Abstract
Background and Aim
Several measurements were taken for frailty classification in geriatric population. “Frailty index” is based on “deficits in health,” but it is still not available in Italian version. Thus, the aim of the present work was to validate a version of “frailty index” for the Italian geriatric community.
Methods
The validation of Italian frailty index (IFi) is based on a cohort study that enrolled 1077 non-disabled outpatients aged 65 years or older (81.3 ± 6.5 years) in Naples (Italy). IFi has been expressed as a ratio of deficits present/deficits considered after a comprehensive geriatric assessment. IFi was stratified in light, moderate and severe frailty. Mortality, disability (considering an increase in ADL lost ≥1 from the baseline) and hospitalization were considered at 3, 6, 12, 18 and 24 months of follow-up. Area under curve (AUC) was evaluated for both Fried’s and IFi frailty index.
Result
At the end of follow-up, mortality increased from 1.0 to 30.3%, disability from 40.9 to 92.3% and hospitalization from 0.0 to 59.0% (p < 0.001 for trend). Multivariate analysis shows that the relative risk for unit increase in IFi is 1.09 (95% CI = 1.01–1.17, p = 0.013) for mortality, 1.04 (95% CI = 1.01–1.06, p = 0.024) for disability and 1.03 (95% CI = 1.01–1.07, p = 0.041) for hospitalization. AUC is higher in IFi with respect to Fried’s frailty index when considering mortality (0.809 vs. 0.658, respectively), disability (0.800 vs. 0.729, respectively) and hospitalization (0.707 vs. 0.646, respectively).
Conclusions
IFi is a valid measure of frailty after the comprehensive geriatric assessment in an Italian cohort of non-institutionalized patients.
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On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical approval
The study protocol was approved by the University of Naples Federico II (Comitato Etico per le attività Biomediche “Carlo Romano” prot. n.211/2013).
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All participants provided informed consent at baseline and at follow-up.
Appendix 1
Appendix 1
Paziente | Cart. cl. | Nato il__/__/__ | Altezza = m | Peso = Kg | Tel. | P | ||
---|---|---|---|---|---|---|---|---|
1. Aiuto nel lavarsi | SI = 1 | No = 0 | ||||||
2. Aiuto nel vestirsi | SI = 1 | No = 0 | ||||||
3. Aiuto nel sedersi o alzarsi dalla sedia | SI = 1 | No = 0 | ||||||
4. Aiuto nel camminare in casa | SI = 1 | No = 0 | ||||||
5. Aiuto nel mangiare | SI = 1 | No = 0 | ||||||
6. Aiuto nella cura della casa | SI = 1 | No = 0 | ||||||
7. Aiuto nell’utilizzare il bagno | SI = 1 | No = 0 | ||||||
8. Aiuto nel salire o scendere le scale | SI = 1 | No = 0 | ||||||
9. Aiuto nell’alzare 4.5 kg | SI = 1 | No = 0 | ||||||
10. Aiuto nel fare la spesa | SI = 1 | No = 0 | ||||||
11. Aiuto nei lavori di casa | SI = 1 | No = 0 | ||||||
12. Aiuto nel preparare i pasti | SI = 1 | No = 0 | ||||||
13. Aiuto nell’assumere i farmaci | SI = 1 | No = 0 | ||||||
14. Aiuto nella gestione del denaro | SI = 1 | No = 0 | ||||||
15. Perdita di più di 4.5 kg di peso nell’ultimo anno | SI = 1 | No = 0 | ||||||
16. Giudizio sulla propria salute | Scarsa = 1 | Discreta = 0.75 | Buona = 0.5 | Molto buona = 0.25 | Eccellente = 0 | |||
17. Come è cambiata la sua salute nell’ultimo anno? | Peggiorata = 1 | Migliorata/stessa = 0 | ||||||
18. Persistenza a letto almeno 1/2 giornata per motivi di salute, nell’ultimo mese? | SI = 1 | No = 0 | ||||||
19. Riduzione della solita attività nell’ultimo mese? | SI = 1 | No = 0 | ||||||
20. Uscire | <3 Giorni = 1 | ≥3 Giorni = 0 | ||||||
