title: A Frailty Instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE) Cross-cultural adaptation and reliability testing of the Tilburg Frailty Indicator for optimizing care of Polish patients with frailty syndrome Frailty syndrome diagnosed according to the Study of Osteoporotic Fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study. Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. How should we grade frailty in nursing home patients? Old or frail: what tells us more? Comparing the Prognostic Accuracy for All-Cause Mortality of Frailty Instruments: A Multicentre 1-Year Follow-Up in Hospitalized Older Patients Psychological well-being and incident frailty in men and women: the English Longitudinal Study of Ageing. A global clinical measure of fitness and frailty in elderly people Sex differences in the risk of frailty for mortality independent of disability and chronic diseases. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. Frailty and incidence of activities of daily living disability among older Mexican Americans. A new operational definition of frailty: the Frailty Trait Scale. Hierarchical components of physical frailty predicted incidence of dependency in a cohort of elderly women. Antecedents of frailty over three decades in an older cohort. The predictive validity of three self-report screening instruments for identifying frail older people in the community The SHARE frailty instrument for primary care predicts incident disability in a European population-based sample. Development of a frailty index for patients with coronary artery disease. Development of an easy prognostic score for frailty outcomes in the aged. Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians Screening for frailty among older patients with cancer that qualify for abdominal surgery. Transitions in cognitive status in relation to frailty in older adults: A Comparison of three frailty measures Predicting mortality of psychogeriatric patients: a simple prognostic frailty risk score A pilot trial to predict frailty syndrome: The Japanese Health Research Volunteer Study
abstract: Background 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 vali date d 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 . Methods 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 prospect i ve 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 . Results Females : the DFactor model included 15,578 cases ( st and ard 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 ( st and ard 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 . Conclusions 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 Background Frail older people are at high risk of developing adverse outcomes , such as disability , mortality , hospitalization , and institutionalization . Previous research suggests that the Tilburg Frailty Indicator ( TFI ) is a valid and reliable instrument for measuring frailty . The aim of this study was to adapt and to test the reliability of the Polish version of the TFI . Method A st and ard guideline was used for translation and cultural adaptation of the English version of the TFI into Polish . The study included 100 Polish patients ( mean age 68.2±6.5 years ) , among them 42 men and 58 women .  Cronbach ’s alpha was used for analysis of the internal consistency of the TFI . Results The mean total TFI score was 6.7±3.1 . Forty patients scored ≥5 , which corresponded to being frail . Cronbach ’s alpha reliability coefficients of the instrument ranged from 0.68 to 0.72 and item-total correlation ranged from 0.12 to 0.52 . Conclusion The TFI is valid and reproducible for assessment of frailty syndrome among a Polish population . The Polish adaptation of the TFI proved a useful and fast tool for assessing frailty The easy-to-apply SOF criteria for frailty were recently vali date d in studies conducted in the U.S. only . In order to determine the ability of the SOF criteria to predict adverse health outcomes at a one-year follow-up in a sample of older out patients in Italy we carried out a prospect i ve cohort study on 265 community-dwelling out patients aged 65 + ( mean age 81.5 years ) consecutively referred to a geriatric clinic . At baseline participants underwent a comprehensive geriatric assessment ( CGA ) including evaluation of their frailty status according to the SOF criteria . At a one-year follow-up , between June and December 2010 , we investigated nursing home placement and death in all participants as well as any fall , any admission to the emergency department ( ED ) , any hospitalization and a greater disability among the subset of subjects still living at home . One year after the visit 231 subjects were still living at home ( 87.2 % ) , 9 had been placed in a nursing home ( 3.4 % ) and 25 had died ( 9.4 % ) . Frailty was associated with a greater risk of falls ( odds ratio [ OR ] 2.01 , 95 % confidence interval [ CI ] 1.05 - 3.83 , p=0.035 ) , hospitalization ( OR 2.08 , 95 % CI 1.02 - 4.24 , p=0.045 ) and death ( OR 3.07 , 95 % 1.02 - 4.24 , p=0.045 ) after correction for demographic characteristics , comorbidity including dementia and depression , socioeconomic position and severe disability . Thus , in an older outpatient population in Italy the frailty syndrome diagnosed according to the SOF criteria was an independent predictor of several adverse health outcomes BACKGROUND A st and ard phenotype of frailty was associated with an increased risk of adverse outcomes including mortality in a recent study of older adults . However , the predictive validity of this phenotype for fracture outcomes and across risk subgroups is uncertain . METHODS To determine whether a st and ard frailty phenotype was independently associated with risk of adverse health outcomes in older women and to evaluate the consistency of associations across risk subgroups defined by age and body mass index ( BMI ) , we ascertained frailty status in a cohort of 6724 women > or=69 years and followed them prospect ively for incident falls , fractures , and mortality . Frailty was defined by the presence of three or more of the following criteria : unintentional weight loss , weakness , self-reported poor energy , slow walking speed , and low physical activity . Incident recurrent falls were defined as at least two falls during the subsequent year . Incident fractures ( confirmed with x-ray reports ) , including hip fractures , and deaths were ascertained during an average of 9 years of follow-up . RESULTS After controlling for multiple confounders such as age , health status , medical conditions , functional status , depressive symptoms , cognitive function , and bone mineral density , frail women were subsequently at increased risk of recurrent falls ( multivariate odds ratio=1.38 , 95 % confidence interval [ CI ] , 1.02 - 1.88 ) , hip fracture ( multivariate hazards ratio [MHR]=1.40 , 95 % CI , 1.03 - 1.90 ) , any nonspine fracture ( MHR=1.25 , 95 % CI , 1.05 - 1.49 ) , and death ( MHR=1.82 , 95 % CI , 1.56 - 2.13 ) . The associations between frailty and these outcomes persisted among women > or=80 years . In addition , associations between frailty and an increased risk of falls , fracture , and mortality were consistently observed across categories of BMI , including BMI > or=30 kg/m2 . CONCLUSION Frailty is an independent predictor of adverse health outcomes in older women , including very elderly women and older obese women BACKGROUND Frailty , as defined by the index derived from the Cardiovascular Health Study ( CHS index ) , predicts risk of adverse outcomes in older adults . Use of this index , however , is impractical in clinical practice . METHODS We conducted a prospect i ve cohort study in 6701 women 69 years or older to compare the predictive validity of a simple frailty index with the components of weight loss , inability to rise from a chair 5 times without using arms , and reduced energy level ( Study of Osteoporotic Fractures [ SOF index ] ) with that of the CHS index with the components of unintentional weight loss , poor grip strength , reduced energy level , slow walking speed , and low level of physical activity . Women were classified as robust , of intermediate status , or frail using each index . Falls were reported every 4 months for 1 year . Disability ( > or = 1 new impairment in performing instrumental activities of daily living ) was ascertained at 4(1/2 ) years , and fractures and deaths were ascertained during 9 years of follow-up . Area under the curve ( AUC ) statistics from receiver operating characteristic curve analysis and -2 log likelihood statistics were compared for models containing the CHS index vs the SOF index . RESULTS Increasing evidence of frailty as defined by either the CHS index or the SOF index was similarly associated with an increased risk of adverse outcomes . Frail women had a higher age-adjusted risk of recurrent falls ( odds ratio , 2.4 ) , disability ( odds ratio , 2.2 - 2.8 ) , nonspine fracture ( hazard ratio , 1.4 - 1.5 ) , hip fracture ( hazard ratio , 1.7 - 1.8 ) , and death ( hazard ratio , 2.4 - 2.7 ) ( P < .001 for all models ) . The AUC comparisons revealed no differences between models with the CHS index vs the SOF index in discriminating falls ( AUC = 0.61 for both models ; P = .66 ) , disability ( AUC = 0.64 ; P = .23 ) , nonspine fracture ( AUC = 0.55 ; P = .80 ) , hip fracture ( AUC = 0.63 ; P = .64 ) , or death ( AUC = 0.72 ; P = .10 ) . Results were similar when -2 log likelihood statistics were compared . CONCLUSION The simple SOF index predicts risk of falls , disability , fracture , and death as well as the more complex CHS index and may provide a useful definition of frailty to identify older women at risk of adverse health outcomes in clinical practice