts to Clinical Aims

描述(由申请人提供)：理论上，虚弱被定义为老年人更易受伤害的临床可识别状态。虽然已经开发了许多工具来识别脆弱性，但尚未就最佳措施达成共识。在老年医学文献中，两种最常被引用的虚弱指标是身体虚弱表型(PFP)和虚弱指数(FI)。在过去的五年里，FI和PFP被引用的次数分别增加了五倍和八倍。随着这些仪器的日益普及，现有表型的简化和近似激增，通常是由于特定研究中的测量方法的可用性，或者是临床实践中对患者评估的速度和简便性的要求。为特定的研究或临床环境量身定做措施的想法可能很有吸引力。然而，如果这些工具测量老年人健康的根本不同方面，或者如果它们在实现不同的脆弱确定目标(例如，脆弱综合征特征与风险分层)方面具有不同的有效性，也存在潜在的危害。虽然已经进行了一些流行病学研究来比较不同的脆弱性评估工具，但到目前为止，比较几乎完全集中在预测有效性上。使用从心血管健康研究收集的超过9年的5888名65岁及以上老年人的数据，本研究以新的方向进行比较分析，以系统地评估PFP标准的可能简化，这些标准可用于(1)关于虚弱综合征识别的内部有效性，(2)在区分虚弱和非虚弱人群对老龄化不利结果的风险方面的准确性，(3)作为易损性增加的潜在标志的有用性，以及(4)确定脆弱分类中PF和FI之间不协调的水平、来源和预测因素。通过阐明两种最常用的脆弱工具的价值和限度，并评估PFP的潜在简化，拟议的研究承诺为选择脆弱措施以匹配脆弱评估的临床目标提供亟需的指导，最终目标是确定脆弱预防和治疗的新领域。

DESCRIPTION (provided by applicant): Frailty has been theoretically defined as a clinically recognizable state of increased vulnerability in older adults. Although numerous instruments have been developed to identify frailty, consensus on best measures has not been achieved. The two most commonly cited frailty measures in the geriatric literature are the Physical Frailty Phenotype (PFP) and the Frailty Index (FI). The number of citations of the FI and the PFP has quintupled and octupled respectively in last five years. With the growing popularity of these instruments simplifications and approximations of existing phenotypes have proliferated, typically motivated by either availability of measures in specific studies or the demand for speed and ease of patient evaluation in clinical practice. The idea of tailoring measures to specific research or clinical settings may be appealing. However, there also are potential harms if the instruments measure fundamentally different aspects of older adults' health, or if they are differentially effective in accomplishing different aims of frailty ascertainment (e.g., frailty syndrome characterization vs. risk stratification). Although a number of epidemiological studies have been conducted to compare the different frailty assessment tools, the comparisons so far have almost exclusively focused on predictive validity. Using data collected over 9 years in the 5888 older adults age 65 and older from the Cardiovascular Health Study, this study conducts the comparative analysis in a novel direction to: systematically evaluate possible simplifications of the PFP criteria that could be used for (1) their internal validity regarding frailty syndrome identification, (2) accuracy in discriminating the risk of frail and non-frail persons for adverse outcomes of aging, (3) usefulness as a potential marker of increased vulnerability, as well as (4) determine the level, sources, and predictors of the discordance between the PF and the FI in frailty classification. By elucidating the values and limits of the two most commonly used frailty instruments and assessing potential simplifications of the PFP, the proposed study promises to provide much needed guidance on the selection of frailty measures to match clinical aims of frailty assessment, with the ultimate goal of identifying new arenas for frailty prevention and treatment.