21. Affaticarsi per qualsiasi cosa | Spesso = 1 | Qualche volta = 0.5 | Raramente = 0 | |||||
22. Sentirsi depresso | Spesso = 1 | Qualche volta = 0.5 | Raramente = 0 | |||||
23. Sentirsi infelice | Spesso = 1 | Qualche volta = 0.5 | Raramente = 0 | |||||
24. Social support score (vedi allegato 1) | >13 = 1 | 6–13 = 0.5 | 1–5 = 0 | |||||
25. Avere difficoltà a mettersi in moto | Spesso = 1 | Qualche volta = 0.5 | Raramente = 0 | |||||
26. Ipertensione | SI = 1 | Sospetta = 0.5 | No = 0 | |||||
27.Angina pectoris | SI = 1 | Sospetta = 0.5 | No = 0 | |||||
28. Insufficienza cardiaca cronica | SI = 1 | Sospetta = 0.5 | No = 0 | |||||
29. Ictus | SI = 1 | Sospetta = 0.5 | No = 0 | |||||
30. Cancro | SI = 1 | Sospetta = 0.5, | No = 0 | |||||
31. Diabete | SI = 1 | Sospetta = 0.5 | No = 0 | |||||
32. Artrosi | SI = 1 | Sospetta = 0.5 | No = 0 | |||||
33. Broncopneumopatia cronica | SI = 1 | Sospetta = 0.5 | No = 0 | |||||
34. MMSE | <10 = 1 | 11–17 = 0.75 | 18–20 = 0.5 | 20–24 = 0.25 | >24 = 0 | |||
35. BMI | <18.5, ≥30 = 1 | 25–<30 = 0.5 | 18.5–24.9 = 0 | |||||
36. Picco flusso espiratorio = _______L/min 1 = ______ 2 = _______ 3 = ______ | ≤340 (uomo), ≤310 (donna) = 1 | >340 (uomo), >310 (donna) = 0 | ||||||
37. Forza muscolare sollevamento = Kg 1 = ______ 2 = _______ 3 = ______ | ≤12 (uomo), ≤9 (donna) = 1 | >12 (uomo), >9 (donna) = 0 | ||||||
38. Forza muscolare presa = Kg 1 = ______ 2 = _______ 3 = ______ | Uomo = 1 | Uomo = 0 | ||||||
BMI ≤24, | Kg ≤29 | BMI ≤24 | Kg >29 | |||||
BMI 24.1–28 | Kg ≤30 | BMI 24.1–28 | Kg >30 | |||||
BMI >28 | Kg ≤32 | BMI >28 | Kg >32 | |||||
Donna = 1 | Donna = 0 | |||||||
BMI ≤23 | Kg ≤17 | BMI ≤23 | Kg >17 | |||||
BMI 23.1–26 | Kg ≤ 17.3 | BMI 23.1–26 | Kg >17 | |||||
BMI 26.1–29 | Kg ≤18 | BMI 26.1–29 | Kg >18 | |||||
BMI >29 | Kg ≤21 | BMI >29 | Kg >21 | |||||
39. Mini nutritional Assessment (vedi allegato 2) | <17 = 1 | 17–23.5 = 0.5 | 24 = 0 | |||||
40. Tempo impiegato per percorrere 4 metri con passo rapido (sec) | >10 = 1 | ≤10 = 0 | ||||||
Totale |
Scala supporto sociale
1. Stato civile | Vedovo o celibe = 1 | Coniugato = 0 |
2. Figli viventi | No = 1 | Sì = 0 |
3. Fratelli e sorelle viventi | No = 1 | Sì = 0 |
4. Frequenza di rapporti familiari | Mai, raramente = 1 | Spesso, di frequente = 0 |
5. Con chi abita | Solo = 1 | In compagnia = 0 |
6. Aiuto finanziario da parte dei familiari | No = 1 | Sì = 0 |
7. Rapporti stretti con parenti non familiari | No = 1 | Sì = 0 |
8. Aiuto concreto da parte dei familiari | No = 1 | Sì = 0 |
9. Con quante persone del vicinato si vede almeno una volta a settimana? | Nessuno = 1 | Almeno una = 0 |
10. Ha amici intimi? | No = 1 | Sì = 0 |
11. Frequenza rapporti? | Mai, raramente = 1 | Spesso, di frequente = 0 |
12. Frequenta posti pubblici? | Mai, raramente = 1 | Spesso, di frequente = 0 |
13. Frequenta cinema-teatri? | Mai, raramente = 1 | Spesso, di frequente = 0 |
14. Frequenta associazioni di volontariato-ricreative? | Mai, raramente = 1 | Spesso, di frequente = 0 |
15. Legge i giornali? | Mai, raramente = 1 | Spesso, di frequente = 0 |
16. Ascolta radio e/o vede TV? | Mai, raramente = 1 | Spesso, di frequente = 0 |
17. Si prende cura dei bambini? | Mai, raramente = 1 | Spesso, di frequente = 0 |
Totale |
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Abete, P., Basile, C., Bulli, G. et al. The Italian version of the “frailty index” based on deficits in health: a validation study. Aging Clin Exp Res 29, 913–926 (2017). https://doi.org/10.1007/s40520-017-0793-9
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DOI: https://doi.org/10.1007/s40520-017-0793-9