OBJECTIVES To define frailty using simple indicators ; to identify risk factors for frailty as targets for prevention ; and to investigate the predictive validity of this frailty classification for death , hospitalization , hip fracture , and activity of daily living ( ADL ) disability . DESIGN Prospect i ve study , the Women 's Health Initiative Observational Study . SETTING Forty U.S. clinical centers . PARTICIPANTS Forty thous and six hundred fifty-seven women aged 65 to 79 at baseline . MEASUREMENTS Components of frailty included self-reported muscle weakness/impaired walking , exhaustion , low physical activity , and unintended weight loss between baseline and 3 years of follow-up . Death , hip fractures , ADL disability , and hospitalizations were ascertained during an average of 5.9 years of follow-up . RESULTS Baseline frailty was classified in 16.3 % of participants , and incident frailty at 3-years was 14.8 % . Older age , chronic conditions , smoking , and depressive symptom score were positively associated with incident frailty , whereas income , moderate alcohol use , living alone , and self-reported health were inversely associated . Being underweight , overweight , or obese all carried significantly higher risk of frailty than normal weight . Baseline frailty independently predicted risk of death ( hazard ratio (HR)=1.71 , 95 % confidence interval (CI)=1.48 - 1.97 ) , hip fracture ( HR=1.57 , 95 % CI=1.11 - 2.20 ) , ADL disability ( odds ratio (OR)=3.15 , 95 % CI=2.47 - 4.02 ) , and hospitalizations ( OR=1.95 , 95 % CI=1.72 - 2.22 ) after adjustment for demographic characteristics , health behaviors , disability , and comorbid conditions . CONCLUSION These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women . Underweight , obesity , smoking , and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention OBJECTIVES To compare 3 methods of describing the frailty of older adults in nursing homes . DESIGN Secondary analysis of a prospect i ve cohort study . SETTING Canadian long-term care institutions . PARTICIPANTS Institutionalized older adults in the second clinical examination cohort of the Canadian Study of Health and Aging ( CSHA-2 ; n = 728 ) . MEASURES Frailty was measured using the Cardiovascular Health Survey definition ( Frail-CHS ) ; the CSHA- Clinical Frailty Scale ( CSHA-CFS ) and a frailty index ( FI ) . RESULTS The sample was very elderly ( 87.7 + /- 6.7 years ) , disabled ( 83 % ) , and showed a high level of mobility impairment ( 83 % ) . Each frailty measure correlated moderately well with each other ( 0.61 - 0.71 ) and with a disability measure ( -0.45 to -0.53 ) but only weakly with age ( 0.13 - 0.19 ) . By each measure , frailty was significantly associated ( P < .01 ) with an increased risk of mortality , disability and cognitive decline . In a model that included both the frailty-CHS definition and the Frailty Index only the latter was associated with a higher risk of mortality ( P < .01 for FI , P = .18 for Frail-CHS ) and decline in the 3MS ( P < .01 for FI , P = .20 for the Frail-CHS definition ) . Both measures were significantly associated with new onset disability ( P < .01 ) . Similar results were found when both the CSHA-CFS and Frailty Index were included in the models . R and om combinations of 15 variables used to make up alternate 5-item Frail-CHS definitions showed that any stratification based on 5 variables allowed tertiles of risk to be discriminated . CONCLUSIONS Frailty is a robust concept and however defined , elderly people who are frail have worse outcomes than those who are not frail . The 3 measures showed varying ability to express grade s of frailty 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 Frailty is a dynamic age-related condition of increased vulnerability characterized by declines across multiple physiologic systems and associated with an increased risk of death . We compared the predictive accuracy for one-month and one-year all-cause mortality of four frailty instruments in a large population of hospitalized older patients in a prospect i ve multicentre cohort study . Methods and Findings On 2033 hospitalized patients aged ≥65 years from twenty Italian geriatric units , we calculated the frailty indexes derived from the Study of Osteoporotic Fractures ( FI-SOF ) , based on the cumulative deficits model ( FI-CD ) , based on a comprehensive geriatric assessment ( FI-CGA ) , and the Multidimensional Prognostic Index ( MPI ) .  