Evaluating frailty scores to predict mortality in older adults using data from population based electronic health records: case control study

被引:48
作者
Stow, Daniel [1 ]
Matthews, Fiona E. [1 ]
Barclay, Stephen [2 ]
Iliffe, Steve [3 ]
Clegg, Andrew [4 ]
De Biase, Sarah [5 ]
Robinson, Louise [6 ]
Hanratty, Barbara [6 ]
机构
[1] Newcastle Univ, Inst Hlth & Soc, Newcastle Upon Tyne NE2 4AX, Tyne & Wear, England
[2] Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge CB2 0SR, England
[3] UCL, Res Dept Primary Care & Populat Hlth, London WC1E 6BT, England
[4] Univ Leeds, Acad Unit Elderly Care & Rehabil, Bradford BD9 6RJ, W Yorkshire, England
[5] Bradford Royal Infirm, Hlth Ageing Collaborat Bradford Inst Hlth Res, Temple Bank House,Duckworth Lane, Bradford BD9 6RJ, W Yorkshire, England
[6] Newcastle Univ, Inst Hlth & Soc, Newcastle Upon Tyne NE2 4AX, Tyne & Wear, England
基金
英国医学研究理事会;
关键词
frailty; palliative care; end of life care; primary care; older people; ELDERLY-PEOPLE; CARE; ACCUMULATION; TRAJECTORIES; PERFORMANCE; DEFICITS; OUTCOMES; DEATH; LIFE;
D O I
10.1093/ageing/afy022
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background: recognising that a patient is nearing the end of life is essential, to enable professional carers to discuss prognosis and preferences for end of life care. Objective: investigate whether an electronic frailty index (eFI) generated from routinely collected data, can be used to predict mortality at an individual level. Design: historical prospective case control study. Setting: UK primary care electronic health records. Subjects: 13,149 individuals age 75 and over who died between 01/01/2015 and 01/01/2016, 1:1 matched by age and sex to individuals with no record of death in the same time period. Methods: two subsamples were randomly selected to enable development and validation of the association between eFI 3 months prior to death and mortality. Receiver operator characteristic (ROC) analyses were used to examine diagnostic accuracy of eFI at 3 months prior to death. Results: an eFI > 0.19 predicted mortality in the development sample at 75% sensitivity and 69% area under received operating curve (AUC). In the validation dataset this cut point gave 76% sensitivity, 53% specificity. Conclusions: the eFI measured at a single time point has low predictive value for individual risk of death, even 3 months prior to death. Although the eFI is a strong predictor or mortality at a population level, its use for individuals is far less clear
引用
收藏
页码:564 / 569
页数:7
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