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首页> 外文期刊>BMC Family Practice >Comparison of 10 single and stepped methods to identify frail older persons in primary care: diagnostic and prognostic accuracy
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Comparison of 10 single and stepped methods to identify frail older persons in primary care: diagnostic and prognostic accuracy

机译：比较10种单一和阶梯式方法识别初级保健中脆弱的老年人的能力：诊断和预后准确性

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Background Many instruments have been developed to identify frail older adults in primary care. A direct comparison of the accuracy and prevalence of identification methods is rare and most studies ignore the stepped selection typically employed in routine care practice. Also it is unclear whether the various methods select persons with different characteristics. We aimed to estimate the accuracy of 10 single and stepped methods to identify frailty in older adults and to predict adverse health outcomes. In addition, the methods were compared on their prevalence of the identified frail persons and on the characteristics of persons identified. Methods The Groningen Frailty Indicator (GFI), the PRISMA-7, polypharmacy, the clinical judgment of the general practitioner (GP), the self-rated health of the older adult, the Edmonton Frail Scale (EFS), the Identification Seniors At Risk Primary Care (ISAR PC), the Frailty Index (FI), the InterRAI screener and gait speed were compared to three measures: two reference standards (the clinical judgment of a multidisciplinary expert panel and Fried’s frailty criteria) and 6-years mortality or long term care admission. Data were used from the Dutch Identification of Frail Elderly Study, consisting of 102 people aged 65 and over from a primary care practice in Amsterdam. Frail older adults were oversampled. The accuracy of each instrument and several stepped strategies was estimated by calculating the area under the ROC-curve. Results Prevalence rates of frailty ranged from 14.8 to 52.9?%. The accuracy for recommended cut off values ranged from poor (AUC?=?0.556 ISAR-PC) to good (AUC?=?0.865 gait speed). PRISMA-7 performed best over two reference standards, GP predicted adversities best. Stepped strategies resulted in lower prevalence rates and accuracy. Persons selected by the different instruments varied greatly in age, IADL dependency, receiving homecare and mood. Conclusion We found huge differences between methods to identify frail persons in prevalence, accuracy and in characteristics of persons they select. A necessary next step is to find out which frail persons can benefit from intervention before case finding programs are implemented. Further evidence is needed to guide this emerging clinical field.
机译：背景技术已经开发出许多手段来识别初级保健中的脆弱老年人。很少能直接比较鉴定方法的准确性和普遍性，并且大多数研究都忽略了常规护理实践中通常采用的阶梯式选择。同样不清楚的是，各种方法是否会选择具有不同特征的人。我们旨在评估10种单步方法的准确性，以识别老年人的虚弱并预测不良健康结果。此外，还比较了这些方法在被识别的体弱者中的普遍性以及被识别的人的特征。方法格罗宁根衰弱指标（GFI），PRISMA-7，综合药店，全科医生的临床判断（GP），老年人的自我评估健康状况，埃德蒙顿衰弱量表（EFS），高危人群将初级保健（ISAR PC），体弱指数（FI），InterRAI筛查和步态速度与以下三个指标进行了比较：两个参考标准（多学科专家小组的临床判断和弗里德的虚弱标准）和6年或更长的死亡率定期护理入院。数据来自荷兰脆弱的老年人识别研究，该研究由来自阿姆斯特丹的初级保健机构的65岁及以上的102人组成。体弱的老年人被过度采样。通过计算ROC曲线下的面积，可以估算出每种仪器和几种步进策略的准确性。结果脆弱的患病率在14.8％至52.9％之间。推荐的截止值的准确度范围从差（AUC≥0.556ISAR-PC）到良好（AUC≥0.865步态速度）。 PRISMA-7在两个参考标准上表现最佳，GP预测逆境最好。采取分步策略会降低患病率和准确性。通过不同工具选择的人的年龄，对IADL的依赖程度，接受家庭护理和情绪的差异很大。结论我们发现，识别脆弱者的方法在患病率，准确性和所选择者的特征方面存在巨大差异。下一步的必要步骤是在实施病例查找程序之前，找出哪些体弱的人可以从干预中受益。需要更多的证据来指导这一新兴的临床领域。

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