FRAIL-NH量表和Tilburg衰弱量表对养老机构老年人衰弱评估比较
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摘要
目的:比较FRAIL-NH量表与Tilburg衰弱量表(Tilburg Frailty Indicator,TFI)对养老机构老年人衰弱的评估能力及评估效果,为养老机构衰弱方面的实践和研究提供指导。方法:采用便利抽样法选取长沙市6所养老机构的302名老年人为研究对象,采用一般资料调查问卷、衰弱指数(FrailtyIndex,FI)、FRAILNH量表以及TFI进行资料收集。结果:以FI判断的衰弱状态为参照,FRAIL-NH、TFI的ROC曲线下面积分别为0.861,0.776,两者ROC曲线下面积之差为0.085(Z=3.455,P<0.001);FRAIL-NH和TFI的衰弱临界值分别为1.5和4.5;二者与FI在衰弱判定方面的交叉验证准确率分别为70.9%,71.9%。FI、FRAIL-NH、TFI三者评估的衰弱发生率分别为66.6%、69.5%、68.5%。结论:相比TFI,FRAIL-NH更适用于养老机构老年人衰弱评估。
Objective: To compare the ability and efficacy of FRAIL-NH Scale and Tilburg Frailty Indicator(TFI) in assessment of frailty in institutional older adults so as to provide guidance for the practice and research on frailty in pension institutions. Methods: A total of 302 older adults in six pension institutions from Changsha were recruited by convenience sampling. Frailty was assessed by the Frailty Index(FI), FRAIL-NH Scale and TFI. General information was collected by a self-designed general information questionnaire. Results: Taking FI as the reference, the areas under the ROC curve for FRAIL-NH and TFI were 0.861 and 0.776 respectively, the difference of area under ROC curve between FRAIL-NH and TFI was 0.085(Z=3.455, P<0.001). The cut off points for FRAIL-NH and TFI in classifying non-frailty and frailty were 1.5 and 4.5,respectively. The cross-validation accuracy of them were 70.9% and 71.9%, respectively. The prevalence of frailty was 66.6%,69.5% and 68.5% by the assessment of FI, FRAIL-NH and TFI, respectively. Conclusion: Compared with TFI, FRAIL-NH is more appropriate for the frailty assessment among institutional older adults.
Objective: To compare the ability and efficacy of FRAIL-NH Scale and Tilburg Frailty Indicator(TFI) in assessment of frailty in institutional older adults so as to provide guidance for the practice and research on frailty in pension institutions. Methods: A total of 302 older adults in six pension institutions from Changsha were recruited by convenience sampling. Frailty was assessed by the Frailty Index(FI), FRAIL-NH Scale and TFI. General information was collected by a self-designed general information questionnaire. Results: Taking FI as the reference, the areas under the ROC curve for FRAIL-NH and TFI were 0.861 and 0.776 respectively, the difference of area under ROC curve between FRAIL-NH and TFI was 0.085(Z=3.455, P<0.001). The cut off points for FRAIL-NH and TFI in classifying non-frailty and frailty were 1.5 and 4.5,respectively. The cross-validation accuracy of them were 70.9% and 71.9%, respectively. The prevalence of frailty was 66.6%,69.5% and 68.5% by the assessment of FI, FRAIL-NH and TFI, respectively. Conclusion: Compared with TFI, FRAIL-NH is more appropriate for the frailty assessment among institutional older adults.
引文
[1]侯晓琳,高静,吴晨曦,等.养老机构老年人衰弱现状及分析.中华护理杂志,2018,53(1):88-93.Hou XL,Gao J,Wu CX,et al.Prevalence and factors associated with frailty among institutional older adults.Chinese Journal of Nursing,2018,53(1):88-93.
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[3]Kojima G.Frailty as a predictor of future falls among community-dwelling older people:a systematic review and meta-analysis.Journal of the American Medical Directors Association,2015,16(12):1027-1033.
[4]Shamliyan T,Talley KM,Ramakrishnan R,et al.Association of frailty with survival:a systematic literature review.Ageing Research Reviews,2013,12(2):719-736.
[5]Vermeulen J,Neyens JC,Rossum EV,et al.Predicting ADL disability in communitydwelling elderly people using physical frailty indicators:a systematic review.BMC Geriatrics,2011,11(33):1-9.
