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Modifications to the frailty phenotype criteria: Systematic review of the current literature and investigation of 262 frailty phenotypes in the Survey of Health, Ageing, and Retirement in Europe
... Consequently, a number of instruments purporting to simplify the PFP have been proposed. Theou and colleagues surveyed this landscape (as well as other modifications) in a 2015 article [14]: Among original research articles identified in a systematic review as using the PFP to assess frailty, roughly 10% used standard self-reported disability items querying difficulty with upper-extremity, ADL, or mobility tasks to replace performance-based assessment of strength or slow walk (each). In this same publication, Theou and colleagues conducted a de novo analysis replacing the phenotype's original strength and slow walk criteria with self-reported disability items (among many other variations) in the Survey of Health, Ageing, & Retirement in Europe: agreement was found to be mediocre (Kappa = 0.44). ...
... In males, misclassification in the reverse direction was far less frequent. Kappa values were 0.56 in the overall sample and ranged from 0.55 in men to 0.57 in women, consistent with other published studies [14]. There was a notable improvement in Kappa after adjusting for prevalence and assessment bias, with PABAK = 0.67 in women, and 0.68 in men and the overall sample (Table 4). ...
... Our study, however, did not seek to identify an optimal proxy, but rather to mimic what others largely have done in their prior substitutions, so as to justify (or not) the need for better alternative substitution items. Our choices were comparable to those used in most other self-reported versions of the PFP reviewed by Theou and colleagues [14]. Secondly, our data suffered from the same limitations typical in epidemiologic cohorts, in which there may be selection bias for study participation and against those who drop out of the study prematurely. ...
Background
Frailty assessment promises to identify older adults at risk for adverse consequences following stressors and target interventions to improve health outcomes. The Physical Frailty Phenotype (PFP) is a widely-studied, well validated assessment but incorporates performance-based slow walk and grip strength criteria that challenge its use in some clinical settings. Variants replacing performance-based elements with self-reported proxies have been proposed. Our study evaluated whether commonly available disability self-reports could be substituted for the performance-based criteria in the PFP while still identifying as “frail” the same subpopulations of individuals.
Methods
Parallel analyses were conducted in 3393 female and 2495 male Cardiovascular Health Study, Round 2 participants assessed in 1989–90. Candidate self-reported proxies for the phenotype’s “slowness” and “weakness” criteria were evaluated for comparable prevalence and agreement by mode of measurement. For best-performing candidates: Frailty status (3 + positive criteria out of 5) was compared for prevalence and agreement between the PFP and mostly self-reported versions. Personal characteristics were compared between those adjudicated as frail by (a) only a self-reported version; (b) only the PFP; (c) both, using bivariable analyses and multinomial logistic regression.
Results
Self-reported difficulty walking ½ mile was selected as a proxy for the phenotype’s slowness criterion. Two self-reported weakness proxies were examined: difficulty transferring from a bed or chair or gripping with hands, and difficulty as just defined or in lifting a 10-pound bag. Prevalences matched to within 4% between self-reported and performance-based criteria in the whole sample, but in all cases the self-reported prevalence for women exceeded that for men by 11% or more. Cross-modal agreement was moderate, with by-criterion and frailty-wide Kappa statistics of 0.55–0.60 in all cases. Frail subgroups (a), (b), (c) were independently discriminated (p < 0.05) by race, BMI, and depression in women; by age in men; and by self-reported health for both.
Conclusions
Commonly used self-reported disability items cannot be assumed to stand in for performance-based criteria in the PFP. We found subpopulations identified as frail by resultant phenotypes versus the original phenotype to systematically differ. Work to develop self-reported proxies that more closely replicate their objective phenotypic counterparts than standard disability self-reports is needed.
... The most commonly used method in the literature is the physical frailty phenotype [11]. The phenotype diagnosis is based on three of the following five criteria: weight loss, exhaustion, physical inactivity, slow walking speed, and weak grip strength [12]. ...
... The phenotype diagnosis is based on three of the following five criteria: weight loss, exhaustion, physical inactivity, slow walking speed, and weak grip strength [12]. The present study reviews five phenotypic criteria that have been measured in different ways across various studies which could potentially affect the estimates of the prevalence of frailty and the predictive ability of the aforementioned phenotype, potentially leading to different classifications and results [11]. Kutner and Zhang [13] commented on the replacement of the performance-based measures (i.e., grip strength and walking speed) in the original frailty phenotype definition with self-reported items. ...
... FATMPH's kappa agreement level was higher than FiND because FATMPH was modified from FFP. Aguayo GA et al. [8], in a study of the agreement between 35 published frailty scores in the general population, found a very wide range of agreement (Cohen's kappa = 0.10-0.83). The frailty phenotype properties were impacted by the modified frailty phenotype criteria [11]. The prevalence of frailty was 31.2% for modified selfreported walking, 33.6% for modified self-reported strength, and 31.4% for modified selfreported walking and strength [11]. ...
This study evaluated the validity of the screening tools used to evaluate the frailty status of older Thai people. A cross-sectional study of 251 patients aged 60 years or more in an out-patient department was conducted using the Frailty Assessment Tool of the Thai Ministry of Public Health (FATMPH) and the Frail Non-Disabled (FiND) questionnaire, and the results were compared with Fried’s Frailty Phenotype (FFP). The validity of the data acquired using each method was evaluated by examining their sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen’s kappa coefficient. Most of the participants were female (60.96%), and most were between 60 and 69 years old (65.34%). The measured prevalences of frailty were 8.37%, 17.53%, and 3.98% using FFP, FATMPH, and FiND tools, respectively. FATMP had a sensitivity of 57.14%, a specificity of 86.09%, a PPV of 27.27%, and an NPV of 95.65%. FiND had a sensitivity of 19.05%, a specificity of 97.39%, a PPV of 40.00%, and an NPV of 92.94%. The results of the Cohen’s kappa comparison of these two tools and FFP were 0.298 for FATMPH and 0.147 for FiND. The predictive values of both FATMPH and FiND were insufficient for assessing frailty in a clinical setting. Additional research on other frailty tools is necessary to improve the accuracy of frailty screening in the older population of Thailand.
... CVD accounts for about one-third of all deaths globally with 17.8 million deaths in 2017, an increase of 21.1% since 2007 [6]. The relationship between CVD and frailty is complex and bidirectional [7][8][9]. ...
... 1. weakness was measured using the self-reported item "di culty in lifting or carrying a weight greater than 5 kg [21]; 2. Slowness was considered present if participants had di culty walking 100 m or climbing several ights of stairs without rest, similar to the method used in previous studies [21]; ...
Background
Cardiovascular disease (CVD) and frailty frequently coexist in older populations, resulting in a synergistic impact on health outcomes. This study aims to develop a prediction model for the risk of frailty among patients with cardiovascular disease.
Methods
Using data from the China Health and Retirement Longitudinal Study (CHARLS), a total of 2,457 patients with cardiovascular disease (CVD) in 2011 (n = 1,470) and 2015 (n = 987) were randomly divided into training set (n = 1,719) and validation set (n = 738) at a ratio of 7:3. LASSO regression analysis was used conducted to determine identify the predictor variables with the most significant influence on the model. Stepwise regression analysis and logistic regression model were used to analyze the risk factors of frailty in patients with cardiovascular disease. The prediction model was established by constructing a nomogram. The predictive accuracy and discriminative ability of the nomogram were determined by the concordance index (C-index) and calibration curve. The area under the receiver operating characteristic curve and decision curve analysis were conducted to assess predictive performance.
Results
A total of 360 patients (17.2%) had frailty symptoms. Among the 29 independent variables, it was found that gender, age, pain, grip strength, vision, activities of daily living (ADL), and depression were significantly associated with the risk of frailty in CVD patients. Using these factors to construct a nomogram model, the model has good consistency and accuracy. The AUC values of the prediction model and the internal validation set were 0.859 (95%CI 0.836–0.882) and 0.860 (95%CI 0.827–0.894), respectively. The C-index of the prediction model and the internal validation set were 0.859 (95%CI 0.836–0.882) and 0.887 (95%CI 0.855–0.919), respectively. The Hosmer-Lemeshow test showed that the model's predicted probabilities were in reasonably good agreement with the actual observations. The calibration curve showed that the Nomogram model was consistent with the observed values. The robust predictive performance of the nomogram was confirmed by Decision Curve analysis (DCA).
Conclusions
This study established and validated a nomogram model, combining gender, age, pain, grip strength, ADL, visual acuity, and depression for predicting physical frailty in patients with cardiovascular disease. Developing this predictive model would be valuable for screening cardiovascular disease patients with a high risk of frailty.
... 1. Weakness was measured using the self-reported item "having difficulty in lifting or carrying weights over 5 kg" [18]. 2. Slowness was considered present if a participant had difficulty walking 100 m or climbing several flights of stairs without resting, which was similar to that used in previous studies [18]. ...
... 1. Weakness was measured using the self-reported item "having difficulty in lifting or carrying weights over 5 kg" [18]. 2. Slowness was considered present if a participant had difficulty walking 100 m or climbing several flights of stairs without resting, which was similar to that used in previous studies [18]. 3. Exhaustion was present if the participant answered "Most or all of the time" or "Occasionally or a moderate amount of the time", in response to either of the Chinese version of the Center for Epidemiologic Studies-Depression scale (CES-D) questions: "I felt everything I did was an effort during last week" or "I could not get going during last week. ...
Background
Frailty is the third most common complication of diabetes after macrovascular and microvascular complications. The aim of this study was to develop a validated risk prediction model for frailty in patients with diabetes.
Methods
The research used data from the China Health and Retirement Longitudinal Study (CHARLS), a dataset representative of the Chinese population. Twenty-five indicators, including socio-demographic variables, behavioral factors, health status, and mental health parameters, were analyzed in this study. The study cohort was randomly divided into a training set and a validation set at a ratio of 70 to 30%. LASSO regression analysis was used to screen the variables for the best predictors of the model based on a 10-fold cross-validation. The logistic regression model was applied to explore the associated factors of frailty in patients with diabetes. A nomogram was constructed to develop the prediction model. Calibration curves were applied to evaluate the accuracy of the nomogram model. The area under the receiver operating characteristic curve and decision curve analysis were conducted to assess predictive performance.
Results
One thousand four hundred thirty-six patients with diabetes from the CHARLS database collected in 2013 (n = 793) and 2015 (n = 643) were included in the final analysis. A total of 145 (10.9%) had frailty symptoms. Multivariate logistic regression analysis showed that marital status, activities of daily living, waist circumference, cognitive function, grip strength, social activity, and depression as predictors of frailty in people with diabetes. These factors were used to construct the nomogram model, which showed good concordance and accuracy. The AUC values of the predictive model and the internal validation set were 0.912 (95%CI 0.887–0.937) and 0.881 (95% CI 0.829–0.934). Hosmer–Lemeshow test values were P = 0.824 and P = 0.608 (both > 0.05). Calibration curves showed significant agreement between the nomogram model and actual observations. ROC and DCA indicated that the nomogram had a good predictive performance.
Conclusions
Comprehensive nomogram constructed in this study was a promising and convenient tool to evaluate the risk of frailty in patients with diabetes, and contributed clinicians to screening the high-risk population.
... Specifically, slowness (measured by gait speed test of a timed walk over a designated distance) and weakness (measured by grip strength with an instrument such as a dynamometer) require more time and resources to collect and may not be feasible in all clinical settings. As a result, several modified versions of the FFP have proposed substitutions replacing objectively assessed measures with self-report (Op Het Veld et al., 2018;Theou et al., 2015) or excluding the objectively assessed measures (Desquilbet et al., 2007;Theou et al., 2015). There is limited validation work among clinical care cohorts specifically evaluating modifications to FFP (Akgun et al., 2014;Bouillon et al., 2013;McMillan et al., 2021), especially among PWH (Aprahamian et al., 2017;Jung et al., 2021;Kim et al., 2020;Van der Elst et al., 2020), which is important to understand measurement properties within particular settings of use. ...
... Specifically, slowness (measured by gait speed test of a timed walk over a designated distance) and weakness (measured by grip strength with an instrument such as a dynamometer) require more time and resources to collect and may not be feasible in all clinical settings. As a result, several modified versions of the FFP have proposed substitutions replacing objectively assessed measures with self-report (Op Het Veld et al., 2018;Theou et al., 2015) or excluding the objectively assessed measures (Desquilbet et al., 2007;Theou et al., 2015). There is limited validation work among clinical care cohorts specifically evaluating modifications to FFP (Akgun et al., 2014;Bouillon et al., 2013;McMillan et al., 2021), especially among PWH (Aprahamian et al., 2017;Jung et al., 2021;Kim et al., 2020;Van der Elst et al., 2020), which is important to understand measurement properties within particular settings of use. ...
Modifications to Fried's frailty phenotype (FFP) are common. We evaluated a self-reported modified frailty phenotype (Mod-FP) used among people with HIV (PWH). Among 522 PWH engaged in two longitudinal studies, we assessed validity of the four-item Mod-FP compared with the five-item FFP. We compared the phenotypes via receiver operator characteristic curves, agreement in classifying frailty, and criterion validity via association with having experienced falls. Mod-FP classified 8% of PWH as frail, whereas FFP classified 9%. The area under the receiver operator characteristic curve for Mod-FP classifying frailty was 0.93 (95% CI = 0.91-0.96). We observed kappa ranging from 0.64 (unweighted) to 0.75 (weighted) for categorizing frailty status. Both definitions found frailty associated with a greater odds of experiencing a fall; FFP estimated a slightly greater magnitude (i.e., OR) for the association than Mod-FP. The Mod-FP has good performance in measuring frailty among PWH and is reasonable to use when the gold standards of observed assessments (i.e., weakness and slowness) are not feasible.
