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Inicio Medicina Clínica (English Edition) Differences in the predictive capability of functional impairment, cognitive dec...
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Vol. 155. Issue 1.
Pages 18-22 (July 2020)
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Vol. 155. Issue 1.
Pages 18-22 (July 2020)
Brief report
DOI: 10.1016/j.medcle.2020.01.008
Differences in the predictive capability of functional impairment, cognitive decline and mortality of different frailty tools: A longitudinal cohort study
Diferencias en la capacidad predictiva para declive funcional, cognitivo y mortalidad para distintas escalas de fragilidad: un estudio de cohortes longitudinal
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Beatriz Contreras-Escámeza,b,
Corresponding author
, Mikel Izquierdoc,d, Arkaitz Galbete Jiménezb,e, Marta Gutiérrez-Valenciab, Bernardo A. Cedeno-Veloza, Nicolás Martínez-Velillaa
a Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
b Navarrabiomed-Departamento de Salud-Universidad Pública de Navarra, Pamplona, Spain
c Universidad Pública de Navarra, IDISNA, Pamplona, Navarra, Spain
d CIBER of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
e Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
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Statistics
Tables (2)
Table 1. Descriptive statistics for mortality and use of hospital resources, differences between robust and frail for each scale studied.
Table 2. Baseline and 3-year values for different functional and cognitive variables. Functional, cognitive decline and risk of death at follow-up estimated for each scale.
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Additional material (1)
Abstract
Background and objectives

There are multiple frailty detection tools, but they have not been specifically developed for the institutionalized population. The aim of this study is to ascertain at 3-year follow-up which tool predicts functional impairment and mortality most precisely.

Methods

Longitudinal cohort study with 110 patients in Pamplona (Navarra) >65 years. Four frailty tools were applied (Fried Criteria, Rockwood Frailty Scale, FRAIL-NH and Imputed Fried Frailty Criteria). The power of the association between the scales and the results was assessed by linear regression and Cox's analyses.

Results

46.5% of the sample died during time to follow-up, 68% of whom died in their nursing home, with 43-month mean survival. Of the studied population, 71.3% showed disability at 3 years, especially the frail subjects. The robust patients had longer hospitalizations (m=3.4 days) than the frail. Imputed Fried and FRAIL-NH found statistically significant differences between groups for the variables studied. Imputed Fried Frailty Criteria showed a significant HR of death for the frail subjects (HR=3.3).

Conclusions

The Imputed Fried and FRAIL-NH tools showed a higher predictive capability for functional and cognitive decline, but only the Imputed Fried Frailty Criteria found a significant relationship between frailty and mortality.

Keywords:
Frailty
Nursing homes
Diagnosis
Disability
Cognitive impairment
Resumen
Antecedentes y objetivos

Existen múltiples escalas para la detección de fragilidad en ancianos, pero no específicamente para población institucionalizada. El objetivo fue comprobar tras 3 años de seguimiento qué escala predice con mayor precisión el declive funcional y la mortalidad.

Métodos

Estudio longitudinal de cohortes con 110 pacientes mayores de 65 años institucionalizados en Pamplona (Navarra). Se aplicaron 4 escalas de fragilidad (Fried, Fried Imputada, Rockwood y FRAIL NH). El poder de la asociación entre las escalas y los resultados se comprobó mediante análisis de regresión lineal y de Cox.

Resultados

El 46,5% de la muestra falleció durante el seguimiento, el 68% de ellos en su residencia, con 43 meses de media de supervivencia. El 71,3% de los ancianos estudiados presentó discapacidad a los 3 años, especialmente los frágiles. Los pacientes robustos experimentaron hospitalizaciones más prolongadas (m=3,4 días) que los frágiles. Las escalas Fried Imputada y la FRAIL NH encontraron diferencias estadísticamente significativas entre grupos para las variables estudiadas; Fried Imputada mostró un HR significativo de muerte para sujetos frágiles (HR=3,3).

Conclusiones

Las escalas Fried Imputada y FRAIL NH mostraron una mayor capacidad predictiva para declive funcional y cognitivo, siendo la escala Fried Imputada la única que relaciona la mortalidad con la fragilidad.

Palabras clave:
Fragilidad
Institucionalizados
Diagnóstico
Discapacidad
Deterioro cognitivo

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