[6]Fried L,Tangen C,Walston J,et al.Frailty in older adults:evidence for a phenotype.Journal of Gerontology,2001,56(3):146-156.
[7]Buta BJ,Walston JD,Godino JG,et al.Frailty assessment instruments:systematic characterization of the uses and contexts of highly-cited instruments.Ageing Research Reviews,2016,42(26):53-61.
[8]Silva TRD,Theou O,Vellas B,et al.Frailty screening(FRAIL-NH)and mortality in french nursing homes:results from the incidence of pneumonia and related consequences in nursing home residents study.Journal of the American Medical Directors Association,2018,19(5):411-414.
[9]董莉娟.社区老年人衰弱与生存质量的关系研究.济南:山东大学,2017.Dong LJ.The relationship between frailty and health-related quality of life among communitydwelling older people.Jinan:Shandong University,2017.
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[11]Martínezvelilla N,Herce PA,HerreroáC,et al.Heterogeneity of different tools for detecting the prevalence of frailty in nursing homes:feasibility and meaning of different approaches.Journal of the American Medical Directors Association,2017,18(10):891-898.
[12]马丽娜,陈彪.老年人衰弱评估工具及其应用.中华老年多器官疾病杂志,2017,16(8):624-628.Ma LN,Chen B.Frailty assessment tools for the elderly and their application.Chinese Journal of Multiple Organ Disease in the Elderly,2017,16(8):624-628.
[13]Kaehr E,Visvanathan R,Malmstrom TK,et al.Frailty in nursing homes:the FRAIL-NHscale.Journal of the American Medical Directors Association,2015,16(2):87-89.
[14]Abellan VKG,Rolland YM,Morley JE,et al.Frailty:toward a clinical definition.Journal of the American Medical Directors Association,2008,9(2):71-72.
[15]Rockwood K,Mitnitski A.Frailty in relation to the accumulation of deficits.The Journals of Gerontology Series A Biological Sciences and Medical Sciences,2007,62(7):722-727.
[16]Kaehr EW,Pape LC,Malmstrom TK,et al.FRAIL-NH predicts outcomes in long term care.Journal of Nutrition Health&Aging,2016,20(2):192-198.
[17]Mariscal B,Mariscal BE,Mena-Madrazo JA.Use of the Spanish version of the FRAIL-NH scale to predict adverse outomes in a nursing home in Mexico city.Journal of the American Medical Directors Association,2018,19(3):B31.
[18]Luo H,Lum TY,Wong GH,et al.Predicting adverse health outcomes in nursing homes:a9-Year longitudinal study and development of the FRAIL-Minimum Data Set(MDS)quick screening tool.Journal of the American Medical Directors Association,2015,16(12):1042-1047.
[19]Searle SD,Mitnitski A,Gahbauer EA,et al.A standard procedure for creating a frailty index.BMC Geriatrics,2008,8(24):1-10.
[20]周白瑜,于冬妮,陶永康,等.北京市社区老年人跌倒发生与衰弱的相关性研究.中华流行病学杂志,2018,39(3):308-312.Zhou BY,Yu DN,Tao YK,et al.Relationship between fall and frailty index in elderly adults of urban community in Beijing.Chinese Journal of Epidemiology,2018,39(3):308-312.
[21]Shi J,Song X,Yu P,et al.Analysis of frailty and survival from late middle age in the Beijing Longitudinal Study of Aging.BMC Geriatrics,2011,11(1):1-8.
[22]Thompson MQ,Theou O,Yu S,et al.Frailty prevalence and factors associated with the Frailty Phenotype and Frailty Index:findings from the North West Adelaide Health Study.Australasian Journal on Ageing,2017,37(2):120-126.
[23]Hoover M,Rotermann M,Sanmartin C,et al.Validation of an index to estimate the prevalence of frailty among community-dwelling seniors.Health Reports,2013,24(9):10-17.
[24]徐勇,吴海苏,徐一峰.病人健康问卷抑郁量表(PHQ-9)在社区老年人群中的应用--信度与效度分析.上海精神医学,2007,19(5):257-259.Xu Y,Wu HS,Xu YF.The reliability and validity of patient health questionnaire depression module(PHQ-9)in Chinese elderly.Shanghai Archives of Psychiatry,2007,19(5):257-259.
[25]Katz S,Downs TD,Cash HR,et al.Progress in development of the index of ADL.Gerontologist,1970,10(1):20-30.