... The modified version of Fried frailty phenotype [10,12] included a low body mass index (BMI) of <20kg/m 2 substituting for unintentional weight loss, slowest 20% in gait speed adjusted for height and gender and lowest 20% in grip strength adjusted for BMI and gender, as previously published [14]. A large systematic review also reported that BMI was a validated tool to determine the weight loss criterion for Fried phenotype [15]. Participants were classified as frail if they met at least three of the following five criteria and pre-frail if they met one or two of the criteria: (1) BMI < 20 kg/m 2 ("Shrinking"); (2) lowest 20% of grip strength taking into account gender and BMI ("Weakness"); (3) the participant endorsed "I felt that everything I did was an effort" and/or "I could not get going" for three or more days during the last week, according to the Center for Epidemiological Studies-Depression 10 Item (CES-D 10) scale [16] ("Exhaustion"); (4) time to walk 3 meters (10 feet) was in the lowest 20% taking into account gender and height ("Slowness"), and (5) no walking outside the home in the last two weeks, or the longest amount of time walking outside without sitting down to rest was less than 10 minutes, ("Low activity") according to LIFE Disability questionnaire responses [17]. ...
... Furthermore, our results may not apply to those who have known CVD, major cognitive impairment, a major impairment in BADL or an expected five-year life-limiting illness. Additionally, we used modified criteria for the Fried phenotype definition, which differed from the original approach [12] though many previous studies [15] used modified criteria depending on data availability. As such, in this relatively healthy cohort of the older population, some individuals have been classified as pre-frail who might not be considered pre-frail in a more representative population sample. ...
Introduction:
Frailty is a common geriatric syndrome that adversely impacts health outcomes. This study examined correlates of physical frailty in healthy community-dwelling older adults and studied the effect of frailty on disability-free survival (DFS), defined as survival free of independence-limiting physical disability or dementia.
Methods:
This is a post hoc analysis of 19,114 community-dwelling older adults (median age 74.0 years, interquartile range or IQR: 6.1 years) from Australia and the United States (US) enrolled in the 'ASPirin in Reducing Events in the Elderly (ASPREE)' clinical trial. Frailty was assessed using a modified Fried phenotype and a deficit accumulation Frailty Index (FI) utilizing a ratio score derived from 66 items. Multinomial logistic regression was used to examine the correlates of frailty and Cox regression to analyze the association between frailty and DFS (and its components).
Results:
At study enrollment, 39.0% were pre-frail, and 2.2% of participants were frail, according to Fried phenotype. Older age, higher waist circumference, lower education, ethno-racial origin, current smoking, depression, and polypharmacy were associated with pre-frailty and frailty according to Fried phenotype and FI. Fried phenotype defined pre-frailty and frailty predicted reduced DFS (pre-frail: HR: 1.67; 95%CI: 1.50, 1.86 and frail: HR: 2.80; 95%CI: 2.27, 3.46), affecting each component of DFS including dementia, physical disability and mortality. Effect sizes were larger according to FI.
Conclusion:
Our study showed that pre-frailty is common in community-dwelling older adults initially free of cardiovascular disease, dementia or independence-limiting physical disability. Pre-frailty and frailty significantly reduced disability-free survival. Addressing modifiable correlates, like depression and polypharmacy, might reduce the adverse impact of frailty on dementia-free and physical disability-free survival.
... (15)(16)(17) Already in 2015 Theo and colleagues found that there were 226 constructs of frailty phenotype. (20) I avoided devising another construct because replicability is a critical practice for cross-country study, choosing to follow closely studies of Fried, Bandeen-Roche and colleagues for HRS, (21,22) Mekli and colleagues' for ELSA, (23) and Santos-Eggimann and colleagues' for SHARE. (24). ...
Background: Childhood poverty is directly associated with many health outcomes in late life irrespective of youth health and of variation in health systems. The childhood poor in America, Britain and Europe have reported worse cognitive, muscle and mental functions in their fifties to nineties. But it is not known whether they have higher probabilities of experiencing frailty as their childhood recollections are likely to be erroneous.
Materials and methods: Some 79428 adults aged 50 and older retrospectively recalled their childhood conditions at ten and underwent prospective examinations to construct their Fried's frailty phenotype. Childhood conditions in ELSA and SHARE include number of books, number of rooms, number of people, presence of running hot or cold water, fixed bath, indoor lavatory and central heating. Across in America, these are mostly replaced with financial hardship indicators including having to move because of family debt. Childhood poverty is a latent construct of error-laced recollection and its distal fully adjusted association with frailty phenotype is estimated with fixed effects probit model.
Results: Childhood poverty associates with higher probabilities of being frail (0.1097 +/- 0.0169, p < 0.001) in 29 countries of America, Britain and Europe. Furthermore, women have higher probabilities of being frail (0.3051 +/- 0.0152, p < 0.001). Age, education, wealth, marital status and youth illness exert influences on the probabilities of being frail. Sensitivity analyses were conducted using random effects model and by stratifying on sex.
Discussion: Evidence is mounting that childhood can last a life time, affecting cognitive and muscle function, mental health and now frailty. This evidence calls for urgent actions to eliminate child poverty on account of its lifelong rewards.
... Frailty was defined as the meeting of three or more of the following five evaluation criteria: shrinkage, exhaustion, low activity, slowness, or weakness. The frailty assessment index has changed frequently in previous studies, and it has been suggested that all details regarding the measurement of the frailty phenotype criteria should be reported to aid in the interpretation of results [24]. Therefore, in this study, we modified and applied Fried's assessment criteria (Table 1). ...
Social isolation exacerbates physical frailty and is associated with subjective well-being. Even those with high levels of social isolation may have different health statuses depending on the type of isolation and their subjective well-being. However, the effect of subjective well-being on the relationship between social isolation and physical frailty remains unclear. This study examined whether the risk of physical frailty was the same for individuals with social isolation according to high and low subjective well-being. The study participants included 1,953 middle-aged Japanese adults aged 45 years and older. Physical frailty was assessed using a modified version of the Fried phenotype criteria. Probabilistic Latent Semantic Analysis was used to classify participants according to social isolation indicators. Subsequently, we focused on the groups with high social isolation and classified them according to whether their subjective well-being was high or low. Subjective well-being was evaluated using the Shiawase and Ikigai scales, which are concepts used in Japan. Finally, we used survival time analysis to examine the relationship between Shiawase or Ikigai and physical frailty in groups with high social isolation. The participants were classified into four groups based on their social isolation status. The physical frailty rate of the high social isolation class was 37.0%, which was significantly higher than that of the other classes. Survival time analysis revealed that among people with high social isolation, those with high Shiawase and Ikigai had a significantly lower risk of physical frailty than those with low Shiawase and Ikigai . All individuals with high social isolation are not at a high risk of physical frailty. The findings reveal that even those with high level of social isolation may have a lower risk of physical frailty if their subjective well-being is high. These results will contribute to promoting the prevention of frailty in middle-aged and older adults.
... It is typified by weakness and reduced physical resilience and functional capacity (Fried et al., 2021;Morley et al., 2013) and associated with adverse outcomes including disability, falls, hospitalization, and death (Clegg et al., 2013;Vermeiren et al., 2016;Xue, 2011). Even with no consensus definition of frailty (Rockwood & Howlett, 2018;Theou et al., 2015), there is growing acknowledgment that a rising proportion of the world's aging population is affected by this declining later life state (Cesari et al., 2016;Collard et al., 2012;Ofori-Asenso et al., 2019). However, the true scale of the problem is difficult to determine due to differences across measuring tools, countries, and settings (Collard et al., 2012;Gale et al., 2015). ...
Physical activity is an effective, proactive intervention to reduce or reverse frailty and functional decline. However, uncertainty exists about the feasibility and impact of resistance training on multidimensional health in prefrail older adults in residential care. This mixed methods feasibility study assessed practicability with limited efficacy testing on health and functional outcomes. Eleven prefrail older adults participated in a 6-week progressive resistance training protocol three times per week. The intervention and measures were found to be appropriate and acceptable by those who completed the trial, with participants self-reporting improved well-being, mood, and function. Analysis identified several barriers to recruitment, including prior commitments, seasonal impact, and session timing, and offered potential solutions with further recommendations for program refinement prior to a definitive randomized controlled trial. These findings add to our understanding of prefrail older adults’ preferences regarding participation in physical activity research and the perceived benefits of resistance training. This trial was registered with ClinicalTrials.gov: NCT03141879.
... (3) Weight loss: weight loss refers to the weight that has decreased by 5 kg or current body mass index (BMI) ≤ 18.5 kg/m 2 during the last 12 months [31,32]. ...
Background
To investigate the cross-sectional and longitudinal associations between depressive symptoms and the prevalence of frailty and its components in a nationally representative sample of middle-aged and older Chinese adults.
Method
The China Health and Retirement Longitudinal Study (CHARLS) provided data on 17,104 adults aged ≥ 45 years. Every two years, face-to-face, computer-aided personal interviews (CAPI), and structured questionnaires were used to follow up with the respondents. The Chinese version of the Center for Epidemiologic Studies-Depression Scale (CES-D) was used to evaluate depressive symptoms, and the Fried criteria were used to measure frailty. The odds ratio (OR) and 95% confidence interval (CI) for the cross-sectional connections among depressive symptoms and frailty and its components in the individuals at baseline were analyzed using logistic regression. A Cox proportional hazards analysis was performed using the hazard ratio (HR) and 95% confidence interval for the prospective connection between baseline depressive symptoms and frailty and its component in the participants without frailty at baseline.
Results
At baseline, 11.62% of participants had frailty, and 57.92% had depressive symptoms. In the cross-sectional analysis, depressive symptoms (OR = 5.222, 95%CI 3.665–7.442) were associated with frailty. In the longitudinal analysis, after adjusting for the full set of covariates among participants free of baseline frailty, depressive symptoms were significantly associated with incident frailty during the short term [HR = 2.193 (1.324–3.631)] and the long term [HR = 1.926 (1.021–3.632)]. Meanwhile, depressive symptoms were associated with an increased risk of weakness [HR = 1.990 (1.250–3.166)], slowness [HR = 1.395 (1.044–1.865)], and exhaustion [HR = 2.827 (2.150–3.719)] onset during the short-term. Depressive symptoms were associated with an increased risk of exhaustion [HR = 2.869 (2.004–4.109)] onset during the long-term.
Conclusion
Among middle-aged and older adults, depressive symptoms could predict frailty during 2 years of follow-up and 4 years of follow-up. When considering potential confounding factors, depressive symptoms were considered a predictor of weakness, slowness, and exhaustion. Interventions aimed at preventing depressive symptoms may be beneficial in reducing frailty and its components.
... The frailty level of the participants was measured using Fried's criteria, including weight loss, exhaustion, physical activity, weakness, and slowness [17]. As a result of cultural differences across countries, there are over 70 modified versions of the Physical Frailty Phenotype (PFP) worldwide with different definitions of the five criteria and cut-off points [18]. This study adopted the modified PFP (mPFP) criteria by Wu et al., which were modified to meet the characteristics of Chinese populations based on the original PFP [19]. ...
Background
Frailty is an aging-related syndrome leading to high mortality in older adults. Without effective assessment and prevention of frailty, the incidence of frailty and relevant adverse outcomes will increase by 2050 as worldwide populations age. Although evidence suggested heart rate variability (HRV) is a potential measure of frailty, the role of HRV in frailty assessment remains unclear because of controversial findings. This study examined the effects of posture on HRV parameters in non-frail and prefrail individuals to understand the role of HRV in assessing frailty.
Methods
Forty-six participants aged ≥ 50 years were recruited between April and August 2022. Frailty was defined using Fried’s criteria. HRV was measured in standing, sitting, and lying postures, respectively, using a Polar Watch, and analyzed using Kubios HRV Standard 3.5.0 (Kubios). The five most commonly used parameters were examined, including standard deviations of all normal-to-normal intervals (SDNN), root mean square of the successive differences (RMSSD), low frequency (LF), high frequency (HF), and LF/HF. Independent t-tests and Mann–Whitney tests were used for inter-group comparisons. Friedman tests were used for intra-group comparisons across postures.
Results
The non-frail group showed significant differences in HRV parameters across postures (all p < 0.05), whereas the prefrail group did not demonstrate any difference (all p > 0.05). The differences in the non-frail group included higher RMSSD and HF in the lying posture compared to those in the standing posture (29.54 vs 21.99 p = 0.003, 210.34 vs 96.34 p = 0.001, respectively), and higher LF and LF/HF in the sitting posture compared to those in the lying posture (248.40 vs 136.29 P = 0.024, 1.26 vs 0.77 p = 0.011, respectively).
Conclusions
The effects of posture on HRV were blunted in the prefrail group, which suggests an impaired cardiac autonomic functioning. Measuring the effects of posture on HRV parameters may contribute to frailty assessment. However, further evidence from larger cohorts and including additional HRV parameters is needed.
... The identification of frailty has therefore become a topic of interest with numerous frailty operationalisations and measurement tools having been developed 4 . Since its original publication in 2001, Fried et al.'s physical frailty phenotype (defined by exhaustion, unexplained weight loss, weakness, slowness and low physical activity) has been one of the most popular and validated tools in the literature 5,6 . However, it is not well adapted for use in primary care settings due to the need for post hoc calculations on a reference sample. ...
