| アブストラクト | BACKGROUND: The electronic frailty index (eFI) was developed in older adults (aged >/=65 years). There are currently no validated frailty scores in clinical practice for younger adults (aged 18-64 years). The aim of this study was to examine whether the eFI score in younger adults had similar or different associations with adverse health outcomes compared with older adults. METHODS: In this population-based cohort study, electronic health records from the UK Clinical Practice Research Datalink GOLD database were analysed. We used a cross-section of patients on Nov 30, 2015, who were alive and had been registered with a general practice for at least 2 years before data capture. Patients were stratified into younger adults (aged 18-64 years, n=708 235; 49.4% female) and older adults (aged 65-95 years, n=231 819; 54.3% female). For all included patients, eFI score, prevalence of individual eFI deficits, and eFI frailty category were calculated. For the main outcomes, crude and age-sex adjusted hazard ratios (HRs) were calculated for 1-year and 3-year mortality and emergency hospitalisation for each group compared with adults defined by the eFI as fit. FINDINGS: The prevalence of eFI-defined frailty was higher in older adults than younger adults. Specifically, in older adults, 77 290 (33.3%) of 231 819 had mild frailty, 44 523 (19.2%) had moderate frailty, and 22 572 (9.7%) had severe frailty. For younger adults, 76 991 (10.9%) of 708 235 had mild frailty, 12 552 (1.8%) had moderate frailty, and 2088 (0.3%) had severe frailty. Adjusted HRs for both 1-year mortality and 1-year emergency hospitalisation in younger adults with mild, moderate, and severe frailty were greater than in older adults with equivalent frailty categorisation. Specifically, compared with fit older adults, age-sex adjusted 1-year mortality HRs were 1.94 (95% CI 1.80-2.09) in older adults with mild frailty, 2.99 (2.77-3.22) with moderate frailty, and 4.03 (3.72-4.36) with severe frailty. Compared with fit younger adults, age-sex adjusted 1-year mortality HRs were 3.15 (2.80-3.55) in younger adults with mild frailty, 5.88 (4.95-6.98) with moderate frailty, and 12.61 (9.76-16.30) with severe frailty (Z score p<0.001 for all comparisons). Compared with fit older adults, age-sex adjusted HRs for 1-year emergency hospitalisation were 2.30 (2.22-2.39) in older adults with mild frailty, 4.09 (3.94-4.25) with moderate frailty, and 6.76 (6.50-7.03) with severe frailty. Compared with fit younger adults, age-sex adjusted HRs for 1-year emergency hospitalisation were 3.16 (3.07-3.25) in younger adults with mild frailty, 6.64 (6.34-6.94) with moderate frailty, and 13.02 (12.04-14.09) with severe frailty (Z score p<0.001 for all comparisons). Similar associations were observed for 3-year mortality and emergency hospitalisation. INTERPRETATION: Similarly to older adults, the eFI identifies younger adults with frailty at high risk of mortality and emergency hospital admission. The eFI might be a tool to identify individuals for further assessment and intervention. FUNDING: Wellcome Trust and Chief Scientist Office. |
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| 組織名 | Division of Population Health and Genomics, University of Dundee, Dundee, UK.;Electronic address: d.r.z.morales@dundee.ac.uk.;Usher Institute, University of Edinburgh, Edinburgh, UK.;School of Health and Wellbeing, University of Glasgow, Glasgow, UK. |
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