[26]Gobbens RJJ,Van Assen MA,Luijkx KG,et al.The Tilburg Frailty Indicator:psychometric properties.Journal of the American Medical Directors Association,2010,11(5):344-355.
[27]司华新,金雅茹,乔晓霞,等.中文版Tilburg衰弱量表在养老机构老年人中的信效度检验.中国老年学杂志,2018,38(16):4046-4049.Si HX,Jin YR,Qiao XX,et al.Reliability and validity of the Chinese version of Tilburg Frailty Scale for the elderly in nursing homes.Chinese Journal of Gerontology,2018,38(16):4046-4049.
[28]Linden A.Measuring diagnostic and predictive accuracy in disease management:an introduction to receiver operating characteristic(ROC)analysis.Journal of Evaluation in Clinical Practice,2010,12(2):132-139.
[29]Morley JE,Vellas B,Kan GAV,et al.Frailty Consensus:a call to action.Journal of the American Medical Directors Association,2013,14(6):392-397.
[30]Dent E,Kowal P,Hoogendijk EO.Frailty measurement in research and clinical practice:a review.European Journal of Internal Medicine,2016,31(1):3-10.
[31]Olga T,Brothers TD,Arnold M,et al.Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality.Journal of the American Geriatrics Society,2013,61(9):1537-1551.
[32]Kulminski A,Ukraintseva SI,Arbeev K,et al.Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty:lessons from the Cardiovascular Health Study.Journal of the American Geriatrics Society,2010,56(5):898-903.
[33]Maturin TT,Eirini K,Laurent D,et al.Frailty Index and mortality in nursing home residents in France:results from the INCUR study.Journal of the American Medical Directors Association,2015,16(7):603-606.
[34]Hogan DB,Freiheit EA,Strain LA,et al.Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living.BMC Geriatrics,2012,12(1):56.
[35]Coelho T,Santos R,Paúl C,et al.Portuguese version of the Tilburg Frailty Indicator:transcultural adaptation and psychometric validation.Geriatrics&Gerontology International,2014,15(8):951-960.
[36]郭秀静,王玉琼,刘樱,等.爱丁堡产后抑郁量表在孕晚期妇女产前抑郁筛查中的临界值研究.中华护理杂志,2009,44(9):808-810.Guo XJ,Wang YQ,Liu Y,et al.Study on the optimal critical value of the edinburgh postnatal depression scale in the screening of antenatal depression.Chinese Journal of Nursing,2009,44(9):808-810.
[37]魏曾曾,王维利.简式简明心境问卷界定胃癌根治术患者术前负性心境状态的临界值研究.中华护理杂志,2011,46(2):169-171.Wei ZZ,Wang WL.Study on the optimal critical value of the profile of mood states-short form in assessing negative emotions of patients waiting for radical gastrectomy.Chinese Journal of Nursing,2011,46(2):169-171.
[38]Fluetti MT,Fhon JRS,Oliveira APD,et al.The frailty syndrome in institutionalized elderly persons.Revista Brasileira de Geriatriae Gerontologia,2018,21(1):60-69.
[39]赵雅宜,李现文,丁亚萍,等.Tilburg量表和衰弱表型对养老机构老年人失能状况预测作用比较.中国卫生统计,2017,34(3):436-438.Zhao YY,Li XW,Ding YP,et al.Comparison of the prediction effect of Tilburg scale and Frailty Phenotype on the disability of elderly in nursing homes.Chinese Journal of Health Statistics,2017,34(3):436-438.
[40]李阳,张立萍,罗洋.哈尔滨市社区老年人衰弱现状及其影响因素调查.护理研究,2018,32(2):224-228.Li Y,Zhang LP,Luo Y.Survey of status and influential factors of elderly frailty in community in Harbin city.Chinese Nursing Research,2018,32(2):224-228.
[2]Kojima G.Prevalence of frailty in nursing homes:a systematic review and meta-analysis.Journal of the American Medical Directors Association,2015,16(11):940-945.
[3]Kojima G.Frailty as a predictor of future falls among community-dwelling older people:a systematic review and meta-analysis.Journal of the American Medical Directors Association,2015,16(12):1027-1033.
[4]Shamliyan T,Talley KM,Ramakrishnan R,et al.Association of frailty with survival:a systematic literature review.Ageing Research Reviews,2013,12(2):719-736.
