title: Old or frail: what tells us more? Frailty and incident dementia. Redefining Geriatric Preoperative Assessment Using Frailty, Disability and Co-Morbidity Validation and comparison of two frailty indexes: The MOBILIZE Boston Study. Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians Transitions in cognitive status in relation to frailty in older adults: A Comparison of three frailty measures
abstract: BACKGROUND Selecting elderly persons who need geriatric interventions  and making accurate treatment decisions are recurring challenges in geriatrics . Chronological age , although often used , does not seem to be the best selection criterion . Instead , the concept of frailty , which indicates several concurrent losses in re sources , can be used . METHODS The predictive values of chronological age and frailty were investigated in a large community sample of persons aged 65 years and older , r and omly drawn from the register of six municipalities in the northern regions of the Netherl and s ( 45 % of the original addressees ) . The participants ' generative capacity to sustain well-being ( i.e. , self-management abilities ) was used as the main outcome measure . RESULTS When using chronological age instead of frailty , both too many and too few persons were selected . Furthermore , frailty related more strongly ( with beta values ranging from -.25 to -.39 ) to a decline in the participants ' self-management abilities than did chronological age ( with beta values ranging from -.06 to -.14 ) . Chronological age added very little to the explained variances of all outcomes once frailty was included . CONCLUSIONS Using frailty as the criterion to select older persons at risk for interventions may be better than selecting persons based only on their chronological age BACKGROUND We sought to examine whether frailty is associated with dementia , Alzheimer 's disease ( AD ) , and non-AD dementia risk . METHODS This is a prospect i ve population -based cohort derived from an integrated health maintenance organization . The sample consisted of 2,619 participants aged 65 and older without dementia at baseline followed from 1994 to 2010 . Frailty was defined as having at least 3 of the following criteria : weakness ( grip strength ) , slowness ( walking speed ) , weight loss , low physical activity , and self-reported exhaustion . Follow-up occurred every 2 years to identify incident dementia , possible or probable AD , and non-AD dementia using st and ard research criteria . Covariates came from self-report and study measures . We used adjusted Cox proportional hazards models to examine the association between frailty and each outcome . RESULTS Over a mean follow-up of 6.5 years , 521 participants developed dementia ( of which 448 developed AD ) . In the model adjusted for age , sex , education , and race , the hazard ratio for frailty was 1.78 ( 95 % confidence interval [ CI ] 1.32 - 2.40 ) . In the fully adjusted models , the hazard ratio for frailty was 1.20 for all-cause dementia ( 95 % CI 0.85 - 1.69 ) , 1.08 for AD ( 95 % CI 0.74 - 1.57 ) , and 2.57 for non-AD dementia ( 95 % CI 1.08 - 6.11 ) . For all-cause dementia , we found an interaction between baseline cognitive score and frailty ( p = .02 ) ; hazard ratio for frailty was 1.78 for those with higher global cognition ( 95 % CI 1.14 - 2.78 ) and 0.79 for those with lower global cognition ( 95 % CI 0.50 - 1.26 ) . CONCLUSION Frailty was associated with dementia when adjusting only for demographic variables but not in the fully adjusted model . Frailty was associated with higher risk of developing non-AD dementia but not AD . Although frailty was not associated with all-cause dementia in the entire sample , an association did exist in participants with higher cognitive scores . Mechanisms underlying these associations remain to be eluci date Objectives : ( 1 ) Determine the relationship of geriatric assessment markers to 6-month postoperative mortality in elderly patients . ( 2 ) Create a clinical prediction rule using geriatric markers from preoperative assessment . Background : Geriatric surgery patients have unique physiologic vulnerability requiring preoperative assessment beyond the traditional evaluation of older adults . The constellation of frailty , disability and comorbidity predict poor outcomes in elderly hospitalized patients . Methods : Prospect ively , subjects ≥65 years undergoing a major operation requiring postoperative intensive care unit admission were enrolled . Preoperative geriatric assessment s included  : Mini-Cog Test ( cognition ) , albumin , having fallen in the past 6-months , hematocrit , Katz Score ( function ) , and Charlson Index ( comorbidities )  . Outcome measures included 6-month mortality ( primary ) and postdischarge institutionalization ( secondary ) . Results : One hundred ten subjects ( age 74 ± 6 years ) were studied . Six-month mortality was 15 % ( 16/110 ) . Preoperative markers related to 6-month mortality included : impaired cognition ( P < 0.01 ) , recent falls ( P < 0.01 ) , lower albumin ( P < 0.01 ) , greater anemia ( P < 0.01 ) , functional dependence ( P < 0.01 ) , and increased comorbidities ( P < 0.01 ) . Similar statistical relationships were found for all 6 markers and postdischarge institutionalization . Logistic regression identified any functional dependence ( odds ratio 13.9 ) as the strongest predictor of 6-month mortality . Four or more markers in any one patient predicted 6-month mortality with a sensitivity of 81 % ( 13/16 ) and specificity of 86 % ( 81/94 ) . Conclusions : Geriatric assessment markers for frailty , disability and comorbidity predict 6-month postoperative mortality and postdischarge institutionalization . The preoperative presence of ≥4 geriatric-specific markers has high sensitivity and specificity for 6-month mortality . Preoperative assessment using geriatric-specific markers is a substantial paradigm shift from the traditional preoperative evaluation of older adults OBJECTIVES To vali date two