This narrative literature review aimed to examine the utilisation of the Survey of Health, Ageing and Retirement in Europe (SHARE) frailty instruments: SHARE-FI and SHARE-FI75+. We used the Google Scholar “cited by” function (accessed on February 20th, 2023) to identify all citations of the original SHARE-FI and SHARE-FI75+ studies. Included articles were categorised into four themes: epidemiological studies (prevalence and associated factors); associations with geriatric syndromes, diseases and health outcomes; randomised clinical trials (RCTs); and expert consensus and practice guidelines. Of 529 articles screened (446 citing SHARE-FI and 83 citing SHARE-FI75+), 64 (12.1%) were included. Sixteen (25.0%) were epidemiological; 35 (54.7%) described associations; 10 (15.6%) were RCTs; and 3 (4.7%) were expert consensus or practice guidelines. Frailty was associated with older age; female sex; higher morbidity; lower education; social isolation; worse nutrition and mobility; rheumatological, cardiovascular, and endocrine diseases; and greater healthcare utilisation and mortality. SHARE-FI was used in RCTs as entry criterion, controlling variable, and intervention outcome. SHARE-FI and SHARE-FI75+ have been recommended to aid the management of atrial fibrillation anticoagulation and hypertension, respectively. SHARE-FI and SHARE-FI75+, two open access phenotypical frailty measurement tools, have been utilised for a range of purposes, and mostly in epidemiological/associational studies.
... Physiological systems exhibit a general and gradual decline with aging. However, in frailty, the decline is accelerated, and the homeostatic mechanisms, speci cally energy metabolism and neuromuscular systems, start failing [3]. Several age-related diseases further accelerate the phenotype and/or onset of frailty in the older population. ...
Purpose
Frailty is a geriatric syndrome that precedes disability and is a common finding in patients with chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and Alzheimer’s disease (AD). The contribution of increased intestinal permeability to frailty phenotype in patients with COPD, CHF, and AD is poorly known.
Methods
We conducted a cross-sectional, multicenter study of older men, including controls and patients with COPD, CHF, and AD (n = 37—48/group). We used Fried's cardiovascular health study (CHS) criteria to measure frailty and measured plasma zonulin levels as a biomarker of intestinal permeability. We also measured plasma c-reactive protein (CRP), 8-isoprostanes, and creatine kinase (CK) levels as markers of inflammation, oxidative stress, and muscle damage, respectively.
Results
Frail patients exhibited higher plasma zonulin than pre-frail patients, irrespective of disease type (all p < 0.05). Plasma zonulin exhibited significant positive associations with CHS frailty index, which were strongest in the control group, followed by CHF, COPD, and AD patients, respectively (all p < 0.05). Plasma zonulin demonstrated significantly high areas under the curve in diagnosing frailty in controls and patients with COPD, CHF, and AD (all p < 0.05). In the frail vs. pre-frail comparisons, we also found elevated plasma CK levels in CHF and AD patients, elevated CRP levels in COPD patients, and elevated 8-isoprostanes in AD patients (all p < 0.05).
Conclusion
Together, our data indicate the potential contribution of the disrupted intestinal mucosal barrier and elevated plasma zonulin to frailty phenotype in patients with COPD, CHF, and AD.
... Za diagnozo sindroma fenotipske (medicinske) krhkosti morajo biti izpolnjeni 3 od 5 pogojev: izguba telesne mase; izčrpanost (utrujenost); nizka stopnja telesne dejavnosti; upočasnjenost; šibkost (2,64,65). ...
... Za diagnozo sindroma fenotipske (medicinske) krhkosti morajo biti izpolnjeni 3 od 5 pogojev: izguba telesne mase; izčrpanost (utrujenost); nizka stopnja telesne dejavnosti; upočasnjenost; šibkost (2,64,65). ...
Izhodišča: Prehransko stanje posameznika uvrščamo med ključne dejavnike njegovega zdravja. Za učinkovito individualno in multidisciplinarno obravnavo stanj, povezanih s prehranskim stanjem posameznika, moramo dobro poznati terminologijo klinične prehrane. Ker je klinična prehrana kot medicinska stroka razvita tudi pri nas, v tujini pa so tovrstni terminološki dokumenti že na voljo, želimo tudi v Sloveniji na podlagi konsenza oblikovati enotno terminologijo. Metode: Prispevek je osnovan na podlagi eksplicitnega terminološkega dogovora. K sodelovanju smo povabili obsežno skupino relevantnih slovenskih strokovnjakov s kliničnih, predkliničnih in drugih področij, ki so povezana z dejavnostjo klinične prehrane v medicini, pri oblikovanju pa je sodeloval tudi terminolog s področja medicine. Kot izhodišče smo izbrali terminološke smernice Evropskega združenja za klinično prehrano in presnovo ter ob njih upoštevali najnovejša strokovna priporočila za posamezne pojme. Avtorji so bili v stiku prek osebnih srečanj in elektronske pošte. Pri končnem oblikovanju konsenza je sodelovalo 42 avtorjev iz 19 slovenskih ustanov. Rezultati: Predstavljamo temeljne pojme, terminološke definicije in pripadajoče slovenske termine s področja klinične prehrane. Opredelili smo osnovne motnje prehranjenosti – podhranjenost, prekomerno hranjenost, neravnovesje mikrohranil in sindrom ponovnega hranjenja. Poleg tega smo opredelili tudi s prehranjenostjo povezana stanja – sarkopenijo in krhkost. Osnovne pojme smo podprli s kliničnim kontekstom, v katerem nastopajo. Zaključki: Poenoteno razumevanje osnovnih patoloških stanj, ki jih obravnava klinična prehrana, je izhodišče za nadaljnji razvoj stroke, poleg tega pa je podlaga tudi za prehransko obravnavo in učinkovito prehransko oskrbo.
... Sarcopenia refers to the age-associated loss of skeletal muscle mass and function, whereas frailty is a physiological state marked by the deregulation of multiple systems in an aging organism. [4][5][6][7][8][9][10][11][12][13][14] Both conditions can have adverse health outcomes, and hand grip strength is used as a diagnostic or screening tool to detect low skeletal muscle strength resulting from sarcopenia and/or frailty. 2,[15][16][17] However, the presence of hand diseases, such as osteoarthritis, tenosynovitis, and entrapment syndromes are common in the geriatric population and can affect grip strength measurement. ...
Objective: The aim of this study was to investigate the impact of untreated hand diseases on hand grip strength, a value that is commonly used as a diagnostic parameter for sarcopenia and frailty in geriatric populations. We hypothesized that individuals with untreated hand diseases would have lower grip strength than those without hand diseases.
Methods: A total of 240 individuals aged at least 65 years were recruited and divided into two groups based on the presence or absence of typical hand diseases. Grip strength was compared between the two groups separately for men and women using a t-test, with each group consisting of 60 women or 60 men.
Results: Both women and men in the hand disease group exhibited significantly lower grip strength than those in the control group.
Conclusions: These findings suggest that untreated hand diseases have a negative impact on grip strength, and this may introduce bias in the screening or diagnosis of sarcopenia and frailty. It is essential to consider the presence of hand diseases when measuring hand grip strength in older adults.
... Data sources. Survey data was used because this is the only data available which captures all the events included in the model structure and allows the creation of a measure of frailty phenotype, a measure which has been used extensively in the frailty literature [24,[30][31][32][33]. The review undertaken by Afzali et al. [25] identified The Survey of Health, Ageing and Retirement in Europe (SHARE) as a relevant database to populate the model [34]. ...
Frailty is a biological syndrome that is associated with increased risks of morbidity and mortality. To assess the value of interventions to prevent or manage frailty, all important impacts on costs and outcomes should be estimated. The aim of this study is to describe the development and validation of an individual-based state transition model that predicts the incidence and progression of frailty and frailty-related events over the remaining lifetime of older Australians. An individual-based state transition simulation model comprising integrated sub models that represent the occurrence of seven events (mortality, hip fracture, falls, admission to hospital, delirium, physical disability, and transitioning to residential care) was developed. The initial parameterisation used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE). The model was then calibrated for an Australian population using data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The simulation model established internal validity with respect to predicting outcomes at 24 months for the SHARE population. Calibration was required to predict longer terms outcomes at 48 months in the SHARE and HILDA data. Using probabilistic calibration methods, over 1,000 sampled sets of input parameter met the convergence criteria across six external calibration targets. The developed model provides a tool for predicting frailty and frailty-related events in a representative community dwelling Australian population aged over 65 years and provides the basis for economic evaluation of frailty-focussed interventions. Calibration to outcomes observed over an extended time horizon would improve model validity.
... A score of 0 indicated 'robustness' , 1 or 2 signified 'prefrailty' , and a score of 3 or 4 identified 'frailty' [25]. Specifically, for longitudinal analyses, weight loss was evaluated in accordance with Stenholm, Ferrucci [26] and Theou, Cann [27] and defined as a weight loss of greater than 5% or ≥ 4.5kg compared to baseline. ...
Background:
Knowledge opportunities lie ahead as everyday activities, social participation, and psychological resilience might be important predictors for frailty state transitioning in the oldest old. Therefore, this article aims to examine whether changes in basic-, instrumental-, advanced- activities of daily living (b-, i-, a-ADLs), social participation, and psychological resilience predict both a transition from robustness to prefrailty or frailty and vice versa among community-dwelling octogenarians over a follow-up period of one year.
Methods:
To evaluate worsened and improved frailty transitions after one year in 322 octogenarians (Mage = 83.04 ± 2.78), the variables sex, ADLs (b-ADL-DI, i-ADL-DI, a-ADL-DI as baseline and as difference after 6 months values), the CD-RISC (Connor-Davidson Resilience Scale, as baseline and as difference after 6 months), the social participation variables (total participation score, being a member, total number of memberships, level of social participation, being a board member, volunteering, and formal participation as baseline and as difference after 6 months values), were included in a logistic regression analysis.
Results:
Limitations in a-ADLs at baseline (OR: 1.048, 95% confidence interval, 1.010-1.090) and an increment of limitations in a-ADLs after 6 months (OR: 1.044, 95% confidence interval, 1.007-1.085) were predictors to shift from robust to a worsened frailty state after one year follow-up. Additionally, being a woman (OR: 3.682, 95% confidence interval, 1.379-10.139) and social participation, specifically becoming a board member in 6 months (OR: 4.343, 95% confidence interval, 1.082-16.347), were protectors of robustness and thus related to an improved frailty transition after one year.
Conclusions:
Encouraging healthy lifestyle behaviors to help the maintenance of ADLs, possibly leading to more social participation, could be promising in the prevention of frailty.
... For the fourth component of physical activity, the study used the question: "How often do you take part in sports or vigorous activities, such as running or jogging, swimming, going to a health center or gym, cycling, or digging with a spade or shovel, heavy lifting, chopping, farm work, fast bicycling, cycling with loads: which was answered as every day, more than once a week, once a week, one to three times a month, or hardly ever or never" Finally, low physical activity was taken as: "One to three times a month or hardly ever or never = 1" and "once a week or more than once a week = 0" [25]. ...
Background
Relatively little is known about how sleep disorders affect frailty of seniors. The study uses Fried's frailty index, to investigate the relationship between sleep disorder and frailty among older Indian adults.
Methods
The study analysed Longitudinal Ageing Study in India (2017–18) data which uses a multistage stratified area probability cluster sampling design. The association between frailty was studied for which the total sample size was 31,902. The principal dependent variable was frailty. Descriptive statistics and cross-tabulation were presented in the study. A binary logistic regression analysis was used to fulfil the study objectives to find the possible association.
Results
The prevalence of frailty in India was 21.3 percent. Older adults with sleep disorder had 66 percent higher likelihood to be frail than their counterparts. The benefits of physical activity in containing frailty is huge, the association were quite high. Poor Self-rated health was significantly associated with higher frailty (OR = 1.73; CI = 1.47–2.04).
Conclusions
Frailty is an enormously growing public health issue and has bi-directional relation with sleep disorders. The study has clinical relevance since sleep complaints offer a means for identifying those who are vulnerable to frailty and through appropriate intervention, the causes of sleep disorder would help to delay and in some cases reverse frailty.
... The observed prevalence of pre-frailty in the present study was lower than reported among communitydwelling older adults worldwide [51], in Europe [52], and Tromsø5 study participants aged ≥ 70 years in 2001 [53]. These discrepancies may be partly explained by the use of different modifications of Fried's frailty definition [54]. Moreover, another study from the Tromsø Study has shown increased grip strength in more recent birth cohorts of older participants [55]. ...
Background
Pre-frailty is an intermediate, potentially reversible state before the onset of frailty. Healthy dietary choices may prevent pre-frailty. Fish is included in most healthy diets, but little is known about the association between long-term habitual fish intake and pre-frailty. We aimed to elucidate the longitudinal association between the frequency of fish intake and pre-frailty in a cohort of older adults in Norway.
Methods
4350 participants (52% women, ≥65 years at follow-up) were included in this prospective cohort study. Data was obtained from three waves of the population-based Tromsø Study in Norway; Tromsø4 (1994–1995), Tromsø6 (2007–2008) and Tromsø7 (follow-up, 2015–2016). Frailty status at follow-up was defined by a modified version of Fried’s phenotype. Fish intake was self-reported in the three surveys and assessed as three levels of frequency of intake: low (0–3 times/month), medium (1–3 times/week) and high (≥ 4 times/week). The fish–pre-frailty association was analysed using multivariable logistic regression in two ways; (1) frequency of intake of lean, fatty and total fish in Tromsø6 and pre-frailty at follow-up, and (2) patterns of total fish intake across the three surveys and pre-frailty at follow-up.
