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      Development and Validation of a New Simple Functional Score in the Older Chinese Population

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          Abstract

          Background

          Existing aging metrics incorporating cognitive and physical function are often not feasible for application in research and clinical practice. Therefore, this study aimed to develop and validate a new simple functional score based on self-reported cognitive and physical function in the older Chinese population.

          Methods

          The development sample included 3,929 older adults aged 60–95 years from the China Health and Retirement Longitudinal Study (CHARLS). The validation sample included 1,345 older adults aged 60–87 years from the Rugao Longitudinal Aging study (RLAS). Logistic regression models and receiver operating characteristic curves were used to examine the associations of the new functional score with all-cause mortality risk.

          Results

          Six items were selected to construct the new functional score in CHARLS. This functional score was associated with all-cause mortality risk, with an adjusted odds ratio of 1.10 (95% confidence interval = 1.07, 1.13). This functional score presented additional predictive utility beyond age and sex, as demonstrated by the significantly increased C-statistic, integrated discrimination improvement (IDI), and continuous net reclassification improvement (NRI) (all P < 0.001). Furthermore, this functional score was further validated in RLAS, such that adding the new functional score to a model of age and sex improved all-cause mortality risk discrimination (IDI = 0.036, P < 0.001; NRI = 0.485, P < 0.001). To facilitate the quick screening of the older population with deteriorations in cognitive and physical function, we introduced a publicly available online tool designed for this new functional score.

          Conclusions

          A new functional score based on six self-reported items was developed and validated in the older Chinese population, and was demonstrated to be a simple and practical tool to assess functional deterioration, showing good feasibility, and performance.

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          Most cited references27

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          Frailty in Older Adults: Evidence for a Phenotype

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            Sarcopenia: European consensus on definition and diagnosis

            The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics—European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as ‘presarcopenia’, ‘sarcopenia’ and ‘severe sarcopenia’. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.
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              Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living

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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                24 February 2022
                2022
                : 10
                : 813323
                Affiliations
                [1] 1Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine , Hangzhou, China
                [2] 2National Center for Acquired Immunodeficiency Syndrome/Sexually Transmitted Disease (AIDS/STD) Control and Prevention, Chinese Center for Disease Control and Prevention , Beijing, China
                [3] 3Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center , Amsterdam, Netherlands
                [4] 4School of Public Affairs, Zhejiang University , Hangzhou, China
                [5] 5Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University , Beijing, China
                [6] 6National Clinical Research Center for Aging and Medicine, Huashan Hospital, and Human Phenome Institute, Fudan University , Shanghai, China
                [7] 7Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University School of Medicine , Hangzhou, China
                Author notes

                Edited by: Lina Ma, Capital Medical University, China

                Reviewed by: Meiling Ge, Sichuan University, China; Yaxin Zhang, Capital Medical University, China

                *Correspondence: Zuyun Liu zuyunliu@ 123456zju.edu.cn

                This article was submitted to Aging and Public Health, a section of the journal Frontiers in Public Health

                †These authors have contributed equally to this work

                Article
                10.3389/fpubh.2022.813323
                8907530
                6928aa7e-914c-44a7-83a8-5977b2ad90cf
                Copyright © 2022 Cao, Chen, He, Zheng, Zhang, Hoogendijk, Liu, Li, Wang, Zhu and Liu.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 19 November 2021
                : 19 January 2022
                Page count
                Figures: 3, Tables: 3, Equations: 0, References: 27, Pages: 10, Words: 6252
                Funding
                Funded by: National Natural Science Foundation of China, doi 10.13039/501100001809;
                Award ID: 82171584
                Funded by: Milstein Medical Asian American Partnership Foundation, doi 10.13039/100014354;
                Funded by: Fundamental Research Funds for the Central Universities, doi 10.13039/501100012226;
                Funded by: Natural Science Foundation of Zhejiang Province, doi 10.13039/501100004731;
                Categories
                Public Health
                Original Research

                aging,chinese,cognitive function,mortality,physical function

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