三种评估量表在门诊老年病人衰弱筛查中的应用研究

Application of three assessment scales in screening for frailty in elderly outpatients

目的比较FARIL量表、Fried衰弱表型(FP)及简易体能状态量表(SPPB)在门诊老年病人衰弱筛查中的一致性和适用性。方法选择2020年10月至2021年5月中国人民解放军总医院老年衰弱认知管理门诊就诊的老年病人为研究对象,分别使用FRAIL量表、FP和SPPB对其进行衰弱筛查。采用Kappa值分析三种量表的一致性;以病人的日常生活能力为评定标准,采用ROC曲线和Bayes判别分析评价三种量表的效度及适用性。结果共218例病人参加测评,有效测评188例,有效测评率为86.23%。三种量表筛查出的衰弱病人比例中,FP最高(17.55%),SPPB次之(15.96%),FRAIL量表最低(14.36%);筛查出的衰弱前期病人比例中,FP最高(58.98%),FRAIL次之(52.66%),SPPB最低(25.00%)。FRAIL量表与FP,FRAIL量表与SPPB,FP与SPPB一致性分析的Kappa值分别为0.565、0.401、0.447(P均<0.001)。ROC曲线分析显示,FRAIL量表、FP和SPPB预测门诊老年病人日常生活能力下降的AUC分别为0.717、0.728、0.786(P均<0.001),进一步的Bayes判别分析显示,FRAIL量表、FP和SPPB交叉验证的准确率分别为57.4%、75.0%、76.7%。结论FRAIL量表、FP及SPPB对门诊老年人的衰弱筛查结果中等一致,但FP可能更适合筛查门诊老年人的衰弱及衰弱前期,FP、SPPB对门诊老年人的日常生活能力下降的预测效果较好。

Objective To compare the consistency and applicability of FRAIL scale,Fried frailty phenotype(FP)and Short Physical Performance Battery(SPPB)in the screening of frailty in the elderly outpatients.Methods The elderly outpatients in the elderly frailty and cognitive management clinic of Chinese PLA General Hospital from October 2020 to May 2021 were selected as the subjects.FRAIL scale,FP and SPPB were used to screen the frailty among the patients,respectively.The Kappa value was calculated to evaluate the consistency of the three scales.The patient’s ability of daily living was used as the evaluation standard,and the validity and applicability of the three scales was evaulated by receiver operating characteristic(ROC)curve and Bayes discriminant analysis,respectively.Results There were 218 patients undergoing the evaluation,and 188 cases were effective,with an effective evaluation rate of 86.23%.Among the three scales,the proportion of frailty patients screened by FP was the highest(17.55%),followed by SPPB(15.96%),and FRAIL scale(14.36%);The proportion of pre-frailty patients screened by FP was the highest(58.98%),followed by FRAIL scale(52.66%),and SPPB(25.00%).The Kappa value of FRAIL scale vs FP,FRAIL scale vs SPPB,FP vs SPPB was 0.565,0.401 and 0.447,respectively(all P<0.001).ROC curve analysis showed that the area under the curve(AUC)of FRAIL scale,FP and SPPB in predicting the decline of ability of daily living in the elderly outpatients was 0.717,0.728 and 0.786,respectively(all P<0.001);Bayes discriminant analysis showed that the cross-verification accuracy rate of FRAIL scale,FP and SPPB was 57.4%,75.0%and 76.7%,respectively.Conclusions FRAIL scale,FP and SPPB are moderately consistent in the screening results of frailty among the elderly outpatients.Among the three assessment scales,FP is more suitable for screening the frailty and pre-frailty of the elderly outpatients,and FP and SPPB have a good predictive effect on the decline of ability of daily living in the elderly outpatients.