Perceived frailty and measured frailty among adults undergoing hemodialysis: a cross-sectional analysis

BMC Geriatrics

Research Article

Reside Lorie Jacob¹  Allan B Massie²  Mara A McAdams-DeMarco²  Andrew H Law²  Dorry L Segev²  Megan L Salter³  Bernard G Jaar⁴  Luis F Gimenez⁵  Natasha Gupta⁶  Jeremy D Walston⁷ 

[1] Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, USA;Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA;Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA;Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA;Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA;Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA;Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA;Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA;Department of Medicine, Johns Hopkins University School of Medicine, 1830 Building Room 416 Nephrology, 600 North Wolfe Street, 21287, Baltimore, MD, USA;Nephrology Center of Maryland, 5601 Loch Raven Boulevard, Suite 3 North, 21239, Baltimore, MD, USA;Department of Medicine, Johns Hopkins University School of Medicine, 1830 Building Room 416 Nephrology, 600 North Wolfe Street, 21287, Baltimore, MD, USA;Department of Surgery, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 36, Baltimore, MD 21205, USA;Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA;Department of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Room 1A.62, 21224, Baltimore, MD, USA;Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Cir, 21224, Baltimore, MD, US;

关键词: Frailty;    Dialysis;    End-stage renal disease;   

DOI  :  10.1186/s12877-015-0051-y

 received in 2015-03-02, accepted in 2015-04-15,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundFrailty, a validated measure of physiologic reserve, predicts adverse health outcomes among adults with end-stage renal disease. Frailty typically is not measured clinically; instead, a surrogate—perceived frailty—is used to inform clinical decision-making. Because correlations between perceived and measured frailty remain unknown, the aim of this study was to assess their relationship.Methods146 adults undergoing hemodialysis were recruited from a single dialysis center in Baltimore, Maryland. Patient characteristics associated with perceived (reported by nephrologists, nurse practitioners (NPs), or patients) or measured frailty (using the Fried criteria) were identified using ordered logistic regression. The relationship between perceived and measured frailty was assessed using percent agreement, kappa statistic, Pearson’s correlation coefficient, and prevalence of misclassification of frailty. Patient characteristics associated with misclassification were determined using Fisher’s exact tests, t-tests, or median tests.ResultsOlder age (adjusted OR [aOR] = 1.36, 95%CI:1.11-1.68, P = 0.003 per 5-years older) and comorbidity (aOR = 1.49, 95%CI:1.27-1.75, P < 0.001 per additional comorbidity) were associated with greater likelihood of nephrologist-perceived frailty. Being non-African American was associated with greater likelihood of NP- (aOR = 5.51, 95%CI:3.21-9.48, P = 0.003) and patient- (aOR = 4.20, 95%CI:1.61-10.9, P = 0.003) perceived frailty. Percent agreement between perceived and measured frailty was poor (nephrologist, NP, and patient: 64.1%, 67.0%, and 55.5%). Among non-frail participants, 34.4%, 30.0%, and 31.6% were perceived as frail by a nephrologist, NP, or themselves. Older adults (P < 0.001) were more likely to be misclassified as frail by a nephrologist; women (P = 0.04) and non-African Americans (P = 0.02) were more likely to be misclassified by an NP. Neither age, sex, nor race was associated with patient misclassification.ConclusionsPerceived frailty is an inadequate proxy for measured frailty among patients undergoing hemodialysis.

【 授权许可】

CC BY   
© Salter et al.; licensee BioMed Central. 2015