三种衰弱量表诊断一致性及测量维度的探讨  

A study on the consistency and their measurement dimensions of three frailty diagnostic instruments

作　　者：王丹 周起 武文斌[3] WANG Dan;ZHOU Qi;WU Wenbin(Donghuashi Community Health Service Center,Beijing 100010;The Key Laboratory of Geriatrics,Beijing Institute of Geriatrics,Beijing Hospital,National Center of Gerontology,National Health Commission,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730;Department of Geriatrics,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京市东城区东花市社区卫生服务中心,100010 [2]北京医院、国家老年医学中心、国家卫生健康委北京老年医学研究所、国家卫生健康委老年医学重点实验室、中国医学科学院老年医学研究院,100730 [3]北京医院老年科、国家老年医学中心、中国医学科学院老年医学研究院,100730

出　　处：《中国老年保健医学》2023年第3期62-66,共5页Chinese Journal of Geriatric Care

基　　金：国家重点研发计划(编号:2020YFC2009006);中央高水平医院临床科研业务费(编号:bj-2022-181)。

摘　　要：目的分析3种衰弱量表在住院老年人中诊断的一致性,并探索影响一致性的原因。方法针对2020年5月至2022年11月本院老年科老年综合评估的住院患者,收集衰弱表型量表(fried frailty phenotype,FFP)、衰弱量表(frail scale,FS),临床衰弱等级(clinical frailty scale,CFS)评估的数据,并对3种量表评估结果做一致性检验。通过探索性因子分析和层次聚类分析对量表测量变量做潜变量归纳分析,分析影响诊断一致性的原因。结果本研究共入选1348例患者,平均年龄(76.8±10.0)岁,女性占50.2%。采用FFP、FS及CFS工具检出衰弱的比例分别为31.1%、28.6%及33.3%。3个量表诊断的一致性为中等及以下(Kappa=0.22~0.44);FS-FFP,FS-CFS,CFS-FFP诊断的一致率分别为61.2%、63.4%及48.6%。因子分析及聚类分析表明,3个量表测量了患者体重下降、疲乏、活动能力、疾病相关、躯体功能共5个维度。FS和FFP在疾病及躯体运动功能维度上差异较大;CFS更多反映了患者的活动能力。对同一维度不同测量方式结果的一致性计算发现:除体重下降及疲乏相关测量变量有较高的一致性性外,其他相同维度不同的测量方式均具有强异质性(Kappa均<0.6)。结论老年住院人群衰弱评估时,3个量表因测量的维度不同及同维度测量的方式差异是诊断结果一致性较低的重要原因。临床医护人员在诊断衰弱时要充分考虑诊断工具能测量的维度及人群的适应性。Objective To analyze the consistency of the three-frailty definition in the diagnosis of frailty among hospitalized elderly and to explore the reasons affecting this consistency Methods For inpatients with comprehensive geriatric assessment in the geriatric department from May 2020 to November 2022,data on assessment of frailty using frailty phenotype(FFP),frail scale(FS)and clinical frailty scale(CFS)were collected and the consistency of the frailty prevalence diagnosed by the three definition was analyzed.Exploratory factor analysis and hierarchical cluster analysis were used to form latent variables representing the measurements of frailty,exploring the factors affecting the diagnostic consistency.Results A total of 1348 patients were enrolled,with a mean age of(76.8±10.0)years and 50.2%of females.The percentage of frailty detected using the FFP,FS and CFS was 31.1%,28.6%and 33.3%,respectively.The diagnostic agreement was moderate or below for all three definitions(Kappa=0.22~0.44);the agreement rates diagnosed by FS-FFP,FS-CFS,and CFS-FFP were 61.2%,63.4%,and 48.6%,respectively.Factor and cluster analyses showed that the three tools measured a total of five dimensions of patients health status,including weight loss,exhaustion,mobility,disease-related,and physical activity.FS and FFP showed great differences in dimensions of disease and physical activity;CFS reflects more of the patient s mobility.The consistency of different variables measuring the same dimension were analyzed.The results showed that most measurements showed high heterogeneity except for those measuring weight loss and exhaustion.Conclusion Different diagnostic dimensions in the FFP,FS,and CFS and disparities among measurements of the same dimension in the assessment of frailty may be responsible for reducing the consistency of diagnostic results among the elderly inpatient population.Clinicians and healthcare professionals should give due consideration to the dimensions that the tool can measure and the suitability for inpatients in frailty

关 键 词：老年 衰弱 一致性 住院人群 

分 类 号：R592[医药卫生—老年医学]