Frailty Assessment: Matching Simplification Efforts to Clinical Aims

衰弱评估：将简化工作与临床目标相匹配

• 批准号: 8772844
• 负责人: Qian-Li Xue
• 金额: $ 8.1万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-15 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8772844
• 关键词: Accounting; Acute; Address; Adverse event; Advocate; Age; Aging; Body Weight decreased; Cardiovascular system; Caring; Cessation of life; Classification; Clinical; Comorbidity; Consensus; Data; Data Quality; Effectiveness; Elderly; Epidemiologic Studies; Evaluation; Event; Frail Elderly; Frail Older Adults; Future; Gait; Goals; Gold; Health; Health Personnel; Heterogeneity; Intervention; Life; Literature; Measurement; Measures; Medical; Methodology; Outcome; Patient Self-Report; Patients; Persons; Phenotype; Physical activity; Physiological; Population; Prevention; Proliferating; Research; Risk; Scheme; Source; Speed; Spouses; Stratification; Syndrome; System; Translating; Weight; Work; adverse outcome; base; clinical practice; comparative; coping; disability; frailty; grasp; improved; indexing; instrument; instrumental activity of daily living; mortality; novel; public health relevance; screening; stressor; tool

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.

描述（由申请人提供）：从理论上讲，脆弱是一种临床上可识别的老年人脆弱性的状态。尽管已经开发了许多仪器来确定脆弱的方法，但尚未达成最佳措施的共识。老年文献中最常见的两种脆弱措施是物理脆弱表型（PFP）和脆弱指数（FI）。在过去五年中，FI和PFP的引用数量分别分别置于五个。随着这些工具的日益普及，简化的现有表型的近似值已经扩大，通常是由于特定研究中的措施的可用性或对速度的需求和临床实践中患者评估的易用性的动机。针对特定研究或临床环境量身定制措施的想法可能会很有吸引力。但是，如果工具衡量老年人健康的根本不同方面，或者它们在实现脆弱的确定目标方面具有不同的有效目标（例如，虚弱的综合征表征与风险分层）有效地有效，则也会有潜在的危害。尽管已经进行了许多流行病学研究来比较不同的脆弱评估工具，但迄今为止的比较几乎完全集中在预测有效性上。本研究使用在心血管健康研究中从65岁及65岁及以上收集的9年内收集的数据，本研究在新方向上进行比较分析，以：系统地评估PFP标准的可能简化，该标准可用于（1）在不适合鉴定的情况下，（2）对较高的差异，（2）对差异性的差异，（2），（2）差异化，（2），（2）差异化，（2）差异，（2）差异，（2）差异，（2）差异。 （3）有用性是增加脆弱性的潜在标记，以及（4）确定脆弱分类中PF和FI之间不一致的水平，来源和预测指标。通过阐明两种最常用的脆弱仪器的价值和限制并评估PFP的潜在简化，拟议的研究承诺将提供急需的指导，以匹配脆弱评估的临床目标，并具有确定脆弱的预防和治疗的最终目标。