住院老年患者衰弱评估及不同衰弱评估工具的比较  

Frailty assessment of hospitalized older patients and comparison of different frailty tools

作　　者：吕卫华[1] 王青[1] 赵清华[1] 吴薇[1] 翟雪亮 张少景 Lv Weihua Wang Qing Zhao Qinghua Wu Wei Zhai Xueliang Zhang Shangjing(Department, Fuxing Hospital, Capital Medical University, Beijing 100038, China)

机构地区：[1]首都医科大学附属复兴医院干保科,北京100038

出　　处：《北京医学》2016年第10期1036-1040,共5页Beijing Medical Journal

基　　金：首都卫生发展科研专项项目(首发2016-2-7021)

摘　　要：目的探讨衰弱表型评估(CHS index)、累积缺陷衰弱指数(FI-CD)、衰弱量表(Frail Scale)3种衰弱评估工具在老年住院患者衰弱评估中的应用及对比。方法选取≥65岁的老年住院患者268例,采用CHS index、Frail Scale、FI-CD评估无衰弱、衰弱前期、衰弱的发生率。应用卡方检验,通过kappa了解各评估方法的一致性。结果入选患者平均年龄(83.45±5.64)岁,采用CHS index、Frail Scale、FI-CD评估工具检出衰弱的患者比例分别为31.0%、18.6%,13.1%。3种评估方法均显示衰弱组患者较无衰弱组患者的年龄更大,多重用药、营养不良、抑郁障碍、认知障碍、日常生活活动能力(ADL)及工具性日常生活活动能力(IADL)受损比例明显增多,血红蛋白水平及e GFR明显降低(P<0.01;应用Frail Scale及FI-CD评估的衰弱组患者共病数量显著多于无衰弱患者(P<0.01;而采用CHS index评估共病数量各组差异无统计学意义(P=0.059)。CHS index与FICD、CHS index与Frail Scale、FI-CD与Frail Scale两两比较kappa分别为0.30、0.45、0.37,提示3种方法对衰弱的评估两两比较一致性较差。结论老年住院患者衰弱者存在更多的健康缺陷,采用不同的衰弱评估工具,对老年住院患者衰弱的检出率相差较大,应慎重对待评估结果。Objectives The aim of this study was to evaluate three frailty tools and to compare the assessment results on frailty in hospitalized old patients defined by the Fried＇s Cardiovascular Health Study index （CHS index）, Frailty Index of Accumulative Deficits （FI-CD） and Frail Scale. Methods A total of 268 elderly hospitalized patients aged 65 andover were selected and nonfrailty, prefrailty and frailty were assessed according to CHS index and Frail Scale. As the continuous variable, the higher the FI value, the severer the frail degree. FIwas grouped in trisection because there was no cutoff value to define frailty： the lower tertile, the middle tertile and the upper tertile. Chi-square test and Kappa were used to identify the consistency between these tools. Results Patients＇average age was 83.45±5.64 years. CHS index, Frail Scale and FI-CD were available, of which 31.0%、 18.6% andl3.1% were classified as frail respectively. All three frailty tools showed that patients were older and had much higher proportion of polypharmacy, malnutrition, depressive disorder, cognitive disorder, impairment of activities of daily living （ADL） and instrumental activities of daily living （IADL） and lower hemoglobin and eGFR in frailty than that in nonfrailty（P〈0.01）.Frail patients had more comorbidity than nonfrail identified by Frail Scale and FI-CD （P〈0.01）, while there was no difference in comorbidity number assessed by CHS index（P=0.059）. Comparing CHS index and FI-CD, CHS index and Frail Scale, FI-CD and Frail Scale in pairwise, kappa value were 0.30 、 0.45and 0.37 separately, which indicated the poor consistency of these three frailty tools. Conclusions Frail older hospitalized patients have more health defects. There is big differences in the frail detection rate by different frailty tools, so the assessment results should be interpretated with caution.

关 键 词：老年 衰弱评估 衰弱评估工具 

分 类 号：R592[医药卫生—老年医学]