Results
At follow-up, 28% (n = 1124) were pre-frail. Participants with a higher frequency of lean, fatty and total fish intake had 28% (odds ratio (OR) = 0.72, 95% confidence interval (CI) = 0.53, 0.97), 37% (OR = 0.63, 95% CI = 0.43, 0.91) and 31% (OR = 0.69, 95% CI = 0.52, 0.91) lower odds of pre-frailty 8 years later compared with those with a low intake, respectively. A pattern of stable high fish intake over 21 years was associated with 41% (OR = 0.59, 95% CI = 0.38, 0.91) lower odds of pre-frailty compared with a stable low intake.
Conclusions
A higher frequency of intake of lean, fatty and total fish, and a pattern of consistent frequent fish intake over time, were associated with lower odds of pre-frailty in older community-dwelling Norwegian adults. These results emphasise the important role of fish in a healthy diet and that a frequent fish intake should be promoted to facilitate healthy ageing.
... Health conditions, malnutrition, reduced cognitive function, vision and hearing problems, psychological factors, reduced mobility and self-care, lack of participation in life roles and complications with services or support systems are all present in frail persons. 24 The FIT program used the ICF scale to classify the common patterns that exist as part or in combination with the frailty syndrome and identified their causes, which are described below. 8,15 The FIT intervention program includes exercise prescription, nutritional assessment, and counseling sessions by a Geriatrician or Physiatrist. ...
Modern rehabilitation is based on the International Classification of Functioning, Disability and Health (ICF). We will discuss this Classification process in frailty. Frailty is defined as a condition of reduced functional reserve, a state of vulnerability that involves poor recovery of homeostasis and increased susceptibility to stressor mechanisms, with consequent difficulty in returning to the previous condition of balance. Rehabilitation of frailty is reported in the ICF, although, its consensus is not sufficiently addressed due to its recent identification and the limited available information regarding how it should be formulated. Thus, the aim of the present article is to present the current evidence-based rehabilitation strategies applied in management of frailty.
... However, previous work shows that there are several hundred physical frailty adaptations of Fried's original model and that despite their modifications they continue to be predictive of adverse outcomes in older adults, thus lending confidence to our PURE frailty classifications. 17 We created two versions of PURE frailty, adapting previous work that operationalised frailty using the assessments available in the PURE study. 18 Global frailty was defined as the presence of two or three of: unintentional weight-loss, weakness and low physical activity levels, where weakness was considered a handgrip strength below the lowest cohort-wide quintile for BMI and sex; and low physical activity was considered an activity level below the lowest cohort-wide quintile for each sex. ...
Objectives:
Handgrip strength and physical activity are commonly used to evaluate physical frailty; however, their distribution varies worldwide. The thresholds that identify frail individuals have been established in high-income countries but not in low-income and middle-income countries. We created two adaptations of physical frailty to study how global versus regional thresholds for handgrip strength and physical activity affect frailty prevalence and its association with mortality in a multinational population.
Design, setting and participants:
Our sample included 137 499 adults aged 35-70 years (median age: 61 years, 60% women) from Population Urban Rural Epidemiology Studies community-dwelling prospective cohort across 25 countries, covering the following geographical regions: China, South Asia, Southeast Asia, Africa, Russia and Central Asia, North America/Europe, Middle East and South America.
Primary and secondary outcome measures:
We measured and compared frailty prevalence and time to all-cause mortality for two adaptations of frailty.
Results:
Overall frailty prevalence was 5.6% using global frailty and 5.8% using regional frailty. Global frailty prevalence ranged from 2.4% (North America/Europe) to 20.1% (Africa), while regional frailty ranged from 4.1% (Russia/Central Asia) to 8.8% (Middle East). The HRs for all-cause mortality (median follow-up of 9 years) were 2.42 (95% CI: 2.25 to 2.60) and 1.91 (95% CI: 1.77 to 2.06) using global frailty and regional frailty, respectively, (adjusted for age, sex, education, smoking status, alcohol consumption and morbidity count). Receiver operating characteristic curves for all-cause mortality were generated for both frailty adaptations. Global frailty yielded an area under the curve of 0.600 (95% CI: 0.594 to 0.606), compared with 0.5933 (95% CI: 0.587 to 5.99) for regional frailty (p=0.0007).
Conclusions:
Global frailty leads to higher regional variations in estimated frailty prevalence and stronger associations with mortality, as compared with regional frailty. However, both frailty adaptations in isolation are limited in their ability to discriminate between those who will die during 9 years' follow-up from those who do not.
... Therefore, measures of sarcopenia are often components of, or are closely related to, physical frailty 81 . There have been numerous adaptations of the original frailty phenotype reported in the literature 82 . Although physical frailty and disability overlap, the former is conceptualised as a pre-disability state 83 that may offer more possibilities for delaying or reversing the disabling process through interventions. ...
Frailty can be reversed and resilience enhanced with optimised primary care intervention.
... In terms of limitations, we used modified criteria for Fried phenotype definition, as we have previously published [21], which included a low BMI of <20 kg/m 2 substituting for unintentional weight loss, slowest 20 % in gait speed adjusted for height and gender and lowest 20 % in grip strength adjusted for BMI and gender. Previously other studies also used modified criteria depending on the availability of data [38]. Though the ASPREE trial had potential limitations in statistical power to examine some of the specific CVD events, the sample size was sufficient to produce a good estimation of the impact of pre-frailty on CVD outcomes. ...
Study objective:
This study examined the association between frailty and incident cardiovascular disease (CVD) events, major adverse cardiovascular events (MACE), and CVD-related mortality.
Design:
Longitudinal cohort study.
Setting:
The ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial in Australia and the United States.
Participants:
19,114 community-dwelling older adults (median age 74.0 years; 56.4 % females).
Interventions:
Pre-frailty and frailty were assessed using a modified Fried phenotype and a deficit accumulation Frailty Index (FI) at baseline.
Main outcome measures:
CVD was defined as a composite of CVD death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for heart failure; MACE included all except heart failure. Cox proportional hazards regression was used to analyze the association between frailty and CVD outcomes over a median follow-up of 4.7 years.
Results:
Baseline pre-frail and frail groups had a higher risk of incident CVD events (Hazard Ratio (HR): 1.31; 95 % Confidence Interval (CI): 1.14-1.50 for pre-frail and HR: 1.63; 95 % CI: 1.15-2.32 for frail) and MACE (pre-frail HR: 1.26; 95 % CI: 1.08-1.47 and frail HR: 1.51; 95 % CI: 1.00-2.29) than non-frail participants according to Fried phenotype after adjusting for traditional CVD risk factors. Effect sizes were similar or larger when frailty was assessed with FI; similar results for men and women.
Conclusion:
Frailty increases the likelihood of developing CVD, including MACE, in community-dwelling older men and women without prior CVD events. Screening for frailty using Fried or FI method could help identify community-dwelling older adults without prior CVD events who are more likely to develop CVD, including MACE, and may facilitate targeted preventive measures to reduce their risk.
... The general prevalence of anorexia is around 21.2% and is highest (34.1%) in care homes residents [74]. Similarly, the prevalence of frailty was 12.7 to 28.2% in one study and was also highest (19.5 to 44.1%) in care home settings [77,78]. In the AM phenotype, there is a predominant loss of the insulin-resistant type II muscle fibres, which leads to reduced insulin resistance. ...
Diabetes mellitus prevalence increases with increasing age. In older people with diabetes, frailty is a newly emerging and significant complication. Frailty induces body composition changes that influence the metabolic state and affect diabetes trajectory. Frailty appears to have a wide metabolic spectrum, which can present with an anorexic malnourished phenotype and a sarcopenic obese phenotype. The sarcopenic obese phenotype individuals have significant loss of muscle mass and increased visceral fat. This phenotype is characterised by increased insulin resistance and a synergistic increase in the cardiovascular risk more than that induced by obesity or sarcopenia alone. Therefore, in this phenotype, the trajectory of diabetes is accelerated, which needs further intensification of hypoglycaemic therapy and a focus on cardiovascular risk reduction. Anorexic malnourished individuals have significant weight loss and reduced insulin resistance. In this phenotype, the trajectory of diabetes is decelerated, which needs deintensification of hypoglycaemic therapy and a focus on symptom control and quality of life. In the sarcopenic obese phenotype, the early use of sodium-glucose transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists is reasonable due to their weight loss and cardio–renal protection properties. In the malnourished anorexic phenotype, the early use of long-acting insulin analogues is reasonable due to their weight gain and anabolic properties, regimen simplicity and the convenience of once-daily administration.
... It is, however, widely known that adapting Fried's criteria with the data available could introduce an important deviation from the original version. 46 In particular, it is not known whether weight loss was or not unintentional as suggested in the original version of the frailty phenotype. The weight loss, in fact, could be beneficial in obese people, whereas in normal weight or underweight older people could be associated not only with frailty, but also with other conditions such as cancer and dementia. ...
Objectives:
Frailty is a relevant issue in older people, being associated with several negative outcomes. Increasing literature is reporting that pollution (particularly air pollution) can increase the risk of frailty, but the research is still limited. We aimed to investigate the potential association of pollution (air, noise) with frailty and prefrailty among participants 60 years and older of the UK Biobank study.
Design:
Cross-sectional.
Settings and participants:
Older participants (age ≥ 60 years) participating to the UK Biobank.
Methods:
Frailty presence was ascertained using a model including 5 indicators (weakness, slowness, weight loss, low physical activity, and exhaustion). Air pollution was measured through residential exposures to nitrogen oxides (NOx) and particulate matter (PM2.5, PM2.5-10, PM10). The average residential sound level during the daytime, the evening, and night was used as an index for noise pollution.
Results:
A total of 220,079 subjects, aged 60 years and older, was included. The partial proportional odds model, adjusted for several confounders, showed that the increment in the exposure to NOx was associated with a higher probability of being in both the prefrail and frail category (odds ratio [OR] 1.003; 95% CI 1.001-1.004). Similarly, the increase in the exposure to PM2.5-10 was associated with a higher probability of being prefrail and frail (OR 1.014; 95% CI 1.001-1.036), such as the increment in the exposure to PM2.5 that was associated with a higher probability of being frail (OR 1.018; 95% CI 1.001-1.037).
Conclusions and implications:
Our study indicates that the exposure to air pollutants as PM2.5, PM2.5-10, or NOx might be associated with frailty and prefrailty, suggesting that air pollution can contribute to frailty and indicating that the frailty prevention and intervention strategies should take into account the dangerous impact of air pollutants.
... 65 The adapted version of the Fried Frailty questionnaire has shown good validity. 65,66 People with multimorbidity are deemed frail if they meet at least three criteria; pre-frail, if they fulfill one or two criteria, and not frail if no criteria are met. ...
Background
Despite the great individual and societal burden associated with multimorbidity, little is known about how to effectively manage it.
Objective
The aim of this multicenter randomized controlled trial (RCT) is to investigate the 12-month effects of a personalized exercise therapy and self-management support program in addition to usual care in people with multimorbidity.
Design
This is a protocol for a pragmatic, parallel-group (1:1 ratio), superiority RCT conducted at five intervention sites (two hospitals, a private practice physiotherapy clinic and two municipal rehabilitation centers) in Region Zealand, Denmark. A total of 228 persons with multimorbidity aged 18 years or older, will be randomly allocated to one of two groups. Both groups will receive usual care, defined as routine care for multimorbidity at the discretion of the treating doctor, while the intervention group will also participate in a 12-week exercise therapy and self-management support program tailored to people with multimorbidity at one of the intervention sites. The primary outcome will be the between-group difference in change in EQ-5D-5L from baseline to the follow-up at 12 months. Secondary outcomes include objectively-measured physical function and physical activity, inflammatory markers, disease and treatment burden, anxiety, depression, stress, sleep, pain and other self-reported parameters. In parallel with the RCT, an observational cohort will follow persons aged ≥18 years with multimorbidity not adhering to all eligibility criteria, as well as people fulfilling all eligibility criteria, but unwilling to participate in the RCT. This study was approved by the Regional Committee on Health Research Ethics for Region Zealand (SJ-857) and results will be communicated in scientific papers, at relevant conferences and to a broader audience.
Discussion
Exercise therapy and self-management support is safe and effective in people with single conditions. However, it is still unclear whether this holds true for individuals with multimorbidity. This pragmatic, multicenter RCT will provide high-quality evidence on the benefits and harms of exercise therapy and self-management support and, if the results support it, lead to the development of a plan for implementation in clinical practice.
... A systematic review that investigated Open access 262 physical frailty phenotypes acknowledged that modifications in the definition of frailty phenotype are common and have an important impact on the classification and predictive ability of the definition. 54 A fair agreement has been reported between Fried's definition and the completely questionnaire-based physical frailty definition. 55 56 The main limitation of our study is the selection bias resulting from differential loss to follow-up. ...
Objective This study investigated the association between obesity, assessed using body mass index (BMI) and waist circumference (WC), and pre-frailty/frailty among older adults over 21 years of follow-up.
Design Prospective cohort study.
Setting Population-based study among community-dwelling adults in Tromsø municipality, Norway.
Participants 2340 women and 2169 men aged ≥45 years attending the Tromsø study in 1994–1995 (Tromsø4) and 2015–2016 (Tromsø7), with additional BMI and WC measurements in 2001 (Tromsø5) and 2007–2008 (Tromsø6).
