The Frailty Index in Europeans: Association with Age and Mortality

Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
Age and Ageing (Impact Factor: 3.64). 04/2012; 41(5):684-9. DOI: 10.1093/ageing/afs051
Source: PubMed


the frailty index (FI) is an approach to the operationalisation of frailty based on accumulation of deficits. It has been less studied in Europeans.
to construct sex-specific FIs from a large sample of Europeans and study their associations with age and mortality.
longitudinal population-based survey.
the Survey of Health, Ageing and Retirement in Europe (SHARE,
a total of 16,217 females and 13,688 males aged ≥50 from wave 1 (2004-05). Mortality data were collected between 2005 and 2006 (mean follow-up: 2.4 years).
regression curve estimations between age and an FI constructed as per the standard procedure. Logistic regressions were used to assess the relative effects of age and the FI towards mortality.
in both sexes, there was a significant non-linear association between age and the FI (females: quadratic R(2) = 0.20, P < 0.001; males: quadratic R(2) = 0.14, P < 0.001). Overall, the FI was a much stronger predictor of mortality than age, even after adjusting for the latter (females: age-adjusted OR 100.5, 95% confidence interval (CI): 46.3-218.2, P < 0.001; males: age-adjusted OR 221.1, 95% CI: 106.7-458.4, P < 0.001).
the FI had the expected properties in this large sample of Europeans.

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    • "In our study population, women were in majority, but no significant gender differences were found in either frailty score or functional improvement. Apart from the fact that age gave different results, this could confirm that older people (age > 80) are more frail compared to patients less than 80 years of old, as previously reported [21] [35]. The work of Fried et al. [21] supports these findings by reporting that those who were frail were older. "
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    ABSTRACT: Background. A geriatric evaluation and management unit (GEM) manages elderly inpatients with functional impairments. There is a paucity of literature on frailty and whether this impacts on rehabilitation outcomes. Objectives. To examine frailty score (FS) as a predictor of functional gain, resource utilisation, and destinations for GEM patients. Methods. A single centre prospective case study design. Participants (n = 136) were ≥65 years old and admitted to a tertiary hospital GEM. Five patients were excluded by the preset exclusion criteria, that is, medically unstable, severe dementia or communication difficulties after stroke. Core data included demographics, frailty score (FS), and functional independence. Results. The mean functional improvement (FIM) from admission to discharge was 11.26 (95% CI 8.87, 13.66; P < 0.001). Discharge FIM was positively correlated with admission FIM (β = 0.748; P < 0.001) and negatively correlated with frailty score (β = −1.151; P = 0.014). The majority of the patients were in the “frail” group. “Frail” and “severely frail” subgroups improved more on mean FIM scores at discharge, relative to that experienced by the “pre-frail” group. Conclusion. All patients experienced functional improvement. Frailer patients improved more on their FIM and improved relatively more than their prefrail counterparts. Higher frailty correlated with reduced independence and greater resource utilisation. This study demonstrates that FS could be a prognostic indicator of physical independence and resource utilisation.
    Full-text · Article · Feb 2014 · Current Gerontology and Geriatrics Research
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    Preview · Article · Jul 2012 · Age and Ageing
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    ABSTRACT: Aim: Frailty is an emerging concept in primary care, which potentially can provide healthcare commissioners with a clinical focus for targeting resources at an aging population. However, primary care practitioners need valid instruments that are easy to use. With that purpose in mind, we created a Frailty Instrument (FIt) for primary care based on the Survey of Health, Aging and Retirement in Europe (SHARE). The aim of the present study was to compare the mortality prediction of the five-item SHARE-FIt with that of a 40-item Frailty Index (FIx) based on comprehensive geriatric assessment (CGA). Methods: The participants were 15 578 women and 12 783 men from the first wave of SHARE. A correspondence analysis was used to assess the degree of agreement between phenotypic classifications. The ability of the continuous frailty measures (FIt score and FIx) to predict mortality (mean follow up of 2.4 years) was compared using receiver–operating characteristic (ROC) plots and areas under the curve (AUC). Results: In both sexes, there was significant correspondence between phenotypic categories. The two continuous measures performed equally well as mortality predictors (women: AUC-FIx = 0.79, 95% CI 0.75–0.82, P < 0.001; AUC-FIt = 0.77, 95% CI 0.73–0.81, P < 0.001; men: AUC-FIx = 0.77, 95% CI 0.74–0.79, P < 0.001; AUC-FIt = 0.76, 95% CI 0.74–0.79, P < 0.001). Their equivalent performance was confirmed by statistical comparisons of the AUC. Conclusions: SHARE-FIt is simpler and more usable, and predicts mortality similarly to a more complex FIx based on CGA. Geriatr Gerontol Int 2013; 13: 497–504.
    No preview · Article · Sep 2012 · Geriatrics & Gerontology International
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