established frailty indexes and compare their ability to predict adverse outcomes in a diverse , elderly , community-dwelling sample of men and women . DESIGN Prospect i ve observational study . SETTING A diverse defined geographic area of Boston . PARTICIPANTS Seven hundred sixty-five community-dwelling participants in the Maintenance of Balance , Independent Living , Intellect , and Zest in the Elderly Boston Study . MEASUREMENTS Two published frailty indexes , recurrent falls , disability , overnight hospitalization , emergency department ( ED ) visits , chronic medical conditions , self-reported health , physical function , cognitive ability ( including executive function ) , and depression . One index was developed from the Study of Osteoporotic Fractures ( SOF ) and the other from the Cardiovascular Health Study ( CHS ) . RESULTS The SOF frailty index classified 77.1 % as robust , 18.7 % as prefrail , and 4.2 % as frail . The CHS frailty index classified 51.2 % as robust , 38.8 % as prefrail , and 10.0 % as frail . Both frailty indexes ( SOF ; CHS ) were similar in their ability to predict key geriatric outcomes such as recurrent falls ( hazard ratio (HR)(frail)=2.2 , 95 % confidence interval (CI)=1.2 - 4.0 ; HR(frail)=1.9 , 95 % CI=1.2 - 3.1 ) , overnight hospitalization ( odds ratio (OR)(frail)=3.5 , 95 % CI=1.5 - 8.0 ; OR(frail)=4.4 , 95 % CI=2.4 - 8.2 ) , ED visits ( OR(frail)=3.5 , 95 % CI=1.4,8.8 ; OR(frail)=3.1 , 95 % CI=1.6 - 5.9 ) , and disability ( OR(frail)=5.4 , 95 % CI=2.3 - 12.3 ; OR(frail)=7.7 , 95 % CI=4.0 - 14.7 ) , as well as chronic medical conditions , physical function , cognitive ability , and depression . CONCLUSION Two established frailty indexes were vali date d using an independent elderly sample of diverse men and women ; both indexes were good at distinguishing geriatric conditions and predicting recurrent falls , overnight hospitalization , and ED visits according to level of frailty . Although both indexes are good measures of frailty , the simpler SOF index may be easier and more practical in a clinical setting Background and aims : Objectives were to develop a frailty index ( FI ) based on a st and ard comprehensive geriatric assessment ( CGA ) derived from a clinical examination ; to assess the validity of the FI-CGA and to compare its precision with other frailty measures . Methods : Design : Secondary analysis of a prospect i ve cohort study , with five-year follow-up data . Setting : Second phase of the Canadian Study of Health and Aging ( CSHA-2 ) ; clinical examinations were performed in clinics , nursing homes , and patients ’ homes . Participants : People selected ( as either cognitively impaired cases or unimpaired controls ) to receive the CSHA-2 clinical examination ( n=2305 ; women=1431 ) . Measurements : Clinical and performance-based measures and diagnostic data were extracted to correspond to the 10 impairment domains and the single comorbidity domain of a CGA . The proportion of deficits accumulated in each domain was calculated to yield the FI-CGA . The FI-CGA was vali date d and its predictive ability compared with other frailty measures . Results : Within the seven grade s of fitness/frailty identified , subjects with greater frailty were older , less educated , and more likely to be women . The FI-CGA correlated highly with a previously vali date d , empirically-derived frailty index ( r=0.76 ) . Frailty was associated with higher risk of death ( for each increment in frailty , the hazard ratio , adjusted for age , sex and education , was 1.23 ( 95 % CI 1.18–1.29 ) and institutionalization ( HR 1.20 ; 1.10–1.32 ) . Conclusions : In a population survey , the FI-CGA is a valid means of quantifying frailty from routinely collected data Objectives Cognitive decline is related to frailty . Frailty can be operationalized in different ways , which have an unknown impact on the estimation of risk . Here , we compared 3 frailty measures in relation to cognitive changes and mortality in the Canadian Study of Health and Aging ( CSHA ) . Design Prospect i ve population -based study , with 5 year follow up . Participants / Setting 2,305 subjects aged 70 + years . Methods For each participant , cognitive status was measured by the errors in the Modified Mini-Mental State Examination ( 3MS ) score .  Three frailty measures were used : a Frailty Index based on the Comprehensive Geriatric Assessment ( FI-CGA ) evaluated from 47 potential deficits , a Clinical Frailty Score and the Fried frailty phenotype . Multivariate Poisson regression and multivariate logistic regression were used to examine the association between baseline cognitive errors and frailty and death , respectively , while controlling for possible confounders ( age , sex , education , and baseline cognitive status ) . Results Changes in cognitive status were strongly associated with baseline cognition and frailty , however defined . In multivariate models adjusted for age , sex and education , each frailty measure was associated with cognitive decline and with mortality . The frailest people ( from the highest FI-CGA tertile ) rarely showed cognitive improvement or stabilization ( 1.5 % , 95 % CI=0.002%–2.8 % ) compared with non-frail people ( from the lowest tertile of the FI-CGA ) , of whom 27.8 % ( 95 % CI=24.5%–31.1 % ) did not deteriorate . Conclusions Frail elderly people have an increased risk of cognitive decline . All frailty measures allowed quantification of individual vulnerability and predict both cognitive changes and mortality
target: The results showed that cognitive decline is strongly associated with frailty , being a probable main clinical outcome .
  In this sense , any strategy aim ed at mitigating or reversing the incidence of frailty with ageing should take into account that physical and cognitive frailty seem to have similar temporal trajectories
background: The purpose of present study was to analyze the magnitude of the effect-size in the assessment of the cognitive status of population s over 60 years of age .