Primary outcome measure Physical frailty was defined as the presence of three or more and pre-frailty as the presence of one to two of the five frailty components suggested by Fried et al: low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity.
Results Participants with baseline obesity (adjusted OR 2.41, 95% CI 1.93 to 3.02), assessed by BMI, were more likely to be pre-frail/frail than those with normal BMI. Participants with high (OR 2.14, 95% CI 1.59 to 2.87) or moderately high (OR 1.57, 95% CI 1.21 to 2.03) baseline WC were more likely to be pre-frail/frail than those with normal WC. Those at baseline with normal BMI but moderately high/high WC or overweight with normal WC had no significantly increased odds for pre-frailty/frailty. However, those with both obesity and moderately high/high WC had increased odds of pre-frailty/frailty. Higher odds of pre-frailty/frailty were observed among those in ‘overweight to obesity’ or ‘increasing obesity’ trajectories than those with stable normal BMI. Compared with participants in a stable normal WC trajectory, those with high WC throughout follow-up were more likely to be pre-frail/frail.
Conclusion Both general and abdominal obesity, especially over time during adulthood, is associated with an increased risk of pre-frailty/frailty in later years. Thus maintaining normal BMI and WC throughout adult life is important.
Buku ini menghadirkan panduan yang komprehensif tentang pentingnya gizi dalam menjaga kesehatan lansia. Menjelajahi kompleksitas perubahan nutrisi yang terjadi seiring bertambahnya usia, serta dampaknya terhadap kesehatan dan kualitas hidup. Para pembaca akan dibimbing untuk memahami kebutuhan nutrisi khusus lansia, serta menjadi panduan yang berharga bagi lansia sendiri, tetapi juga bagi keluarga yang peduli akan kesejahteraan orang tua mereka, dari pengetahuan mendasar hingga strategi penerapan sehari-hari. Buku ini membantu pembaca memahami pentingnya menerapkan pola makan seimbang dan sehat bagi kesehatan lansia. Melalui pengetahuan yang disajikan dalam buku ini, pembaca diharapkan dapat memperbaiki kualitas hidup lansia di sekitar mereka dengan memberikan asupan nutrisi yang tepat, buku ini menjadi sumber informasi yang tak ternilai bagi siapa pun. Dalam buku ini terdapat tiga belas bab yang terdiri dari: Kebutuhan Gizi Khusus Lansia; Pola Makan Seimbang untuk Lansia; Asupan Cairan yang Adekuat untuk Lansia; Pentingnya Aktivitas Fisik dalam Mendukung Kesehatan Gizi Lansia; Manajemen Berat Badan pada Lansia; Gangguan Penyerapan Nutrisi pada Usia Lanjut; Aspek Psikologis dan Sosial dalam Gizi Lansia; Pengelolaan Penyakit Kronis melalui Gizi pada Lansia; Pencegahan Penyakit Terkait Gizi pada Lansia; Strategi Peningkatan Gizi untuk Lansia di Panti Jompo; Peran Keluarga dalam Menjaga Kesehatan Gizi Lansia; Intervensi Gizi pada Lansia dengan Mobilitas Terbatas; Penggunaan Suplemen Gizi pada Lansia.
Background
Patients with COPD are prone to be accompanied by frailty, whether frailty poses a burden of developing COPD in in the general population remains unknown. The purpose of this study is to explore whether prefrailty and frailty increase the risk of COPD, and whether the risk of COPD is significantly increased in the preserved ratio impaired spirometry population with frailty.
Methods
We included 412,351 adults without COPD at baseline in UK Biobank study. Frailty phenotypes were assessed using five components (weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength). Cox proportional hazard regression models were used to analyze the association between frailty and the incidence of COPD, as well as the impact of frailty in conjunction with preserved ratio impaired spirometry on the incidence of COPD.
Results
Among all participants, 243,777 (59.1%) were nonfrailty, 155,114 (37.6%) were prefrailty, and 13,460 (3.3%) were frailty. During a median follow-up of 13.5 years, 10,695 COPD cases were recorded. In the multivariable-adjusted model, frailty and prefrailty significantly increased the risk of COPD (HR 2.22, 95%CI: [2.07, 2.38] for frailty and HR 1.45, 95%CI: [1.39, 1.51] for prefrailty). The hazard ratio for the incidence of COPD in individuals with both frailty and preserved ratio impaired spirometry was 4.34 (95%CI: 3.69, 5.12).
Conclusions
Prefrailty and frailty were associated with an increased risk of COPD. Such association was independent of socioeconomic factors, lifestyles, morbidities, and genetic susceptibility, and modified by preserved ratio impaired spirometry status.
Purpose
Frailty in HIV is extensively explored in epidemiological and clinical studies; it is infrequently assessed as an outcome in routine care. The focus on health-related quality of life (HRQL) measures in HIV presents a unique opportunity to understand frailty at a larger scale. The objective was to identify the extent to which generic and HIV-related HRQL measures capture information relevant to frailty.
Methods
A systematic mapping review using directed and summative content analyses was conducted. An online search in PubMed/Medline identified publications on frailty indices and generic and HIV-related HRQL measures. Directed content analysis involved identifying contributors, components, and consequences of frailty from the frailty indices based on the International Classification of Functioning, Disability, and Health framework. Summative content analysis summarized the results numerically.
Results
Electronic and hand search identified 447 review publications for frailty indices; nine reviews that included a total of 135 unique frailty indices. The search for generic and HIV-related HRQL measures identified 2008 records; five reviews that identified 35 HRQL measures (HIV-specific: 17; generic: 18). Of the 135 frailty indices, 88 cover more than one frailty dimension and 47 cover only physical frailty. Contributors to frailty, like sensory symptoms and nutrition, are extensively covered. Components of frailty such as physical capacity, cognitive ability, and mood are also extensively covered. Consequences of frailty namely self-rated health, falls, hospitalization, and health services utilization are incomprehensively covered. HRQL measures are informative for contributing factors, components of frailty, and a consequence of frailty.
Conclusion
HRQL items and measures show a strong potential to operationalize multidimensional frailty and physical frailty. The study suggests that these measures, connected to evidence-based interventions, could be pivotal in directing resources toward vulnerable populations to mitigate the onset of frailty.
Background and Purpose: There is a high frequency of frailty in patients with musculoskeletal pain. Pain from osteoarthritis and lower back pain may be associated with frailty. However, the future risk of frailty among older adults with pain remains unclear. Thus, the primary objective of this study was to examine the association between musculoskeletal pain and the risk of becoming prefrail and frail in older adults.
Participants and Methods: A secondary analysis was performed using data from baseline and 1-, 2-, 3-, 4-, 6-, and 8-year followups of the Osteoarthritis Initiative (OAI). The OAI recruited participants from 4 clinical sites in the United States, between February 2004 and May 2006. A self-reported questionnaire was used to determine the baseline musculoskeletal pain status in older adults (n = 1780) 65 years and older, including pain in the lower back, hip, knee, and at 2 or more sites. Using the Fried phenotypic criteria, participants were classified as nonfrail, prefrail, and frail at each period over 8 years.
Results: After adjusting for age, sex, race, education, marital status, annual income, smoking status, comorbidities, and body mass index, binary logistic regression modeling using generalized estimating equations revealed that in older adults musculoskeletal pain in the lower back and at multiple sites was associated with a slightly but significantly decreased risk of prefrailty over time (adjusted odds ratio [AOR] = 0.98, 95% CI = 0.95-0.99, P = .019; AOR = 0.96, CI = 0.92-0.99, P = .032). The association between musculoskeletal pain and frailty among older adults was not statistically significant (all P > .05).
Conclusions: Musculoskeletal pain did not independently significantly increase the risk of prefrailty or frailty over time. It remains possible that when musculoskeletal is combined with other factors, the risk of prefrailty and frailty may be heightened. Further research into the combination of characteristics that best predict prefrailty and frailty, including but not limited to musculoskeletal pain, is warranted.
Background & Aims
Frailty in patients with cirrhosis is associated with increased morbidity and mortality. In this study, we aimed to determine the prevalence of frailty and its impact on mortality and hospitalization in patients with cirrhosis.
Methods
An elaborate search was undertaken in the following databases: "PubMed, Scopus, Web of Science, Cochrane, and preprint servers”, and an assessment of all published articles till 17 February 2023 was done. Studies that provided data on prevalence, mortality and hospitalization, among frail patients with cirrhosis were included. The study characteristics and data on the prevalence, mortality, and hospitalization were extracted from included studies. The primary outcome was to estimate the pooled prevalence of frailty and determine its impact on mortality and hospitilization in patients with cirrhosis.
Results
Overall, 12 studies were included. Data on prevalence of frailty and mortality was available in 11 studies while seven studies reported data on hospitalization. The analysis conducted amongst 6126 patients with cirrhosis revealed pooled prevalence of frailty to be 32% (95% confidence interval [CI] 24-41). A total of 540 events of death revealed pooled mortality rate of 29% (95% CI, 19-41). Six months and twelve months pooled estimates of mortality were found to be 24% (95% CI, 17-33) and 33% (95% CI, 23-45) respectively. The pooled hospitalization rate among the seven studies was 43% (95% CI, 21-68).
Conclusions
The prevalence of frailty in patients with cirrhosis is high leading to poor outcomes. Frailty assessment should become an integral part of cirrhosis evaluation.
Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new “science of frailty” has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.
This study surveyed 1,067 older adults aged 65 years or older living in a hilly suburban residential area and used the total score of the Kihon Check List as an indicator of frailty to examine the relationship between the built environment, frailty, and outgoing behavior. The results showed an association between frailty and having about 6-8 steps at the entrance approach. In addition, an association was found between having about 9-11 steps and frequency of going out for those aged 80 years and older.
Frailty is a clinical geriatric syndrome where loss of physical resiliency increases vulnerability to external stressors. Frailty is predictive of many adverse health outcomes. Frailty exists across a spectrum where prefrailty is an intermediary, subclinical state of frailty. Evidence suggests that it is easier to reverse prefrailty states than to reverse established frailty, and therefore may be an ideal target for preventative interventions. This narrative review discusses clinical methods of identifying individuals with prefrailty, and interventions shown to be effective in improving frailty status in older adults.
Diabetes in aging communities imposes a substantial personal and public health burden by virtue of its high prevalence, its capacity to cause disabling vascular complications, the emergence of new non-vascular complications, and the effects of frailty. Diabetes, frailty, and cognitive dysfunction are closely related to the mechanisms of aging. Frailty is a geriatric syndrome and represents a state of multisystem impairments leading to decreased physiological reserve and resistance to stressors, leaving patients more vulnerable to poor health outcomes. It is not unusual for frail older adults to have varying degrees of “organ failures,” including failure in skin, one of the largest organs, thus increasing the likelihood of impaired healing and biomechanical complications in foot and ankle. In this chapter, we discuss backgrounds in diabetes, diabetic foot ulceration, and frailty, impacts of frailty on health outcomes in diabetes and diabetic foot ulceration, screening tools for frailty status in people with diabetes and diabetic foot ulceration. We also discuss potential solutions to manage frailty status.
Over the last few decades, frailty has become a pillar of research and clinical assessment in human gerontology. This complex syndrome, characterized by loss of physiologic reserves leading to decreased resilience to stressors, is of critical importance because it predicts higher risks of poor health outcomes, including mortality. Thus, identifying frailty among the elderly human population has become a key focus of gerontology. This narrative review presents current scientific literature on frailty in both humans and animals. The authors discuss the need for an accessible frailty instrument for companion dogs suitable for general use in veterinary medicine and the advances that would be facilitated by this instrument. A phenotypic frailty instrument for companion dogs, utilizing components that are easily collected by owners, or in the general practice setting, is proposed. The authors elaborate on the domains (physical condition, physical activity, mobility, strength, cognitive task performance, and social behavior), factors that will be included, and the data from the Dog Aging Project that inform each domain.
This review examines the current literature to identify biomarkers of frailty across patients with solid tumors. We conducted the systematic review using preferred reporting items for systematic reviews and meta-analysis guidelines (PRISMA). PubMed, Web of Science, and Embase databases were searched from their inception to December 08, 2021, for reports of biomarkers and frailty. Two reviewers independently screened titles, abstracts, and full-text articles. A quality assessment was conducted using NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and Quality Assessment of Case-Control Studies. In total, 915 reports were screened, and 14 full-text articles were included in the review. Most studies included breast tumors, were cross-sectional in design, and measured biomarkers at baseline or pre-treatment. Frailty tools varied with Fried Frailty Phenotype and the geriatric assessment most frequently used. Increased inflammatory parameters (i.e., Interleukin-6, Neutrophil Lymphocyte Ratio, Glasgow Prognostic Score-2) were associated with frailty severity. Only six studies were rated as good quality using assessment ratings. Together, the small number of studies and heterogeneity in frailty assessment limited our ability to draw conclusions from the extant literature. Future research is needed to identify potential target biomarkers of frailty in cancer survivors that may aid in early detection and referral.
Aging involves the transformation of the population reproduction mode under the rapid development of the social economy. We studied population survey data based on the WorldPop population statistics website and used ArcGIS to construct a spatial database and implement spatial analysis methods. In this study, we analyzed the spatiotemporal evolution characteristics of population aging and its main influencing factors in counties of China, in order to provide a reference for the formulation of a national population development policy and the construction of a pension system. The results are as follows: ① The situation of population aging in China is becoming more serious, showing a point-line-area spatial pattern and two core–periphery aging patterns of high core–low periphery and low core–high periphery. ② The speed of population aging in China is characterized by rapid growth, large scale, and a high degree. Large areas of growing old before getting rich have emerged in the central and western regions. ③ The aging of the population has gradually spread to the northeast, southwest, northwest, and other regions. Influenced by factors such as population migration, population structure change, transportation facility construction, and geographic environment changes, a trend of aging that has spread across the Hu Huan-Yong line has appeared.