The overall mortality rates were 8.6 % after one-month and 24.9 % after one-year follow-up . All frailty instruments were significantly associated with one-month and one-year all-cause mortality . The areas under the receiver operating characteristic ( ROC ) curves estimated from age- and sex-adjusted logistic regression models , accounting for clustering due to centre effect , showed that the MPI had a significant higher discriminatory accuracy than FI-SOF , FI-CD , and FI-CGA after one month ( areas under the ROC curves : FI-SOF = 0.685 vs. FI-CD = 0.738 vs. FI-CGA = 0.724 vs. MPI = 0.765 , p<0.0001 ) and one year of follow-up ( areas under the ROC curves : FI-SOF = 0.694 vs. FI-CD = 0.729 vs. FI-CGA = 0.727 vs. MPI = 0.750 , p<0.0001 ) . The MPI showed a significant higher discriminatory power for predicting one-year mortality also in hospitalized older patients without functional limitations , without cognitive impairment , malnourished , with increased comorbidity , and with a high number of drugs . Conclusions All frailty instruments were significantly associated with short- and long-term all-cause mortality , but MPI demonstrated a significant higher predictive power than other frailty instruments in hospitalized older patients BACKGROUND Observations that older people who enjoy life more tend to live longer suggest that psychological well-being may be a potential re source for healthier ageing . We investigated whether psychological well-being was associated with incidence of physical frailty . METHOD We used multinomial logistic regression to examine the prospect i ve relationship between psychological well-being , assessed using the CASP-19 , a question naire that assesses perceptions of control , autonomy , self-realization and pleasure , and incidence of physical frailty or pre-frailty , defined according to the Fried criteria ( unintentional weight loss , weakness , self-reported exhaustion , slow walking speed and low physical activity ) , in 2557 men and women aged 60 to ≥ 90 years from the English Longitudinal Study of Ageing ( ELSA ) . RESULTS Men and women with higher levels of psychological well-being were less likely to become frail over the 4-year follow-up period . For a st and ard deviation higher score in psychological well-being at baseline , the relative risk ratio ( RR ) for incident frailty , adjusted for age , sex and baseline frailty status , was 0.46 [ 95 % confidence interval ( CI ) 0.40 - 0.54 ] . There was a significant association between psychological well-being and risk of pre-frailty ( RR 0.69 , 95 % CI 0.63 - 0.77 ) . Examination of scores for hedonic ( pleasure ) and eud aim onic ( control , autonomy and self-realization ) well-being showed that higher scores on both were associated with decreased risk . Associations were partially attenuated by further adjustment for other potential confounding factors but persisted . Incidence of pre-frailty or frailty was associated with a decline in well-being , suggesting that the relationship is bidirectional . CONCLUSIONS Maintaining a stronger sense of psychological well-being in later life may protect against the development of physical frailty . Future research needs to establish the mechanisms underlying these findings Background : There is no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information OBJECTIVES To determine the effect of static and dynamic frailty on mortality in older men and women . DESIGN A prospect i ve cohort study with three 3-year measurement cycles . SETTING Population based . PARTICIPANTS The sample was derived from the Longitudinal Aging Study Amsterdam and consisted of respondents who participated in two cycles ( T1 : 1992/1993 and T2 : 1995/1996 ) and for whom there was complete data on disability and chronic diseases ( N=2,257 ) .  MEASUREMENTS Nine frailty markers were assessed at T1 and T2 . The frailty markers were defined in two ways : low functioning at T2 ( static frailty ) and change in functioning between T1 and T2 ( dynamic frailty ) . Survival time , calculated in days from T2 to January 1 , 2000 , was used as the outcome variable . Predictive ability was examined using Cox proportional hazards analyses separately for men and women . RESULTS Women were frailer than men . Static frailty was significantly associated with mortality in men ( relative risk (RR)=2.4 ) and in women ( RR=2.6 ) . Dynamic frailty was also associated with mortality in women ( RR=2.6 ) , but it was not significantly associated with mortality in men ( RR=1.3 ) . When disability and chronic diseases were included in the model as possible mediators , these RRs dropped to 1.6 , 2.0 , 2.1 , and 1.2 , respectively , of which the first three were still significant . CONCLUSION Frailty was associated with mortality to a greater extent in women than in men , and this effect was independent of disability and chronic disease . In men , the static definition of frailty was more predictive of mortality than the dynamic definition OBJECTIVES To construct and vali date a frailty index ( FI ) that is clinical ly sensible and practical for geriatricians by basing it on a routinely used comprehensive geriatric assessment ( CGA ) instrument . DESIGN Secondary analysis of a 3-month r and omized , controlled trial of a specialized