Research Square · May 17, 2022
Comparison of four frailty scales in predicting adverse outcomes in Chinese community-dwelling older adults: a longitudinal cohort study
By Qin F, Guo Y, Ruan Y et al.
Abstract BACKGROUND: Frailty is related to numerous adverse outcomes and can be operationalized in a variety of ways. However, data on which frailty scales are most suitable for estimating risk remain limited. Herein we examined and compared four validated frailty scales in predicting adverse outcomes in a large population-based cohort of older adults.METHODS: A total of 5402 subjects aged 50 and older from the WHO Study on global AGEing and adult health (SAGE) in Shanghai were studied. Frailty was measured using a 35-item frailty index (FI), the frailty phenotype (FP), FRAIL, and Tilburg Frailty Indicator (TFI). Logistic regression models were performed unadjusted/adjusted to evaluate the association between frailty and outcomes including 4-year disability, hospitalization, and 4- and 7-year all-cause mortality. The accuracy for predicting these outcomes was determined by assessing the area under the curve (AUC) as well as sensitivity and specificity.RESULTS: Prevalence of frailty ranged from 4.2% (FRAIL) to 16.9% (FI). Frailty, however defined, was associated with an increased risk of any outcome. The aforementioned associations, except for those of FP with disability and hospitalization, remained significant after controlling for potential covariates. FI, followed by TFI and FRAIL, showed acceptable predictive ability for disability and mortality (AUC: 0.65-0.78). While specificity estimates (85.3-97.3%) for each scale were higher and similar across all outcomes, sensitivity estimates (6.3-56.8%) varied considerably within a lower range.CONCLUSIONS: All four scales did have the potential to identify Chinese older adults at high risk of adverse outcomes; however, their predictive accuracy varied.