Abstract: Background Pre-frailty represents a transitional risk status between health and frailty. Early identification and intervention during this stage can delay or even reverse the frailty development. However, there is a lack of standardized pre-frailty assessment tool tailored for community-dwelling older adults. Objective To compare the effectiveness of Fried's Frailty Phenotype (FP) and FRAIL Scale in assessing pre-frailty among community-dwelling older adults undergoing health examinations, thereby providing evidence for the selection of appropriate assessment tools.Methods A cross-sectional study was conducted using convenience sampling to recruit older adults aged 60 years and above undergoing health examinations at five community health centres in Beijing from December 1,2024,to March 20, 2025. Demographic data were collected, and frailty status was assessed using the FP and the FRAIL scale. Activities of daily living (ADL) were evaluated using the Modified Barthel Index (MBI), and quality of life was assessed using the 36-Item Short Form Survey (SF-36). Spearman rank correlation and Kappa statistics were used to analyze the consistency and correlation between the two scales. Using MBI and SF-36 scores as validity criteria, the validity of both tools was evaluated via Spearman rank correlation, Receiver Operating Characteristic (ROC) curve analysis, and Bayes discriminant analysis. Results The prevalence of pre-frailty detected by the FP was higher than that by the FRAIL scale (36.3% vs. 25.3%). The two scales showed a moderate positive correlation (rs=0.713, P<0.001) and moderate agreement (Kappa=0.606, P<0.001), with consistent classification in 81.2% of participants. Frailty severity assessed by both scales was positively correlated with ADL decline and negatively correlated with SF-36 total, Physical Component Summary(PCS), and Mental Component Summary (MCS) scores. Both scales demonstrated associations with ADL decline, with ROC curve areas under the curve (AUC) of0.736 and 0.735, respectively (P<0.001). Bayes discriminant analysis indicated that the cross-validation accuracy for ADL decline was higher for the FP (86.3%) than the FRAIL scale (85.1%).ROC analysis revealed that the FP had higher sensitivity (74.0% vs.64.4%), while the FRAIL scale had superior specificity (80.1% vs. 65.8%) for predicting ADL decline. The optimal cutoff value for both scales in predicting ADL decline was 0.5. Conclusion The FP and FRAIL scale demonstrate moderate correlation and consistency, and both are negatively associated with quality of life. Both tools possess moderate validity in verifying ADL decline and are suitable for assessing pre-frailty in community-dwelling older adults. The FP, with its higher sensitivity and inclusion of objective indicators, is more suitable for pre-frailty screening in health examination settings aiming for "early detection and intervention." Conversely, the FRAIL scale, due to its simplicity and high specificity, serves as a viable alternative for rapidly identifying high-risk individuals in resource-limited settings. These findings suggest practical value in integrating frailty screening into routine community health examinations and initiating interventions based on a 0.5 cutoff value.

Key words: Frailty, Pre-frailty, Aged, Fried phenotype, FRAIL scale, Community health services, General practitioners

摘要： 背景 衰弱前期是介于健康与衰弱之间的风险状态，早期有效识别并干预衰弱前期可延缓甚至逆转衰弱进程。然而，目前尚无统一的适用于社区体检老年人的衰弱前期评估工具。目的 比较Fried衰弱表型量表（FP）与FRAIL量表在社区体检老年人衰弱前期评估中的效果，为社区老年人衰弱前期评估工具的选择提供参考。方法 采取便利抽样法选取2024-12-01—2025-03-20于北京市5个社区卫生服务中心健康体检的60岁及以上老年人作为研究对象。收集一般资料，分别采用FP和FRAIL量表进行衰弱评估，采用改良Barthel指数（MBI）评估日常生活活动能力(ADL)，采用生活质量评价量表(SF-36)评估生活质量，使用Spearman秩相关分析和Kappa值分析FP与FRAIL量表对衰弱状况评估的一致性和相关性。以MBI和SF-36评分作为效度评价标准，采用Spearman秩相关分析、受试者工作特征（ROC）曲线和Bayes判别分析两种评估工具的效度。结果 经FP评估的社区体检老年人衰弱前期发生率高于FRAIL量表（36.3% vs.25.3%）；FP与FRAIL量表评估社区体检老年人衰弱状况的结果呈中度正相关（rs=0.713，P<0.001）。两种评估工具对81.2%（349/430）的社区体检老年人的衰弱状况评估结果一致，Kappa值为0.606（P<0.001），具有中等一致性。FP、FRAIL量表评估的衰弱程度与ADL下降均呈正相关（P<0.05），与SF-36总分、PCS、MCS均呈负相关（P<0.05）；FP、FRAIL量表均与社区体检老年人ADL下降有一定的关联强度，ROC曲线下面积分别为0.736、0.735（P<0.001）；Bayes判别分析结果显示，FP对ADL下降的交叉验证准确率较FRAIL量表高（86.3%vs.85.1%）。ROC曲线分析显示，FP对ADL下降的灵敏度更高（74.0%vs.64.4%），而FRAIL量表的特异度更优（80.1%vs.65.8%），二者预测ADL下降的最佳临界值均为0.5。结论 FP与FRAIL量表中度相关且一致，均与生活质量评分呈负相关，对社区体检老年人ADL下降的验证能力均为中等，均可用于社区体检老年人的衰弱前期评估；FP因其更高的敏感性以及包含客观指标，更适合于社区体检背景下旨在“早发现、早干预”的衰弱前期筛查；而FRAIL量表凭借其简便性和高特异性，可作为资源有限情况下快速识别高风险个体的备选工具。本研究结果提示，将衰弱筛查整合至社区常规体检并基于0.5的临界值启动干预具有实践意义。

关键词: 衰弱, 衰弱前期, 老年人, Fried 衰弱表型, FRAIL 量表, 社区卫生服务, 全科医生