摘要
目的生物-心理-社会衰弱与死亡风险增加和医疗卫生服务利用有关。本研究旨在评估老年人功能评估简表(Short Functional Geriatric Evaluation,SFGE)对老年人死亡率和住院率的预测效能。方法采用回顾性队列研究对参与意大利“老年人长寿!”项目的人群进行分析。共纳入8561名75岁以上的意大利社区居民,平均随访时间516.6 d。计算老年人死亡率、住院率、养老机构入住率和SFGE评估的衰弱程度并进行分析。SFGE评分中社会经济相关条目占40%。结果与健康老年人相比,衰弱前期、衰弱和非常衰弱老人死亡(RR分别为1.40、2.78和5.41)、住院(OR分别为1.31、1.67和2.08)和养老机构入住(OR分别为3.63、9.52和10.61)风险显著增加。在仅纳入社会经济条目的模型中得到类似结果。衰弱预测死亡率的受试者工作特征曲线下面积为0.70(95%CI 0.68~0.72),敏感性和特异性分别为83.2%和40.4%。结论SFGE评分通过对老年人衰弱程度进行分层来预测死亡、住院和养老机构入住风险。该评估工具简短、包含社会经济变量等特征使之可作为公众健康大样本筛查工具,将衰弱作为社区老年人照护的核心。
Objectives Bio-psycho-social frailty is related to increased risk of death and utilization of health services.This paper reports the predictive validity of a 10-min multidimensional questionnaire on the risk of death,hospitalization and institutionalization.Methods A retrospective cohort study was performed based on data from the“Long Live the Elderly!”program,involving 8,561 community-dwelling Italian people>75,followed for an average of 516.6 days(Median=448,P_(25)-P_(75):309-692).Mortality,hospitalization,and institutionalization rates according to frailty levels assessed by the Short Functional Geriatric Evaluation(SFGE)have been calculated.Results Compared with the robust,the pre-frail,frail,and very frail faced a statistically significant increase in the risk of mortality(RR=1.40,2.78 and 5.41),hospitalization(OR=1.31,1.67,and 2.08)and institutionalization(OR=3.63,9.52,and 10.62).Similar results were obtained in the sub-sample of those with only socio-economic issues.Frailty predicted mortality with an area under the ROC curve of 0.70(95%CI 0.68-0.72)with sensitivity and specificity of 83.2%and 40.4%.Analyses of single determinants of these negative outcomes showed a multivariable pattern of determinants for all the events.Conclusions The SFGE predicts death,hospitalization and institutionalization by stratifying older people according to the levels of frailty.The short administration time,the socio-economic variables and the characteristics of personnel administering the questionnaire make it suitable for being used in public health as a screening tool for a large population,to put frailty at the core of the care for community-dwelling older adults.The difficulty in capturing the complexity of the frailty is witnessed by the moderate sensitivity and specificity of the questionnaire.
关键词
老年人
衰弱
老年医学评估
意大利
问卷调查
Aged
Frailty
Geriatric assessment
Italy
Surveys and questionnaires