mobile geriatric assessment team . SETTING Rural Nova Scotia . Participants were seen in their homes . PARTICIPANTS Frail older adults , of whom 92 were in the intervention group and 77 in the control group . MEASUREMENTS A st and ard CGA form that accounts for impairment , disability , and comorbidity burden was scored and summed as a frailty index ( FI-CGA ) . The FI-GCA was stratified to describe three levels of frailty . Patients were followed for up to 12 months to determine how well the index predicted adverse outcomes ( institutionalization or mortality , whichever came first ) . RESULTS The three levels of frailty were mild ( FI-CGA 0 - 7 ) , moderate ( FI-CGA 7 - 13 ) , and severe ( FI-CGA>13 ) . Demographic and social traits were similar across groups , but greater frailty was associated with worse function ( r=0.55 ) and mental status ( r=0.33 ) . Those with moderate and severe frailty had a greater risk of adverse outcomes than those with mild frailty ( unadjusted hazard ratio=1.9 and 5.5 , respectively ) . There was no difference between frailty groups in mean 3-month goal -attainment scaling scores . Intrarater reliability was 0.95 . CONCLUSION The FI-CGA is a valid , reliable , and sensible clinical measure of frailty that permits risk stratification of future adverse outcomes OBJECTIVE To examine the association between frailty status and incidence of disability among non-disabled older Mexican Americans . DESIGN A 10-year prospect i ve cohort study . SUBJECTS A total of 1645 non-institutionalized Mexican Americans aged 67 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly ( H-EPESE ) , who reported no limitation in activities of daily living at baseline . METHODS Frailty was defined as meeting 3 or more of the following components : ( i ) unintentional weight loss of > 2.26 kg ; ( ii ) weakness ( lowest 20 % in h and grip strength ) ; ( iii ) self-reported exhaustion ; ( iv ) slow walking speed ; and ( v ) low physical activity level . Socio-demographic factors , Mini Mental State Examination , medical conditions , body mass index , and self-reported activities of daily living were obtained . RESULTS Of the 1645 non-disabled subjects at baseline , 820 ( 50 % ) were not frail , 749 ( 45.7 % ) were pre-frail , and 71 ( 4.3 % ) were frail . The hazard ratio of activities of daily living disability at 10-year follow-up for pre-frail subjects was 1.32 ( 95 % confidence interval 1.10 - 1.58 ) and 2.42 ( 95 % confidence interval 70 - 3.46 ) for frail subjects compared with not frail subjects . This association remained statistically significant after controlling for potential confounding factors at baseline . CONCLUSION Pre-frail and frail status in older Mexican Americans was associated with an increased risk of activities of daily living disability over a 10-year period among non-disabled subjects OBJECTIVES To provide a new instrument to diagnose frailty , the Frailty Trait Scale ( FTS ) , that allows a more precise assessment and monitoring of individuals . DESIGN Prospect i ve population -based cohort study . SETTING The Toledo Study for Healthy Aging , Spain . PARTICIPANTS A total of 1972 men and women aged 65 years or older . MEASUREMENTS We identified 7 frailty dimensions ( energy balance-nutrition , physical activity , nervous system , vascular system , strength , endurance , and gait speed ) represented by 12 items . Each item was pondered based on the quintiles of its distribution in the study population . Validity was evaluated by testing its association with factors related to frailty and its predictive value for adverse events . This predictive capacity was further compared with the capacity of 2 well-established frailty models ( the frailty phenotype and the Frailty Index ) . RESULTS FTS score was associated with several comorbidities and biomarkers classically associated with frailty . The FTS was associated with the incidence of hospitalization and mortality ( hazard ratio associated with a score in the highest quartile [ versus the first quartile ] = 2.3 , 95 % confidence interval [ CI ] 1.6 - 3.4 , and 2.5 , 95 % CI 1.8 - 3.6 , respectively ) . Compared with Fried et al 's definition , the FTS showed a better predictor for hospitalization in persons younger than 80 ( area under the curve [ AUC ] = 0.65 vs 0.62 , P = .01 ) , and for mortality in the oldest group ( AUC = 0.77 vs 0.72 , P = .02 ) . FTS showed similar predictive value to the Frailty Index . CONCLUSION FTS associates with many of the factors linked to frailty and has a similar predictive capacity to that provided by the classical instruments . Its characteristics offer some advantages over them , with potential utility in research and clinical practice OBJECTIVE To identify the most important predictors of early disability  incidence and devise a simple score of physical frailty . METHODS A cohort of 545 high-functioning