衰弱表型和衰弱指数评估老年人衰弱效果的初步研究

目的探讨衰弱表型定义和衰弱指数(FI)这两种衰弱评估法筛查老年人衰弱的效果,为临床和科研应用提供参考。方法选择2015年北京医院参加老年医学门诊体检的106例老年人为研究对象,年龄(79.5±7.6)岁,在完成常规体检的基础上进行综合评估,计算FI并完成衰弱表型定义的评估。比较两种衰弱评估方法筛查同一老年人群的结果并分析两种方法的相关性或一致性,同时评价不同FI临界值对衰弱的筛检价值。结果本组老年人的FI值为0.19±0.07,根据表型定义分期,衰弱前期65例(61.3%),衰弱15例(14.2%),无衰弱26例(24.5%)。两种评估方法均表明衰弱程度随老年人年龄增长而增加。F1值与衰弱表型定义的分期呈正相关(r=0.433,P=0.000)。采用0.09~0.25的FI分级与表型定义分期的一致性Kappa值为0.143(P=0.029),曲线下面积(AUC)为0.760(95%CI:0.616~0.905,P=0.001);而采用0.20~0.35的F1分级与表型定义分期对衰弱评估的一致性Kappa值为0.178(P=0.002),AUC为0.774(95%CI:0.629~0.919,P=0.001)。适合评估该组老年人衰弱水平的FI临界值为0.19~0.27。结论该组老年人中处于衰弱前期者比例较高,衰弱程度随年龄增长而增加。FI值和表型定义分期呈中度正相关,两种F1分级方法均有筛检价值,但准确性并不是很高。

Values of frailty phenotype and frailty index in assessment of frailty for Chinese elderly

Objective To explore the efficacy of 2 frailty assessment methods, frailty phenotype and frailty index (FI) in assessment of frailty in the elderly so as to provide reference for clinical practice and scientific researches. Methods Totally 106 elderly individuals at the age of(79.5±7.6)years] who took physical examination in our outpatient department of geriatrics in 2015, were enrolled in the study. After general examination, all the subjects underwent comprehensive geriatric assessment. FI value was calculated and frailty phenotype were assessed for each subject. The prevalence of frailty in the same population was measured by the above approaches, and the relevance or consistency were analyzed based on the results. Receiver operating characteristic (ROC) curves were used to evaluate the effects of FI cut-off points on frailty screening. Results The mean value of FI was 0.19±0.07 in this cohort. According to the results of frailty phenotype assessment, 65 cases (61.3%) were categorized as pre-frailty, 15 cases (14.2%) as frailty, and 26 cases (24.5%) as non-frailty. Both assessment methods indicated that the severity of frailty was increased with age. FI value was positively correlated with frailty level staged by phenotype assessment (r=0.433, P=0.000). When FI cut-off values ranged from 0.09 to 0.25, its consistency (Kappa value) with frailty phenotype was 0.143 (P=0.029), and the area under the curve (AUC) was 0.760 (95%CI:0.616-0.905, P=0.001). While the Kappa value was 0.178 (P=0.002) and the AUC was 0.774 (95%CI:0.629-0.919, P=0.001) when the cut-off value of FI was 0.20-0.35. The optimal cut-off point of FI was 0.19-0.27. Conclusion The elderly at pre-frailty accounts for a larger proportion in this study, and the frailty severity is increased with age. Moderate positive correlation is found between FI value and frailty level by phenotype. The 2 pairs of FI cut-off values can be used to screen frailty for Chinese elderly, but the accuracy is not quite satisfactory.