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Early identification and intervention of the frailty of the elderly will help lighten the burden of social medical care and improve the quality of life of the elderly. Therefore, we used machine learning (ML) algorithm to develop models to predict frailty risk in the elderly.
A prospective cohort study.
We collected data on 6997 elderly people from Chinese Longitudinal Healthy Longevity Study wave 6–7 surveys (2011–2012, 2014). After the baseline survey in 1998 (wave 1), the project conducted follow-up surveys (wave 2–8) in 2000–2018. The osteoporotic fractures index was used to assess frailty. Four ML algorithms (random forest [RF], support vector machine, XGBoost and logistic regression [LR]) were used to develop models to identify the risk factors of frailty and predict the risk of frailty. Different ML models were used for the prediction of frailty risk in the elderly and frailty risk was trained on a cohort of 4385 elderly people with frailty (split into a training cohort [75%] and internal validation cohort [25%]). The best-performing model for each study outcome was tested in an external validation cohort of 6997 elderly people with frailty pooled from the surveys (wave 6–7). Model performance was assessed by receiver operating curve and F2-score.
Among the four ML models, the F2-score values were similar (0.91 vs. 0.91 vs. 0.88 vs. 0.90), and the area under the curve (AUC) values of RF model was the highest (0.75), followed by LR model (0.74). In the final two models, the AUC values of RF and LR model were similar (0.77 vs. 0.76) and their accuracy was identical (87.4% vs. 87.4%).
Our study developed a preliminary prediction model based on two different ML approaches to help predict frailty risk in the elderly.
The presented models from this study can be used to inform healthcare providers to predict the frailty probability among older adults and maybe help guide the development of effective frailty risk management interventions.
Detecting frailty at an early stage and implementing timely targeted interventions may help to improve the allocation of health care resources and to reduce frailty-related burden. Identifying risk factors for frailty could be beneficial to provide tailored and personalized care intervention for older adults to more accurately prevent or improve their frail conditions so as to improve their quality of life.
The study has adhered to STROBE guidelines.
No patient or public contribution.
To obtain an in-depth understanding of the lived experiences, values, and beliefs of Taiwanese women with breast cancer who withdrew from cancer treatment.
Fear of side effects, negative experiences and personal beliefs were identified as reasons for withdrawing from cancer treatments. Body–mind consciousness and body autonomy play a crucial role in cancer treatment decisions.
Descriptive phenomenological approach.
We conducted semi-structured, face-to-face and in-depth interviews with 16 women diagnosed with breast cancer. Participants were purposefully selected from the Cancer Registry database. Employing a phenomenological approach, our aim was to explore the lived experiences of these individuals. Data analysis followed Giorgi's five-step process. To ensure a comprehensive report the COREQ checklist was applied.
‘The Determination to Preserve Me’ is the essence of treatment withdrawal, identified by three themes and seven sub-themes. ‘Raising Body-Mind Consciousness’ was generated using body autonomy and preventing repeated psychological trauma from the participant's view. Their lifestyles, maintaining the family role, and returning to a normal trajectory help develop ‘Maintaining Stability for Being a Patient and a Family Carer’. ‘Self-Defending Against the Body Harm’ was generated by concerns about maintaining health and preventing harm.
Women's behaviours became transformed by suffering. Actions were influenced by physical and psychological distress, misconceptions about treatments, and appearance changes by self-determination through self-protection.
Healthcare professionals should respect women's autonomy and work collaboratively to ensure their decision-making with accurate information and awareness of the potential risks and benefits of treatment withdrawal need to concern.
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