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Abstract：
Electronic frailty indices (eFIs) can expand measurement of frailty in research and practice and have demonstrated predictive validity in associations with clinical outcomes. However, their construct validity is less well studied. We aimed to assess the construct validity of the VA-FI, an eFI developed for use in the U.S. Veterans Affairs Healthcare System.
Veterans who underwent comprehensive geriatric assessments between January 31, 2019 and June 6, 2022 at VA Boston and had sufficient data documented for a comprehensive geriatric assessment-frailty index (CGA-FI) were included. The VA-FI, based on diagnostic and procedural codes, and the CGA-FI, based on geriatrician-measured deficits, were calculated for each patient. Geriatricians also assessed the Clinical Frailty Scale (CFS), functional status (ADLs and IADLs), and 4-meter gait speed (4MGS).
A total of 132 veterans were included, with median age 81.4 years (IQR 75.8-88.7). Across increasing levels of VA-FI (<0.2; 0.2-0.4; >0.4), mean CGA-FI increased (0.24; 0.30; 0.40). The VA-FI was moderately correlated with the CGA-FI (r 0.45, p < 0.001). Every 0.1-unit increase in the VA-FI was associated with an increase in the CGA-FI (linear regression beta 0.05; 95% confidence interval [CI] 0.03-0.06), higher CFS category (ordinal regression OR 1.69; 95% CI 1.24-2.30), higher odds of ADL dependency (logistic regression OR 1.59; 95% CI 1.20-2.11), IADL dependency (logistic regression OR 1.68; 95% CI 1.23-2.30), and a decrease in 4MGS (linear regression beta -0.07, 95% CI -0.12 to -0.02). All models were adjusted for age and race, and associations held after further adjustment for the Charlson Comorbidity Index.
Our results demonstrate the construct validity of the VA-FI through its associations with clinical measures of frailty, including summary frailty measures, functional status, and objective physical performance. Our findings complement others\' in showing that eFIs can capture functional and mobility domains of frailty beyond just comorbidity and may be useful to measure frailty among populations and individuals.
Veterans who underwent comprehensive geriatric assessments between January 31, 2019 and June 6, 2022 at VA Boston and had sufficient data documented for a comprehensive geriatric assessment-frailty index (CGA-FI) were included. The VA-FI, based on diagnostic and procedural codes, and the CGA-FI, based on geriatrician-measured deficits, were calculated for each patient. Geriatricians also assessed the Clinical Frailty Scale (CFS), functional status (ADLs and IADLs), and 4-meter gait speed (4MGS).
A total of 132 veterans were included, with median age 81.4 years (IQR 75.8-88.7). Across increasing levels of VA-FI (<0.2; 0.2-0.4; >0.4), mean CGA-FI increased (0.24; 0.30; 0.40). The VA-FI was moderately correlated with the CGA-FI (r 0.45, p < 0.001). Every 0.1-unit increase in the VA-FI was associated with an increase in the CGA-FI (linear regression beta 0.05; 95% confidence interval [CI] 0.03-0.06), higher CFS category (ordinal regression OR 1.69; 95% CI 1.24-2.30), higher odds of ADL dependency (logistic regression OR 1.59; 95% CI 1.20-2.11), IADL dependency (logistic regression OR 1.68; 95% CI 1.23-2.30), and a decrease in 4MGS (linear regression beta -0.07, 95% CI -0.12 to -0.02). All models were adjusted for age and race, and associations held after further adjustment for the Charlson Comorbidity Index.
Our results demonstrate the construct validity of the VA-FI through its associations with clinical measures of frailty, including summary frailty measures, functional status, and objective physical performance. Our findings complement others\' in showing that eFIs can capture functional and mobility domains of frailty beyond just comorbidity and may be useful to measure frailty among populations and individuals.
摘要：
背景：电子衰弱指数（eFI）可以在研究和实践中扩展衰弱的测量，并已证明与临床结果相关的预测有效性。然而,他们的结构效度研究较少。我们的目的是评估VA-FI的结构效度，为在美国退伍军人事务医疗保健系统中使用而开发的eFI。
方法：包括在2019年1月31日至2022年6月6日期间在VA波士顿接受全面老年评估的退伍军人，并且有足够的数据记录为全面老年评估-虚弱指数（CGA-FI）。VA-FI,基于诊断和程序代码，还有CGA-FI,根据老年病科医生测量的赤字，对每位患者进行了计算。老年医生还评估了临床虚弱量表(CFS)，功能状态（ADL和IADL），和4米的步态速度（4MGS）。
结果：共纳入132名退伍军人，中位年龄81.4岁（IQR75.8-88.7）。在不断增加的VA-FI水平（<0.2；0.2-0.4；>0.4），平均CGA-FI增加（0.24；0.30；0.40）。VA-FI与CGA-FI中度相关(r0.45,p<0.001)。VA-FI每增加0.1个单位与CGA-FI增加相关（线性回归β0.05;95％置信区间[CI]0.03-0.06），更高的CFS类别(序数回归OR1.69；95%CI1.24-2.30)，ADL依赖性的几率更高(逻辑回归OR1.59；95%CI1.20-2.11)，IADL依赖性(逻辑回归OR1.68；95%CI1.23-2.30)，4MGS下降（线性回归β-0.07，95%CI-0.12至-0.02）。所有型号都根据年龄和种族进行了调整，以及在进一步调整Charlson合并症指数后举行的协会。
结论：我们的结果表明，VA-FI通过其与虚弱的临床测量相关，包括概要脆弱措施，功能状态，和客观的物理表现。我们的发现补充了其他发现，表明eFI可以捕获除了合并症之外的脆弱的功能和移动域，并且可能有助于测量人群和个体之间的脆弱。
方法：包括在2019年1月31日至2022年6月6日期间在VA波士顿接受全面老年评估的退伍军人，并且有足够的数据记录为全面老年评估-虚弱指数（CGA-FI）。VA-FI,基于诊断和程序代码，还有CGA-FI,根据老年病科医生测量的赤字，对每位患者进行了计算。老年医生还评估了临床虚弱量表(CFS)，功能状态（ADL和IADL），和4米的步态速度（4MGS）。
结果：共纳入132名退伍军人，中位年龄81.4岁（IQR75.8-88.7）。在不断增加的VA-FI水平（<0.2；0.2-0.4；>0.4），平均CGA-FI增加（0.24；0.30；0.40）。VA-FI与CGA-FI中度相关(r0.45,p<0.001)。VA-FI每增加0.1个单位与CGA-FI增加相关（线性回归β0.05;95％置信区间[CI]0.03-0.06），更高的CFS类别(序数回归OR1.69；95%CI1.24-2.30)，ADL依赖性的几率更高(逻辑回归OR1.59；95%CI1.20-2.11)，IADL依赖性(逻辑回归OR1.68；95%CI1.23-2.30)，4MGS下降（线性回归β-0.07，95%CI-0.12至-0.02）。所有型号都根据年龄和种族进行了调整，以及在进一步调整Charlson合并症指数后举行的协会。
结论：我们的结果表明，VA-FI通过其与虚弱的临床测量相关，包括概要脆弱措施，功能状态，和客观的物理表现。我们的发现补充了其他发现，表明eFI可以捕获除了合并症之外的脆弱的功能和移动域，并且可能有助于测量人群和个体之间的脆弱。