Background: Fragile home-dwelling older adults are at risk of undernutrition despite receiving meal delivery services. Weight loss is associated with increased morbidity and mortality. To promote healthy aging, home-delivered between-meal snacks (BMS) were tested in a region of Denmark. Methods: A quasi-experiment was set up with an intervention group (n=39, mean age 85.3) and a control group (n=32, mean age 80.8). The intervention group received BMS for 18 weeks corresponding to a weekly intake of 5600-9600 kJ and 40-112 g protein. The following outcomes were evaluated: weight, body mass index (BMI), body composition, and handgrip strength. Results: The intervention group had increased weight (mean ±SD) of 0.88 ±2.96 kg and fat mass of 1.56 ±2.55 kg but reduced muscle mass of 0.14 ±1.09 kg resulting in an increased BMI of 0.35 ±1.22 kg/m2. For comparison, the results of the control group were as follows: 0.29 ±2.56 kg, 0.27 ±3.65 kg, -0.04 ±1.76 kg, and 0.12 ±0.44 kg/m2. The between-group mean differences were not statistically significant. The intervention group had an increased right handgrip strength of 1.40 ±5.27 kg, while a decrease of 1.41 ±3.27 kg was observed for the control group resulting in a statistically significant between-group mean difference. Conclusion: This study suggests that BMS may reduce the risk of undernutrition and improve the functional status among fragile home-dwelling older adults, although the effect is minor. Nevertheless, the frequency of unplanned weight loss was lower within the intervention group even though the group constituted a more fragile population.
Background:
Data on population-based self-reported dual vision and hearing impairment are sparse in Europe. We aimed to investigate self-reported dual sensory impairment (DSI) in European population.
Methods:
A standardised questionnaire was used to collect medical and socio-economic data among individuals aged 15 years or more in 29 European countries. Individuals living in collective households or in institutions were excluded from the survey.
Results:
Among 296 677 individuals, the survey included 153 866 respondents aged 50 years old or more. The crude prevalence of DSI was of 7.54% (7.36-7.72). Among individuals aged 60 or more, 9.23% of men and 10.94% of women had DSI. Eastern and southern countries had a higher prevalence of DSI. Multivariable analyses showed that social isolation and poor self-rated health status were associated with DSI with ORs of 2.01 (1.77-2.29) and 2.33 (2.15-2.52), while higher income was associated with lower risk of DSI (OR of 0.83 (0.78-0.89). Considering country-level socioeconomic factors, Human Development Index explained almost 38% of the variance of age-adjusted prevalence of DSI.
Conclusion:
There are important differences in terms of prevalence of DSI in Europe, depending on socioeconomic and medical factors. Prevention of DSI does represent an important challenge for maintaining quality of life in elderly population.
Background:
frailty is a state of vulnerability to adverse outcomes. Routine identification of frailty is recommended in international guidance. This systematic review investigates the diagnostic test accuracy (DTA) of simple instruments for identifying frailty in community-dwelling older people.
Methods:
the review methodology followed Cochrane procedures. Databases were searched from January 1990 to October 2013. Prospective studies assessing the DTA of simple instruments for identifying frailty in community-dwelling older people (aged ≥65 years) as index tests against a reference standard phenotype model, cumulative deficit frailty index or comprehensive geriatric assessment were eligible for inclusion. Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios were calculated for index tests. Risk of bias was assessed using the QUADAS-2 checklist.
Results:
three studies involving 3,261 participants were included. Median frailty prevalence was 10.5%. Seven index tests were assessed: gait speed, timed-up-and-go test, PRISMA 7 questionnaire, self-reported health, general practitioner clinical assessment, polypharmacy and Groningen Frailty Index. For a gait speed of <0.8 m/s, the sensitivity = 0.99 and specificity = 0.64. For the PRISMA 7, the sensitivity = 0.83 and specificity = 0.83. For the timed get-up-and-go test of 10 s, the sensitivity = 0.93 and specificity = 0.62. DTA was notably lower for all other index tests. All three studies were judged at unclear risk of bias.
Discussion:
slow gait speed, PRISMA 7 and the timed get-up-and-go test have high sensitivity for identifying frailty. However, limited specificity implies many false-positive results which means that these instruments cannot be used as accurate single tests to identify frailty.
The frailty index (FI) is used to measure the health status of ageing individuals. An FI is constructed as the proportion of deficits present in an individual out of the total number of age-related health variables considered. The purpose of this study was to systematically assess whether dichotomizing deficits included in an FI affects the information value of the whole index.
Secondary analysis of three population-based longitudinal studies of community dwelling individuals: Nova Scotia Health Survey (NSHS, n = 3227 aged 18+), Survey of Health, Ageing and Retirement in Europe (SHARE, n = 37546 aged 50+), and Yale Precipitating Events Project (Yale-PEP, n = 754 aged 70+). For each dataset, we constructed two FIs from baseline data using the deficit accumulation approach. In each dataset, both FIs included the same variables (23 in NSHS, 70 in SHARE, 33 in Yale-PEP). One FI was constructed with only dichotomous values (marking presence or absence of a deficit); in the other FI, as many variables as possible were coded as ordinal (graded severity of a deficit). Participants in each study were followed for different durations (NSHS: 10 years, SHARE: 5 years, Yale PEP: 12 years).
Within each dataset, the difference in mean scores between the ordinal and dichotomous-only FIs ranged from 0 to 1.5 deficits. Their ability to predict mortality was identical; their absolute difference in area under the ROC curve ranged from 0.00 to 0.02, and their absolute difference between Cox Hazard Ratios ranged from 0.001 to 0.009.
Analyses from three diverse datasets suggest that variables included in an FI can be coded either as dichotomous or ordinal, with negligible impact on the performance of the index in predicting mortality.
Background The rapid increase of frail older people worldwide will have a substantial impact on healthcare systems. The frailty process may be delayed or even reversed, which makes it attractive for early interventions. However, little is known about the determinants of frailty state changes. The aim of this study is to compare socio-demographic determinants of worsening in frailty state in 11 European countries.
Methods Data of 14 424 community-dwelling persons aged ≥55 years, enrolled in 2004 in the Survey of Health, Ageing and Retirement in Europe, were analysed. Three frailty states were identified (non-frail, pre-frail and frail) using Fried's criteria, and frailty state changes over a 2-year period were determined. Multinomial regression analyses adjusted for baseline frailty state were conducted to investigate whether sex, age, marital status and level of education determined a worsening in frailty state in the total and country-specific European population.
Results Of all individuals, 22.1% worsened, 61.8% showed no change and 16.1% improved in frailty state. Women, those aged ≥65 years, and lower educated persons showed an increased risk of worsening in frailty state. In Southern European countries, there was an earlier and larger increase in risk of worsening in frailty state in life, which was more pronounced in women compared with men.
Conclusions In Europe, persons aged ≥65 years, women and lower educated persons are at increased risk of worsening in frailty state. Differences between countries indicate that interventions aimed at delaying the frailty process in Southern European countries should start earlier with more attention towards women.
Low physical activity, one of five criteria in a validated clinical phenotype of frailty, is assessed by a standardized, semiquantitative questionnaire on up to 20 leisure time activities. Because of the time demanded to collect the interview data, it has been challenging to translate to studies other than the Cardiovascular Health Study (CHS), for which it was developed. Considering subsets of activities, we identified and evaluated streamlined surrogate assessment methods and compared them to one implemented in the Women's Health and Aging Study (WHAS).
Using data on men and women ages 65 and older from the CHS, we applied logistic regression models to rank activities by "relative influence" in predicting low physical activity.We considered subsets of the most influential activities as inputs to potential surrogate models (logistic regressions). We evaluated predictive accuracy and predictive validity using the area under receiver operating characteristic curves and assessed criterion validity using proportional hazards models relating frailty status (defined using the surrogate) to mortality.
Walking for exercise and moderately strenuous household chores were highly influential for both genders. Women required fewer activities than men for accurate classification. The WHAS model (8 CHS activities) was an effective surrogate, but a surrogate using 6 activities (walking, chores, gardening, general exercise, mowing and golfing) was also highly predictive.
We recommend a 6 activity questionnaire to assess physical activity for men and women. If efficiency is essential and the study involves only women, fewer activities can be included.
Frailty in later life is viewed as a state of heightened vulnerability to poor outcomes. The utility of frailty as a measure of vulnerability in the assisted living (AL) population remains unexplored. We examined the feasibility and predictive accuracy of two different interpretations of the Cardiovascular Health Study (CHS) frailty criteria in a population-based sample of AL residents.
CHS frailty criteria were operationalized using two different approaches in 928 AL residents from the Alberta Continuing Care Epidemiological Studies (ACCES). Risks of one-year mortality and hospitalization were estimated for those categorized as frail or pre-frail (compared with non-frail). The prognostic significance of individual criteria was explored, and the area under the ROC curve (AUC) was calculated for select models to assess the utility of frailty in predicting one-year outcomes.
Regarding feasibility, complete CHS criteria could not be assessed for 40% of the initial 1,067 residents. Consideration of supplementary items for select criteria reduced this to 12%. Using absolute (CHS-specified) cut-points, 48% of residents were categorized as frail and were at greater risk for death (adjusted risk ratio [RR] 1.75, 95% CI 1.08-2.83) and hospitalization (adjusted RR 1.54, 95% CI 1.20-1.96). Pre-frail residents defined by absolute cut-points (48.6%) showed no increased risk for mortality or hospitalization compared with non-frail residents. Using relative cut-points (derived from AL sample), 19% were defined as frail and 55% as pre-frail and the associated risks for mortality and hospitalization varied by sex. Frail (but not pre-frail) women were more likely to die (RR 1.58 95% CI 1.02-2.44) and be hospitalized (RR 1.53 95% CI 1.25-1.87). Frail and pre-frail men showed an increased mortality risk (RR 3.21 95% CI 1.71-6.00 and RR 2.61 95% CI 1.40-4.85, respectively) while only pre-frail men had an increased risk of hospitalization (RR 1.58 95% CI 1.15-2.17). Although incorporating either frailty measure improved the performance of predictive models, the best AUCs were 0.702 for mortality and 0.633 for hospitalization.
Application of the CHS criteria for frailty was problematic and only marginally improved the prediction of select adverse outcomes in AL residents. Development and validation of alternative approaches for detecting frailty in this population, including consideration of female/male differences, is warranted.
A frailty paradigm would be useful in primary care to identify older people at risk, but appropriate metrics at that level are lacking. We created and validated a simple instrument for frailty screening in Europeans aged ≥50. Our study is based on the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE, http://www.share-project.org), a large population-based survey conducted in 2004-2005 in twelve European countries.
Subjects: SHARE Wave 1 respondents (17,304 females and 13,811 males). Measures: five SHARE variables approximating Fried's frailty definition. Analyses (for each gender): 1) estimation of a discreet factor (DFactor) model based on the frailty variables using LatentGOLD. A single DFactor with three ordered levels or latent classes (i.e. non-frail, pre-frail and frail) was modelled; 2) the latent classes were characterised against a biopsychosocial range of Wave 1 variables; 3) the prospective mortality risk (unadjusted and age-adjusted) for each frailty class was established on those subjects with known mortality status at Wave 2 (2007-2008) (11,384 females and 9,163 males); 4) two web-based calculators were created for easy retrieval of a subject's frailty class given any five measurements.
Females: the DFactor model included 15,578 cases (standard R2 = 0.61). All five frailty indicators discriminated well (p < 0.001) between the three classes: non-frail (N = 10,420; 66.9%), pre-frail (N = 4,025; 25.8%), and frail (N = 1,133; 7.3%). Relative to the non-frail class, the age-adjusted Odds Ratio (with 95% Confidence Interval) for mortality at Wave 2 was 2.1 (1.4 - 3.0) in the pre-frail and 4.8 (3.1 - 7.4) in the frail. Males: 12,783 cases (standard R2 = 0.61, all frailty indicators had p < 0.001): non-frail (N = 10,517; 82.3%), pre-frail (N = 1,871; 14.6%), and frail (N = 395; 3.1%); age-adjusted OR (95% CI) for mortality: 3.0 (2.3 - 4.0) in the pre-frail, 6.9 (4.7 - 10.2) in the frail.
The SHARE Frailty Instrument has sufficient construct and predictive validity, and is readily and freely accessible via web calculators. To our knowledge, SHARE-FI represents the first European research effort towards a common frailty language at the community level.
Preoperative risk assessment is important yet inexact in older patients because physiologic reserves are difficult to measure. Frailty is thought to estimate physiologic reserves, although its use has not been evaluated in surgical patients. We designed a study to determine if frailty predicts surgical complications and enhances current perioperative risk models.
We prospectively measured frailty in 594 patients (age 65 years or older) presenting to a university hospital for elective surgery between July 2005 and July 2006. Frailty was classified using a validated scale (0 to 5) that included weakness, weight loss, exhaustion, low physical activity, and slowed walking speed. Patients scoring 4 to 5 were classified as frail, 2 to 3 were intermediately frail, and 0 to 1 were nonfrail. Main outcomes measures were 30-day surgical complications, length of stay, and discharge disposition. Multiple logistic regression (complications and discharge) and negative binomial regression (length of stay) were done to analyze frailty and postoperative outcomes associations.