women aged 75 years and older was followed for 7 years . Every year , the self-reported loss of at least one instrumental activity of daily living was chosen as definition of disability . An extension of the logistic regression for repeated responses , the r and om-effect model , was used to assess the effects of baseline predictors . The regression coefficients of the final multivariate model were scaled and rounded to create a practical score . RESULTS The proportion of women reporting disability increased from 22.1 % to 52.1 % throughout the follow-up . In the multivariate model , increasing age , lower performances in mobility and balance tests , bad perceived health , lower muscle strength , higher body mass index , lower educational level , and lower reported physical activity were strong predictors of disability . Evaluating the predictive value of the simplified predictive score on an independent cohort gave a c-statistic equal to .71 . CONCLUSION The use of a powerful fitting method allows to establish a hierarchy between the components of physical frailty and to provide a predictive score with substantial practical value for clinicians and public health professionals Studies of disability in old age have focused on gross measures of physical functioning . More useful results for prevention might be gleaned from examining risk factors associated with frailty , a concept implying a broader range of more subtle problems in multiple domains . This study conceptualized frailty as involving problems or difficulties in two or more functional domains ( physical , nutritive , cognitive , and sensory ) and analyzed prospect i ve predictors . Subjects were 574 Alameda County Study respondents age 65 - 102 . One-fourth scored as frail ; there was no gender difference . Frail persons reported reduced activities , poorer mental health , and lower life satisfaction . Cumulative predictors over the previous three decades included heavy drinking , cigarette smoking , physical inactivity , depression , social isolation , fair or poor perceived health , prevalence of chronic symptoms , and prevalence of chronic conditions . By modifying these risk factors , it may be possible to postpone the onset of frailty or ameliorate its further development Background If brief and easy to use self report screening tools are available to identify frail elderly , this may avoid costs and unnecessary assessment of healthy people . This study investigates the predictive validity of three self-report instruments for identifying community-dwelling frail elderly . Methods This is a prospect i ve study with 1-year follow-up among community-dwelling elderly aged 70 or older ( n = 430 ) to test sensitivity , specificity , and positive and negative predicted values of the Groningen Frailty Indicator , Tilburg Frailty Indicator and Sherbrooke Postal Question naire on development of disabilities , hospital admission and mortality . Odds ratios were calculated to compare frail versus non-frail groups for their risk for the adverse outcomes . Results Adjusted odds ratios show that those identified as frail have more than twice the risk ( GFI , 2.62 ; TFI , 2.00 ; SPQ , 2,49 ) for developing disabilities compared to the non-frail group ; those identified as frail by the TFI and SPQ have more than twice the risk of being admitted to a hospital . Sensitivity and specificity for development of disabilities are 71 % and 63 % ( GFI ) , 62 % and 71 % ( TFI ) and 83 % and 48 % ( SPQ ) . Regarding mortality , sensitivity for all tools are about 70 % and specificity between 41 % and 61 % . For hospital admission , SPQ scores the highest for sensitivity ( 76 % ) . Conclusion All three instruments do have potential to identify older persons at risk , but their predictive power is not sufficient yet . Further research on these and other instruments is needed to improve targeting frail elderly BACKGROUND The adoption of a frailty paradigm in primary care would be helpful to identify adults who need priority access to specialised re sources . 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 vali date d 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.biomed central .com/1471 - 2318/10/57 ) . AIM To provide further prospect i ve validation of SHARE-FI , with a focus on disability . METHODS DESIGN longitudinal study ( wave 1 : 2004 - 2006 ; mean follow-up : 2.4 years ) . SETTING European population -based survey ( 12 countries ) . SUBJECTS 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 . MAIN OUTCOME MEASURES number of difficulties with basic ( ADL ) and instrumental ( IADL ) activities of daily living . STATISTICAL ANALYSES repeated measures ANOVA with adjustment for baseline age . RESULTS 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 . CONCLUSION 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 re sources , and it serves as