[5]Vermeulen J,Neyens JC,Rossum EV,et al.Predicting ADL disability in communitydwelling elderly people using physical frailty indicators:a systematic review.BMC Geriatrics,2011,11(33):1-9.
[6]Fried L,Tangen C,Walston J,et al.Frailty in older adults:evidence for a phenotype.Journal of Gerontology,2001,56(3):146-156.
[7]Buta BJ,Walston JD,Godino JG,et al.Frailty assessment instruments:systematic characterization of the uses and contexts of highly-cited instruments.Ageing Research Reviews,2016,42(26):53-61.
[8]Silva TRD,Theou O,Vellas B,et al.Frailty screening(FRAIL-NH)and mortality in french nursing homes:results from the incidence of pneumonia and related consequences in nursing home residents study.Journal of the American Medical Directors Association,2018,19(5):411-414.
[9]董莉娟.社区老年人衰弱与生存质量的关系研究.济南:山东大学,2017.Dong LJ.The relationship between frailty and health-related quality of life among communitydwelling older people.Jinan:Shandong University,2017.
[10]Theou O,Tan EC,Bell JS,et al.Frailty levels in residential aged care facilities measured using the frailty index and FRAIL-NH scale.Journal of the American Geriatrics Society,2016,64(11):e207-212.
[11]Martínezvelilla N,Herce PA,HerreroáC,et al.Heterogeneity of different tools for detecting the prevalence of frailty in nursing homes:feasibility and meaning of different approaches.Journal of the American Medical Directors Association,2017,18(10):891-898.
[12]马丽娜,陈彪.老年人衰弱评估工具及其应用.中华老年多器官疾病杂志,2017,16(8):624-628.Ma LN,Chen B.Frailty assessment tools for the elderly and their application.Chinese Journal of Multiple Organ Disease in the Elderly,2017,16(8):624-628.
[13]Kaehr E,Visvanathan R,Malmstrom TK,et al.Frailty in nursing homes:the FRAIL-NHscale.Journal of the American Medical Directors Association,2015,16(2):87-89.
[14]Abellan VKG,Rolland YM,Morley JE,et al.Frailty:toward a clinical definition.Journal of the American Medical Directors Association,2008,9(2):71-72.
[15]Rockwood K,Mitnitski A.Frailty in relation to the accumulation of deficits.The Journals of Gerontology Series A Biological Sciences and Medical Sciences,2007,62(7):722-727.
[16]Kaehr EW,Pape LC,Malmstrom TK,et al.FRAIL-NH predicts outcomes in long term care.Journal of Nutrition Health&Aging,2016,20(2):192-198.
[17]Mariscal B,Mariscal BE,Mena-Madrazo JA.Use of the Spanish version of the FRAIL-NH scale to predict adverse outomes in a nursing home in Mexico city.Journal of the American Medical Directors Association,2018,19(3):B31.
[18]Luo H,Lum TY,Wong GH,et al.Predicting adverse health outcomes in nursing homes:a9-Year longitudinal study and development of the FRAIL-Minimum Data Set(MDS)quick screening tool.Journal of the American Medical Directors Association,2015,16(12):1042-1047.
[19]Searle SD,Mitnitski A,Gahbauer EA,et al.A standard procedure for creating a frailty index.BMC Geriatrics,2008,8(24):1-10.
[20]周白瑜,于冬妮,陶永康,等.北京市社区老年人跌倒发生与衰弱的相关性研究.中华流行病学杂志,2018,39(3):308-312.Zhou BY,Yu DN,Tao YK,et al.Relationship between fall and frailty index in elderly adults of urban community in Beijing.Chinese Journal of Epidemiology,2018,39(3):308-312.
[21]Shi J,Song X,Yu P,et al.Analysis of frailty and survival from late middle age in the Beijing Longitudinal Study of Aging.BMC Geriatrics,2011,11(1):1-8.
[22]Thompson MQ,Theou O,Yu S,et al.Frailty prevalence and factors associated with the Frailty Phenotype and Frailty Index:findings from the North West Adelaide Health Study.Australasian Journal on Ageing,2017,37(2):120-126.
[23]Hoover M,Rotermann M,Sanmartin C,et al.Validation of an index to estimate the prevalence of frailty among community-dwelling seniors.Health Reports,2013,24(9):10-17.