Preoperative frailty was associated with an increased risk for postoperative complications (intermediately frail: odds ratio [OR] 2.06; 95% CI 1.18-3.60; frail: OR 2.54; 95% CI 1.12-5.77), length of stay (intermediately frail: incidence rate ratio 1.49; 95% CI 1.24-1.80; frail: incidence rate ratio 1.69; 95% CI 1.28-2.23), and discharge to a skilled or assisted-living facility after previously living at home (intermediately frail: OR 3.16; 95% CI 1.0-9.99; frail: OR 20.48; 95% CI 5.54-75.68). Frailty improved predictive power (p < 0.01) of each risk index (ie, American Society of Anesthesiologists, Lee, and Eagle scores).
Frailty independently predicts postoperative complications, length of stay, and discharge to a skilled or assisted-living facility in older surgical patients and enhances conventional risk models. Assessing frailty using a standardized definition can help patients and physicians make more informed decisions.
Frailty can be measured in relation to the accumulation of deficits using a frailty index. A frailty index can be developed from most ageing databases. Our objective is to systematically describe a standard procedure for constructing a frailty index.
This is a secondary analysis of the Yale Precipitating Events Project cohort study, based in New Haven CT. Non-disabled people aged 70 years or older (n = 754) were enrolled and re-contacted every 18 months. The database includes variables on function, cognition, co-morbidity, health attitudes and practices and physical performance measures. Data came from the baseline cohort and those available at the first 18-month follow-up assessment.
Procedures for selecting health variables as candidate deficits were applied to yield 40 deficits. Recoding procedures were applied for categorical, ordinal and interval variables such that they could be mapped to the interval 0-1, where 0 = absence of a deficit, and 1= full expression of the deficit. These individual deficit scores were combined in an index, where 0= no deficit present, and 1= all 40 deficits present. The values of the index were well fit by a gamma distribution. Between the baseline and follow-up cohorts, the age-related slope of deficit accumulation increased from 0.020 (95% confidence interval, 0.014-0.026) to 0.026 (0.020-0.032). The 99% limit to deficit accumulation was 0.6 in the baseline cohort and 0.7 in the follow-up cohort. Multivariate Cox analysis showed the frailty index, age and sex to be significant predictors of mortality.
A systematic process for creating a frailty index, which relates deficit accumulation to the individual risk of death, showed reproducible properties in the Yale Precipitating Events Project cohort study. This method of quantifying frailty can aid our understanding of frailty-related health characteristics in older adults.
Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established.
To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality.
Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline).
This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.
Three terms are commonly used interchangeably to identify vulnerable older adults: comorbidity, or multiple chronic conditions,
frailty, and disability. However, in geriatric medicine, there is a growing consensus that these are distinct clinical entities
that are causally related. Each, individually, occurs frequently and has high import clinically. This article provides a narrative
review of current understanding of the definitions and distinguishing characteristics of each of these conditions, including
their clinical relevance and distinct prevention and therapeutic issues, and how they are related. Review of the current state
of published knowledge is supplemented by targeted analyses in selected areas where no current published data exists. Overall,
the goal of this article is to provide a basis for distinguishing between these three important clinical conditions in older
adults and showing how use of separate, distinct definitions of each can improve our understanding of the problems affecting
older patients and lead to development of improved strategies for diagnosis, care, research, and medical education in this
area.
"Frailty" is an adverse, primarily gerontologic, health condition regarded as frequent with aging and having severe consequences. Although clinicians claim that the extremes of frailty can be easily recognized, a standardized definition of frailty has proved elusive until recently. This article evaluates the cross-validity, criterion validity, and internal validity in the Women's Health and Aging Studies (WHAS) of a discrete measure of frailty recently validated in the Cardiovascular Health Study (CHS).
The frailty measure developed in CHS was delineated in the WHAS data sets. Using latent class analysis, we evaluated whether criteria composing the measure aggregate into a syndrome. We verified the criterion validity of the measure by testing whether participants defined as frail were more likely than others to develop adverse geriatric outcomes or to die.
The distributions of frailty in the WHAS and CHS were comparable. In latent class analyses, the measures demonstrated strong internal validity vis à vis stated theory characterizing frailty as a medical syndrome. In proportional hazards models, frail women had a higher risk of developing activities of daily living (ADL) and/or instrumental ADL disability, institutionalization, and death, independently of multiple potentially confounding factors.
The findings of this study are consistent with the widely held theory that conceptualizes frailty as a syndrome. The frailty definition developed in the CHS is applicable across diverse population samples and identifies a profile of high risk of multiple adverse outcomes.
Frailty is a new, controversial and enigmatic concept. Research workers, decision makers and health care providers, have all noticed the impact of frailty on patients, on their families, on nursing staff and on society. Over the past two decades, there has been more and more literature concerning frailty. However, there is not yet any universally recognised definition or criteria to describe frailty, neither is there much information regarding the quality of the concept's research results. The Canadian Initiative on frailty and ageing was set-up in order to foster a better understanding of the causes, consequences and itinerary of frailty. Through the circulation of information on the prevention, screening and treatment of frailty as well as on the efficient organisation of facilities, it was also set-up to improve the quality of life of elderly people at risk of becoming frail. The first phase of the Initiative consists of a systematic review of the literature on frailty so as to synthesise the present state of research and to create a provisional model and to establish those research priorities which could be used to set-up a research programme. The provisional model on frailty needs to integrate all those biological, social, clinical, psychological and environmental factors which interact through life meaning either that one ages-healthily or not, thus delaying the apparition of frailty or on the contrary favouring it.
Not all people age the same way. Some people remain healthy until very old age, whereas others have health problems as they age and die early. Many healthy older adults are refused treatment because of their age, whereas many frail older adults who are treated do not survive. Decisions for clinical treatment based primarily on age are not best suited to the complexity of the human body, especially the complexity of older humans. The evaluation of a patients frailty status appears to represent a better way to approach the care and treatment of complex older patients, but more research is needed before the precise benefit realized by screening for frailty is known.
Background:
A well-accepted definition of frailty includes measurements of physical performance, which may limit its clinical utility.
Study design:
In a cross-sectional study, we compared prevalence and patient characteristics based on a frailty definition that uses self-reported function to the classic performance-based definition and developed a modified self-report-based definition.
Setting & participants:
Prevalent adult patients receiving hemodialysis in 14 centers around San Francisco and Atlanta in 2009-2011.
Index tests:
Self-report-based frailty definition in which a score lower than 75 on the Physical Function scale of the 36-Item Short Form Health Survey (SF-36) was substituted for gait speed and grip strength in the classic definition; modified self-report definition with optimized Physical Function score cutoff points derived in a development (one-half) cohort and validated in the other half.
Reference test:
Performance-based frailty defined as 3 of the following: weight loss, weakness, exhaustion, low physical activity, and slow gait speed.
Results:
387 (53%) patients were frail based on self-reported function, of whom 209 (29% of the cohort) met the performance-based definition. Only 23 (3%) met the performance-based definition of frailty only. The self-report definition had 90% sensitivity, 64% specificity, 54% positive predictive value, 93% negative predictive value, and 72.5% overall accuracy. Intracellular water per kilogram of body weight and serum albumin, prealbumin, and creatinine levels were highest among nonfrail individuals, intermediate among those who were frail by self-report, and lowest among those who also were frail by performance. Age, percentage of body fat, and C-reactive protein level followed an opposite pattern. The modified self-report definition had better accuracy (84%; 95% CI, 79%-89%) and superior specificity (88%) and positive predictive value (67%).
Limitations:
Our study did not address prediction of outcomes.
Conclusions:
Patients who meet the self-report-based but not the performance-based definition of frailty may represent an intermediate phenotype. A modified self-report definition can improve the accuracy of a questionnaire-based method of defining frailty.
Background
Frailty is a syndrome with important epidemiological and clinical implications in older adults. One of the most accepted definitions of frailty is that of Fried and Walston, who operationalised it according to five well defined criteria. However, their criteria are not readily applicable in primary care, where practitioners need tools to identify patients who require priority access to more specialised resources. With that objective in mind, our research group published the Frailty Instrument of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI). The present paper reports the results of the Spanish sample.
In a national cohort of patients starting renal replacement therapy, Bao and colleagues1 classified 73% as frail using a modification of criteria proposed by Fried et al2 in their seminal delineation of a frailty phenotype. Bao et al1(p1071) describe frailty as “extremely common among patients starting dialysis in the United States” and, more generally, as a “clinical syndrome highly prevalent in the population with end-stage renal disease (ESRD).” While we fully support the recognition of frailty and understanding of contributors to frailty as valuable research objectives, the article by Bao et al1 provides a case in point that assignment of frailty classification is very dependent on the particular criteria and operational measures that are applied. In particular, reliance on a patient-reported measure of physical functioning (PF) as a substitute for performance-based measures of weakness and slowness specified in the frailty phenotype validated by Fried et al2 may yield a different picture of the prevalence of “frailty.”
Objectives:
To develop and evaluate a modification of the Fried frailty assessment using population-independent cutpoints and to determine frailty prevalence of community-dwelling elderly people in a German population.
Design:
Cross-sectional analysis of 8-year follow-up data of a large German cohort study.
Setting:
Saarland, Germany.
Participants:
Three thousand one hundred twelve community-dwelling adults aged 59 and older.
Measurements:
Frailty was operationalized using modified Fried frailty criteria. Criteria were categorized according to quintiles (lowest-quintile approach) or using population-independent cutpoints derived from the literature (population-independent approach). Agreement and construct validity of frailty classification according to both approaches were evaluated according to weighted kappa (κ) and Spearman rank correlation (r(Sp) ). Associations between frailty and covariates were assessed using multiple logistic regression models.
Results:
Although more participants were identified as frail according to the population-independent index (8.9%) than the lowest-quintile index (6.5%), agreement and correlation of frailty classification using both approaches was high (κ = 0.75 and r(Sp) = 0.84). Sex differences in frailty prevalence were more pronounced when the population-independent approach was used (women 11.4%; men 6.1%). Similarly strong significant associations with sociodemographic, lifestyle, and medical factors such as older age, female sex, smoking, and obesity were seen for both approaches.
Conclusion:
The modified Fried index using literature-derived cutpoints independent from the frailty criteria distributions in the underlying study population showed good correlation with the lowest-quintile approach and enables prevalence estimates that are directly comparable between different populations.
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.
The purpose of this study was to examine the association of disability and co-morbidity with frailty in older adults. 2305 participants aged 65+ from the second wave of the Canadian Study of Health and Aging (CSHA), a prospective population-based cohort study, comprised the study sample. Following a standard procedure, two different frailty index (FI) measures were constructed from 37 deficits by dividing the recorded deficits by the total number of measures. One version excluded disability and co-morbidity items, the other included them. Time to death was measured for up to five years. Frailty was defined using either the frailty phenotype or a cut-point applied to each FI. Of people defined as frail using the frailty phenotype, 15/416 (3.6%) experienced neither disability nor co-morbidity. Using 0.25 as the cut-point score for the FI (without disability/co-morbidity) resulted in 101/1176 (8.6%) frail participants that had neither disability nor co-morbidity. Activities of daily living (ADL) limitations and co-morbidities occurred more often among people with the highest levels of frailty. The first ADLs to become impaired with increasing frailty were bathing, managing medication, and cooking with more than 25% of older adults with a FI score (without disability/co-morbidity) >0.22 experiencing dependency on them. The hazard ratio (HR) per 0.1 increase in FI score was 1.25 (95% CI: 1.20-1.30) when disability and co-morbidity were included in the index and 1.21 (1.16-1.25) when they were not included. In conclusion, disability and co-morbidity greatly overlap with other deficits that might be used to define frailty and add to their ability to predict mortality.
Frailty is a known risk factor for those aged 65 and over, and its prevalence increases with age. Definitions of frailty vary widely, and prevalence estimates are affected by the way frailty is defined. Systematic reviews have yet to examine the literature on the association between definitions of frailty and mortality. We examined the definitions and prevalence of frailty and its association with survival in older community-dwelling adults. We conducted a systematic review of observational population-based studies published in English. We calculated pooled prevalence of frailty with a random effects model. We identified 24 population-based studies that examined frailty in community-dwelling older adults. The pooled prevalence was 14% when frailty was defined as a phenotype exhibiting three or more of the following: weight loss, fatigue/exhaustion, weakness, low physical activity/slowness, and mobility impairment. The pooled prevalence was 24% when frailty was defined by accumulation of deficits indices that included up to 75 diseases and impairments. The prevalence of frailty increased with age and was greater in women and in African Americans. Frailty in older adults was associated with poor survival with a dose-responsive reduction in survival per increasing number of frailty criteria. Taking into account population prevalence and multivariate adjusted relative risks, we estimated that 3-5% of deaths among older adults could be delayed if frailty was prevented. Frailty is a prevalent and important geriatric syndrome associated with decreased survival. Geriatric assessment of frailty provides clinically important information about functional status and survival of older adults.
Determine which PA assessment tools are most closely related to frailty and whether PA is different across levels of frailty.
Fifty community-dwelling Greek older women (63-90 years) participated in this study. PA was measured objectively over 10h using an accelerometer, a heart rate (HR) monitor, a portable electromyography (EMG) unit, and a global positioning system (GPS) and subjectively using the short version of the Minnesota Leisure Time Activity Questionnaire (MLTAQ). Participants were divided into three tertiles based on level of frailty as calculated from a Frailty Index (FI): low FI group (<0.17 FI); intermediate FI group (0.17-0.38 FI); and high FI group (>0.38 FI).
