Predictive Ability of Individual Items of the Cardiovascular Health Study (CHS) Scale Compared With the Summative Score.

To examine the ability of each item of the Fried phenotype of frailty to predict physical limitation and physical performance measures after 4 years, walking speed and hospitalization after 7 years, and mortality after 12 years. Prospective cohort study. Community-living older people in Hong Kong SAR, China. 4000 community-living Chinese men and women aged 65 and older were recruited using stratified sampling so that approximately 33% each would be aged 65-69, 70-74, and 75 and older. Those who were unable to walk independently, had had bilateral hip replacement, or were not competent to give informed consent were excluded. Information was collected from questionnaire to include sociodemographic and lifestyle data, medical history, cognition, mood, and ability to carry out daily functional tasks. Frailty was assessed using the 5-item Fried phenotype, or Cardiovascular Health Study (CHS) scale. Measurements include grip strength, 6-m walking speed, and chair stand. Length of hospital stay was obtained from the hospital records. Death was ascertained from the Death Registry. Logistic regression was used to analyze the association between individual items and health outcomes, adjusting for age, education, chronic obstructive pulmonary disease, diabetes mellitus, hypertension, heart disease, current smoker, Mini-Mental State Examination score, and depression. The predictive ability of each item was examined using the area under the curve (AUC), and stepwise models were applied to assess the incremental predictive validity. In men, all items of the CHS scale predicted increased risk of physical limitation after 4 years with similar AUC values. The lowest quintile of walking speed and grip strength predicted increased risk of walking speed <0.8 m/s at 4 and 7 years. The other items had variable predictive ability for outcomes. For women, low walking speed and grip strength were the only 2 items that predicted all the adverse outcomes except mortality. When each item was entered into a stepwise model to predict adverse outcomes, low walking speed predicted nearly as well as the combined 5-item CHS. The 5-item Fried phenotype in frailty screening in clinical management may be replaced by a single physical performance measure such as walking speed or grip strength, but cut-off values derived from individual populations need to be applied.

Woo J ，Yu R ，Leung J 《-》

A 3-Item SARC-F.

To examine individual items of the SARC-F in predicting adverse outcomes. Prospective cohort study. Community-dwelling older people in Hong Kong SAR China. A total of 4000 men and women aged 65 years and over, stratified in 3 age groups (65-69, 70-74, 75+ years of age). Information was collected by questionnaire, on sociodemographic details, lifestyle habits, cognitive function using the Mini-Mental State Examination, depression using the Geriatric Depression Scale, SARC-F, and physical limitation in daily activities. Physical performance measures include chair stand and walking speed. Adverse outcomes included physical limitation, lower limb strength using repeated chair stands, slow walking speed, length of hospital stay, and mortality. Predictive ability of each item of the SARC-F was assessed using receiver operating characteristic curve. Stepwise model was used to assess incremental predictive ability. The overall ranking of the questions in order of highest predictability in terms of area under the curve values were strength, climb stairs, assistance in walking, rise from a chair, and falls. The first 3 questions individually predicted all the adverse outcomes, and in stepwise models of the individual questions, a combination of these 3 questions gave the highest area under the curve values. The 5-item SARC-F may be shortened to 3 items (strength, climb stairs, and assistance in walking) in rapid screening for sarcopenia in clinical practice.

Woo J ，Yu R ，Leung J 《-》

The feasibility of assessing frailty and sarcopenia in hospitalised older people: a comparison of commonly used tools.

Ibrahim K ，Howson FFA ，Culliford DJ ，Sayer AA ，Roberts HC ... -  《BMC Geriatrics》

Defining sarcopenia in terms of incident adverse outcomes.

The objectives of this study were to compare the performance of different diagnoses of sarcopenia using European Working Group on Sarcopenia in Older People, International Working Group on Sarcopenia, and the US Foundation of National Institutes of Health (FNIH) criteria, and the screening tool SARC-F, against the Asian Working Group for Sarcopenia consensus panel definitions, in predicting physical limitation, slow walking speed, and repeated chair stand performance, days of hospital stay and mortality at follow up. Longitudinal study. Community survey in Hong Kong. Participants were 4000 men and women 65 years and older living in the community. Information from questionnaire regarding activities of daily living, physical functioning limitations, and constituent questions of SARC-F; body mass index (BMI), grip strength (GS), walking speed, and appendicular muscle mass (ASM). FNIH, consensus panel definitions, and the screening tool SARC-F all have similar AUC values in predicting incident physical limitation and physical performance measures at 4 years, walking speed at 7 years, days of hospital stay at 7 years, and mortality at 10 years. None of the definitions predicted increase in physical limitation at 4 years or mortality at 10 years in women, and none predicted all the adverse outcomes. The highest AUC values were observed for walking speed at 4 and 7 years. When applied to a Chinese elderly population, criteria used for diagnosis of sarcopenia derived from European, Asian, and international consensus panels, from US cutoff values defined from incident physical limitation, and the SARC-F screening tool, all have similar performance in predicting incident physical limitation and mortality.

Woo J ，Leung J ，Morley JE 《-》

Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation.

To compare three simple bedside tools based on frailty phenotypes with a Frailty Index using the multiple deficit approach in the prediction of mortality and physical limitation after 4 years. Cohort study. Hong Kong, China. Four thousand men and women aged 65 and older living in the community who were ambulatory enough to attend the study center. Interviewers obtained information regarding physical, psychological, and functional health; body mass index (BMI), grip strength, blood pressure, and ankle brachial index were determined. Three clinical frailty scales based on the Fried phenotype (Cardiovascular Health Study (CHS); Fatigue, Resistance, Ambulation, Illness, and Loss (FRAIL); and Hubbard) and a frailty index (FI) were constructed from these variables, and their ability to predict incident mortality and physical function limitations was compared using receiver operating characteristic (ROC) curves. All tools predicted adverse outcomes. More participants were categorized into frail and prefrail categories using the CHS than with the other two clinical scales. For all frailty measures, with increasing levels of frailty, the sensitivity fell and the specificity increased to greater than 90%; the area under the ROC curve values were approximately 0.6. Simple frailty scores are comparable with a multidimensional deficit accumulation FI in predicting mortality and physical limitations. The newer FRAIL, proposed for use in a clinical setting, is comparable with other existing short screening tools, as well as tools based on the multiple-deficits model used for research settings. Addition of a physical performance measure to screening tools may increase predictive accuracy.

Woo J ，Leung J ，Morley JE 《-》