[24]徐勇,吴海苏,徐一峰.病人健康问卷抑郁量表(PHQ-9)在社区老年人群中的应用--信度与效度分析.上海精神医学,2007,19(5):257-259.Xu Y,Wu HS,Xu YF.The reliability and validity of patient health questionnaire depression module(PHQ-9)in Chinese elderly.Shanghai Archives of Psychiatry,2007,19(5):257-259.
[25]Katz S,Downs TD,Cash HR,et al.Progress in development of the index of ADL.Gerontologist,1970,10(1):20-30.
[26]Gobbens RJJ,Van Assen MA,Luijkx KG,et al.The Tilburg Frailty Indicator:psychometric properties.Journal of the American Medical Directors Association,2010,11(5):344-355.
[27]司华新,金雅茹,乔晓霞,等.中文版Tilburg衰弱量表在养老机构老年人中的信效度检验.中国老年学杂志,2018,38(16):4046-4049.Si HX,Jin YR,Qiao XX,et al.Reliability and validity of the Chinese version of Tilburg Frailty Scale for the elderly in nursing homes.Chinese Journal of Gerontology,2018,38(16):4046-4049.
[28]Linden A.Measuring diagnostic and predictive accuracy in disease management:an introduction to receiver operating characteristic(ROC)analysis.Journal of Evaluation in Clinical Practice,2010,12(2):132-139.
[29]Morley JE,Vellas B,Kan GAV,et al.Frailty Consensus:a call to action.Journal of the American Medical Directors Association,2013,14(6):392-397.
[30]Dent E,Kowal P,Hoogendijk EO.Frailty measurement in research and clinical practice:a review.European Journal of Internal Medicine,2016,31(1):3-10.
[31]Olga T,Brothers TD,Arnold M,et al.Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality.Journal of the American Geriatrics Society,2013,61(9):1537-1551.
[32]Kulminski A,Ukraintseva SI,Arbeev K,et al.Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty:lessons from the Cardiovascular Health Study.Journal of the American Geriatrics Society,2010,56(5):898-903.
[33]Maturin TT,Eirini K,Laurent D,et al.Frailty Index and mortality in nursing home residents in France:results from the INCUR study.Journal of the American Medical Directors Association,2015,16(7):603-606.
[34]Hogan DB,Freiheit EA,Strain LA,et al.Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living.BMC Geriatrics,2012,12(1):56.
[35]Coelho T,Santos R,Paúl C,et al.Portuguese version of the Tilburg Frailty Indicator:transcultural adaptation and psychometric validation.Geriatrics&Gerontology International,2014,15(8):951-960.
[36]郭秀静,王玉琼,刘樱,等.爱丁堡产后抑郁量表在孕晚期妇女产前抑郁筛查中的临界值研究.中华护理杂志,2009,44(9):808-810.Guo XJ,Wang YQ,Liu Y,et al.Study on the optimal critical value of the edinburgh postnatal depression scale in the screening of antenatal depression.Chinese Journal of Nursing,2009,44(9):808-810.
[37]魏曾曾,王维利.简式简明心境问卷界定胃癌根治术患者术前负性心境状态的临界值研究.中华护理杂志,2011,46(2):169-171.Wei ZZ,Wang WL.Study on the optimal critical value of the profile of mood states-short form in assessing negative emotions of patients waiting for radical gastrectomy.Chinese Journal of Nursing,2011,46(2):169-171.
[38]Fluetti MT,Fhon JRS,Oliveira APD,et al.The frailty syndrome in institutionalized elderly persons.Revista Brasileira de Geriatriae Gerontologia,2018,21(1):60-69.
[39]赵雅宜,李现文,丁亚萍,等.Tilburg量表和衰弱表型对养老机构老年人失能状况预测作用比较.中国卫生统计,2017,34(3):436-438.Zhao YY,Li XW,Ding YP,et al.Comparison of the prediction effect of Tilburg scale and Frailty Phenotype on the disability of elderly in nursing homes.Chinese Journal of Health Statistics,2017,34(3):436-438.
[40]李阳,张立萍,罗洋.哈尔滨市社区老年人衰弱现状及其影响因素调查.护理研究,2018,32(2):224-228.Li Y,Zhang LP,Luo Y.Survey of status and influential factors of elderly frailty in community in Harbin city.Chinese Nursing Research,2018,32(2):224-228.