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Predictive Ability of Individual Items of the Cardiovascular Health Study (CHS) Scale Compared With the Summative
Jean Woo1, Ruby Yu1, Jason Leung2
1Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; The Chinese University of Hong Kong Jockey Club Institute of Ageing, Shatin, Hong Kong.
Insights
The Fried frailty phenotype
Area of Science:
- Gerontology
- Public Health
- Epidemiology
Background:
- Frailty is a significant predictor of adverse health outcomes in older adults.
- The Fried phenotype is a commonly used measure of frailty, but its individual components' predictive abilities are not fully understood.
- Identifying simpler frailty screening tools is crucial for clinical practice and public health initiatives.
Purpose of the Study:
- To assess the predictive capacity of each component of the Fried frailty phenotype.
- To determine the ability of individual Fried phenotype items to predict physical limitation, physical performance, hospitalization, and mortality over time.
- To explore the potential of using single physical performance measures as alternatives to the full Fried phenotype.
Main Methods:
- Prospective cohort study of 4000 community-living older adults in Hong Kong.
- Frailty assessed using the 5-item Fried phenotype (Cardiovascular Health Study scale).
- Logistic regression and area under the curve (AUC) analysis used to evaluate predictive ability for various health outcomes over 4, 7, and 12 years.
Main Results:
- In men, all Fried phenotype items predicted physical limitation. Low walking speed and grip strength predicted slower walking speed.
- In women, low walking speed and grip strength predicted most adverse outcomes, excluding mortality.
- Low walking speed alone demonstrated predictive ability comparable to the full 5-item Fried phenotype for adverse outcomes.
Conclusions:
- Individual components of the Fried frailty phenotype, particularly walking speed and grip strength, show significant predictive value.
- A single physical performance measure, such as walking speed, may suffice for frailty screening in certain contexts.
- Population-specific cut-off values are necessary when using simplified frailty screening measures.
Objectives:
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.
Design:
Prospective cohort study.
Setting:
Community-living older people in Hong Kong SAR, China.
Participants:
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.
Measurements:
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.
Statistical Analysis:
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.
Results:
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.
Conclusion:
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.
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