Accelerometer step counts had the strongest correlation with frailty and were different across levels of frailty. The percentage of time engaged in PA was 31±15% when PA was determined using an accelerometer. Forty-five percent of the variability in the FI was explained by a combination of PA assessment tools including; accelerometer, EMG, GPS, and MLTAQ. The individual contribution of EMG determined activity from the biceps brachii (BB) to the FI prediction was 16%. Accelerometer contributed an additional 10% and time engaged in PA, as assessed with the MLTAQ, added an additional 6% to the prediction of FI score.
PA assessment tools, when used in combination, provide important information about the PA accumulation of older women across levels of frailty.
The adoption of a frailty paradigm in primary care would be helpful to identify adults who need priority access to specialised resources. The frailty phenotype by Fried et al is a popular operationalisation of frailty, but it is not easily applicable in routine primary care practice. We recently created and validated a frailty instrument based on the Survey of Health, Ageing and Retirement in Europe (SHARE-FI), in order to provide primary care practitioners with an easy, reliable and freely accessible tool for the assessment and monitoring of frailty in community dwelling adults over the age of 50 years (www.biomedcentral.com/1471-2318/10/57).
To provide further prospective validation of SHARE-FI, with a focus on disability.
Design: longitudinal study (wave 1: 2004-2006; mean follow-up: 2.4 years).
European population-based survey (12 countries).
17 567 community dwelling participants (mean age 63.3 years), of whom 13 378 (76.2%) were non-frail, 3438 (19.6%) pre-frail and 751 (4.3%) frail.
number of difficulties with basic (ADL) and instrumental (IADL) activities of daily living. Statistical analyses: repeated measures ANOVA with adjustment for baseline age.
By wave 2, 3.6% of the non-frail, 12.2% of the pre-frail and 30.4% of the frail had increased their number of ADL difficulties by at least one. Likewise, 6.6% of the non-frail, 20.4% of the prefrail and 36.6% of the frail had, by wave 2, increased their number of IADL difficulties by at least one. Table 1 shows the repeated measures ANOVA suggested.
SHARE-FI may contribute to quality in primary care by offering a quick and reliable way to assess and monitor frailty in community dwelling individuals over the age of 50 and prioritize their access to resources, and it serves as a novel tool for audit and research.
Frailty is a syndrome with important epidemiological and clinical implications in older adults. One of the most accepted definitions of frailty is that of Fried and Walston, who operationalised it according to five well defined criteria. However, their criteria are not readily applicable in primary care, where practitioners need tools to identify patients who require priority access to more specialised resources. With that objective in mind, our research group published the Frailty Instrument of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI). The present paper reports the results of the Spanish sample.
In the wave 1 of SHARE (2004), the Spanish sample was composed of 1,279 women and 933 men, all living in the community (mean age: 65.6 years). For each sex, a latent class analysis was used to summarise the five (adapted) frailty criteria into three incremental frailty classes. We tested the association of the frailty classes against a biopsychosocial range of wave 1 variables; the predictive validity of the frailty classes was tested using mortality data from the second wave of SHARE (2006-2007), which were available for 846 women and 660 men.
The frailty classes had the expected cross-sectional associations. The age-adjusted Odds ratio for mortality (with 95% confidence interval) associated with the frail class was 3.2 (1.0-10.2) for women and 8.3 (3.1-22.1) for men.
SHARE-FI is a valid and freely accessible instrument, which is intended to facilitate the adoption of the frailty paradigm in primary care.
Frailty is one of the greatest challenges for healthcare professionals. The level of frailty depends on several interrelated factors and can change over time while different interventions seem to be able to influence the level of frailty. Therefore, an outcome instrument to measure frailty with sound clinimetric properties is needed. A systematic review on evaluative measures of frailty was performed in the databases PubMed, EMBASE, Cinahl and Cochrane. The results show numerous instruments that measure the level of frailty. This article gives a clear overview of the content of these frailty instruments and describes their clinimetric properties. Frailty instruments, however, are often developed as prognostic instruments and have also been validated as such. The clinimetric properties of these instruments as evaluative outcome measures are unclear.
No clear consensual definition regarding frailty seems to emerge from the literature after 30 years of research in the topic, and a large array of models and criteria has been proposed to define the syndrome. Controversy continues to exist on the choice of the components to be included in the frailty definition. Two main definitions based on clusters of components are found in literature: a physical phenotype of frailty, operationalized in 2001 by providing a list of 5 measurable items of functional impairments, which coexists with a multidomain phenotype, based on a frailty index constructed on the accumulation of identified deficits based on comprehensive geriatric assessment. The physical phenotype considers disability and comorbidities such as dementia as distinct entities and therefore outcomes of the frailty syndrome, whereas comorbidity and disability can be components of the multidomain phenotype. Expanded models of physical frailty (models that included clusters other than the original 5 items such as dementia) increased considerably the predicting capacity of poor clinical outcomes when compared with the predictive capacity of the physical phenotype. The unresolved controversy of the components shapes the clusters of original frailty syndrome, and the components depend very much on how frailty is defined. This update also highlights the growing evidence on gait speed to be considered as a single-item frailty screening tool. The evaluation of gait speed over a short distance emerges from the literature as a tool with the capacity to identify frail older adults, and slow gait speed has been proven to be a strong predictor for frailty-adverse outcomes.
Frailty is an indicator of health status in old age. Its frequency has been described mainly for North America; comparable data from other countries are lacking. Here we report on the prevalence of frailty in 10 European countries included in a population-based survey.
Cross-sectional analysis of 18,227 randomly selected community-dwelling individuals 50 years of age and older, enrolled in the Survey of Health, Aging and Retirement in Europe (SHARE) in 2004. Complete data for assessing a frailty phenotype (exhaustion, shrinking, weakness, slowness, and low physical activity) were available for 16,584 participants. Prevalences of frailty and prefrailty were estimated for individuals 50-64 years and 65 years of age and older from each country. The latter group was analyzed further after excluding disabled individuals. We estimated country effects in this subset using multivariate logistic regression models, controlling first for age, gender, and then demographics and education.
The proportion of frailty (three to five criteria) or prefrailty (one to two criteria) was higher in southern than in northern Europe. International differences in the prevalences of frailty and prefrailty for 65 years and older group persisted after excluding the disabled. Demographic characteristics did not account for international differences; however, education was associated with frailty. Controlling for education, age and gender diminished the effects of residing in Italy and Spain.
A higher prevalence of frailty in southern countries is consistent with previous findings of a north-south gradient for other health indicators in SHARE. Our data suggest that socioeconomic factors like education contribute to these differences in frailty and prefrailty.
To determine the independent prognostic effect of seven potential frailty criteria, including five from the Fried phenotype, on several adverse outcomes.
Prospective cohort study.
Greater New Haven, Connecticut.
Seven hundred fifty-four initially nondisabled, community-living persons aged 70 and older.
An assessment of seven potential frailty criteria (slow gait speed, low physical activity, weight loss, exhaustion, weakness, cognitive impairment, and depressive symptoms) was completed at baseline and every 18 months for 72 months. Participants were followed with monthly telephone interviews for up to 96 months to determine the occurrence of chronic disability, long-term nursing home (NH) stays, injurious falls, and death.
In analyses adjusted for age, sex, race, education, number of chronic conditions, and the presence of the other potential frailty criteria, three of the five Fried criteria (slow gait speed, low physical activity, and weight loss) were independently associated with chronic disability, long-term NH stays, and death. Slow gait speed was the strongest predictor of chronic disability (hazard ratio (HR)=2.97, 95% confidence interval (CI)=2.32-3.80) and long-term NH stay (HR=3.86, 95% CI=2.23-6.67) and was the only significant predictor of injurious falls (HR=2.19, 95% CI=1.33-3.60). Cognitive impairment was also associated with chronic disability (HR=1.82, 95% CI=1.40-2.38), long-term NH stay (HR=2.64, 95% CI=1.75-3.99), and death (HR=1.54, 95% CI=1.13-2.10), and the magnitude of these associations was comparable with that of weight loss.
The results of this study provide strong evidence to support the use of slow gait speed, low physical activity, weight loss, and cognitive impairment as key indicators of frailty while raising concerns about the value of self-reported exhaustion and muscle weakness.
Aim of this study was to compare three different working definitions for selecting a frail elderly population. Frailty was defined as inactivity combined with (1) low energy intake (n = 29), (2) weight loss (n = 26), or (3) low body mass index (n = 26). In the Zutphen Elderly Study (n = 450; age 69-89 years) differences in health, functioning, and diet in 1990 and functional decline and mortality in the following 3 years between "frail" and "nonfrail" participants, according to the working definitions, were studied using logistic regression analysis. Differences according to the inactivity/weight loss criterium were more pronounced than according to the other two criteria. Inactivity/weight loss was associated with lower subjective health and performance and more diseases and disabilities in 1990. Three-year relative risks of mortality (odds ratio [OR]: 4.1, 1.8-9.4) and functional decline (OR: 5.2, 1.04-25.8 for disabilities, OR: 3.7, 0.8-16.2 for performance) were higher as well. Inactivity in combination with weight loss seems a practicable working definition for selecting a frail elderly population.
The purpose of this study was to simultaneously validate 10 physical activity (PA) questionnaires in a homogenous population of healthy elderly men against the reference method: doubly labeled water (DLW).
Cross-sectional study.
Community-based sample from Lyon, France.
Nineteen healthy old men (age 73.4 +/- 4.1 years), recruited from various associations for elderly people in Lyon, agreed to participate in the study.
The questionnaire-derived measures (scores) were compared with two validation measures: DLW and maximal oxygen uptake (VO2max). With the DLW method three parameters were calculated: (1) total energy expenditure (TEE), (2) physical activity level (PAL), i.e., the ratio of TEE to resting metabolic rate, (3) energy expenditure of PA.
Relative validity. Correlation between the questionnaires and TEE ranged from 0.11 for the Yale Physical Activity Survey (YPAS) total index to 0.63 for the Stanford usual activity questionnaire. This questionnaire also gave the best correlation coefficients with PAL (0.75), and with VO2max (0.62). Significant results with TEE measured by the DLW method were also obtained for college alumni sports score, Seven Day Recall moderate activity, and Questionnaire d'Activité Physique Saint-Etienne sports activity (r = 0.54, r = 0.52, and r = 0.54, respectively). Absolute validity. No difference was found between PA measured by the Seven Day Recall or by the YPAS and DLW, on a group basis. The limits of agreement were wide for all the questionnaires.
Only a few questionnaires demonstrated a reasonable degree of reliability and could be used to rank healthy older men according to PA. Correlation coefficients were best when the Stanford Usual Activity Questionnaire was compared with all the validation measures. The two questionnaires reporting recent PA, the Seven Day Recall, and YPAS accurately assessed energy expenditure for the group. The individual variability was high for all the questionnaires, suggesting that their use as a proxy measure of individual energy expenditure may be limited.
The purpose of the study was to identify physical activity questionnaires for older adults that might be suitable outcome measures in clinical trials of fall-injury-prevention intervention and to undertake a systematic quality assessment of their measurement properties. PubMed, CINAHL, and PsycINFO were systematically searched to identify measurements and articles reporting the methodological quality of relevant measures. Quality extraction relating to content, population, reliability, validity, responsiveness, acceptability, practicality, and feasibility was undertaken. Twelve outcome measures met the inclusion criteria. There is limited evidence about the measures' properties. None of the measures is entirely satisfactory for use in a large-scale trial at present. There is a need to develop suitable measures. The Stanford 7-day Physical Activity Recall Questionnaire and the Community Health Activities Model Program for Seniors questionnaire might be appropriate for further development. The results have implications for the designs of large-scale trials investigating many different geriatric syndromes.
Cardiovascular Health Study Collaborative Research Group, 2001. Frailty in older adults: evidence for a phenotype
- L P Fried
- C M Tangen
- J Walston
- A B Newman
- C Hirsch
- J Gottdiener
- T Seeman
- R Tracy
- G Burke
- M A Mcburnie
Fried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Burke, G., McBurnie, M.A., Cardiovascular Health Study Collaborative Research Group, 2001. Frailty in older adults: evidence for a phenotype. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 56 (3), M146–M156.
Comparison of alternate scoring of variables on the performance of the frailty index. BMC Geriatri. 14, 25. Romero Ortuno, R., 2011. The frailty instrument for primary care of the survey of health, ageing and retirement in Europe (SHARE-FI): results of the Spanish sample
- F G Pe Na
- O Theou
- L Wallace
- T D Brothers
- T M Gill
- E A Gahbauer
- S Kirkland
- A Mitnitski
- K Rockwood
Pe na, F.G., Theou, O., Wallace, L., Brothers, T.D., Gill, T.M., Gahbauer, E.A., Kirkland, S., Mitnitski, A., Rockwood, K., 2014. Comparison of alternate scoring of variables on the performance of the frailty index. BMC Geriatri. 14, 25. Romero Ortuno, R., 2011. The frailty instrument for primary care of the survey of health, ageing and retirement in Europe (SHARE-FI): results of the Spanish sample. Rev. Esp. Geriatr. Gerontol. 46 (5), 243–249.
Prognostic significance of potential frailty criteria
- M D Rothman
- L Leo-Summers
- T M Gill
Rothman, M.D., Leo-Summers, L., Gill, T.M., 2008. Prognostic significance of
potential frailty criteria. J. Am. Geriatr. Soc. 56 (12), 2211-2216.