Frailty Assessment: Matching Simplification Efforts to Clinical Aims

描述（由申请人提供）： 虚弱在理论上被定义为老年人中临床上可识别的脆弱性增加的状态。虽然已经制定了许多工具来确定脆弱性，但尚未就最佳措施达成共识。老年医学文献中最常引用的两种虚弱指标是身体虚弱表型（PFP）和虚弱指数（FI）。在过去五年中，引用第四国际和私营部门筹资伙伴关系的次数分别增加了五倍和八倍。随着这些工具的日益普及，现有表型的简化和近似已经激增，通常由特定研究中的测量的可用性或临床实践中对患者评估的速度和容易性的需求所驱动。根据具体的研究或临床环境定制措施的想法可能很有吸引力。然而，如果这些仪器测量老年人健康的根本不同方面，或者如果它们在实现虚弱确定的不同目标方面有差异，也会有潜在的危害（例如，虚弱综合征表征与风险分层）。虽然已经进行了一些流行病学研究来比较不同的虚弱评估工具，但迄今为止的比较几乎完全集中在预测有效性上。使用心血管健康研究中5888名65岁及以上老年人9年来收集的数据，本研究在一个新的方向进行了比较分析：系统地评价PFP标准的可能简化，其可用于（1）关于虚弱综合征识别的内部有效性，（2）区分体弱和非体弱者对老龄化不良后果的风险的准确性，（3）作为脆弱性增加的潜在标志的有用性，以及（4）确定水平，来源，PF和FI在虚弱分类中的不一致性的预测因子。通过阐明两种最常用的虚弱工具的价值和限制，并评估PFP的潜在简化，拟议的研究有望为虚弱评估的临床目标提供选择虚弱措施的指导，最终目标是确定新的虚弱预防和治疗领域。

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.