a novel tool for audit and research OBJECTIVES To construct a brief frailty index for older patients with coronary artery disease ( CAD ) undergoing coronary angiography  that includes physical , cognitive , and psychosocial criteria and accurately predicts future disability and decline in health-related quality of life ( HRQL ) . DESIGN Prospect i ve cohort . SETTING An urban tertiary care hospital in Alberta , Canada . PARTICIPANTS Three hundred seventy-four patients aged 60 and older ( 73 % male ) undergoing cardiac catheterization for CAD between October 2003 and May 2007 . MEASUREMENTS Potential frailty criteria examined at baseline ( before the procedure ) included measures of  balance , gait speed , cognition , self-reported health , body mass index ( BMI ) , depressive symptoms , and living alone . The outcomes assessed over 1 year were dependency in activities of daily living ( ADLs ) and HRQL . RESULTS The five best-fitting criteria from regression analyses for ADL decline were poor balance ( risk ratio (RR)=2.4 , 95 % confidence interval (CI)=1.4–4.0 ) , abnormal BMI ( RR=1.8 , 95 % CI=1.1–3.0 ) , impaired Trail-Making Test Part B performance ( RR=2.3 , 95 % CI=1.3–4.2 ) , depressive symptoms ( RR=1.8 , 95 % CI=1.1–3.1 ) , and living alone ( RR=2.2 , 95 % CI=1.3–3.8 ) . Using the five criteria as separate variables or as a summary frailty index yielded identical areas under the receiver operating characteristic curve ( 0.76 , 95 % CI=0.66–0.84 ) . Patients with three or more criteria ( vs none ) were at statistically significant greater risk for increased disability ( RR=10.4 , 95 % CI=4.4–24.2 ) and decreased HRQL ( RR=4.2 , 95 % CI=2.3–7.4 ) after 1 year . CONCLUSION This brief frailty index including physical , cognitive , and psychosocial criteria was predictive of increased disability and decreased HRQL at 1 year in older patients with CAD undergoing angiography . This index may have applications for clinicians and research ers but requires further validation BACKGROUND identification of frailty is recommended in geriatric practice . However , there is a lack of frailty scores combining easy-to-collect predictors from multiple domains . OBJECTIVE to develop a frailty score including only self-reported information and easy-to-perform st and ardised measurements recommended in routine geriatric practice . DESIGN prospect i ve population -based study . SETTING / PARTICIPANTS included 1,007 Italian subjects aged 65 and over . MEASUREMENTS seventeen baseline possible mortality predictors from several domains , 4-year risk of mortality and other adverse health outcomes associated with frailty [ fractures , hospitalisation , and new and worsening activities of daily living ( ADL ) disability ] . METHODS a multivariate Cox model was used to identify the best sub-group of independent predictors and to develop a mortality prognostic score , defined as the number of adverse predictors present . Logistic regression was used to verify whether the score also predicted risk of other frailty outcomes in the cohort survivors . RESULTS nine independent mortality predictors were identified . Among subjects with score > or =3 , each one point increase in the score was associated with a doubling in mortality risk and , among survivors , with an increased risk of all the other adverse health outcomes . CONCLUSIONS nine easy-to-collect predictors may identify aged people at increased risk of adverse health outcomes associated with frailty 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 OBJECTIVE The Geriatric Assessment ( GA ) is an established method for evaluating and optimizing diagnostic and treatment plans . However , it requires experience and is time-consuming . Therefore , a variety of screening methods have been developed . The aim of this study was to compare their accuracy for predicting frailty among older patients with cancer qualified for abdominal surgery based on comparison to the GA . MATERIAL AND METHODS One hundred and thirty five consecutive patients ≥65years of age were prospect ively enrolled . The diagnostic performance of eight screening tests was evaluated : The Vulnerable Elderly Survey ( VES-13 ) , Triage Risk Screening Tool ( TRST ) , Geriatric 8 ( G8 ) , Groningen Frailty Index ( GFI ) , abbreviated Comprehensive Geriatric Assessment ( aCGA ) , Rockwood , Balducci and Fried score . RESULTS The prevalence of frailty as diagnosed by the GA was 73 % . Screening methods identified frail patients in 40 - 75.5 % of cases . The sensitivity and specificity of these tests in predicting frailty were 52%-97 % ( Fried score-G8 ) and 44 - 100 % ( G8-Rockwood score ) , respectively . The positive and negative predictive values were 82 - 100 % ( Balducci-Rockwood ) and 43 - 84 % ( TRST-G8 ) , respectively . Age significantly influenced the predictive value of the screening tests whereas gender and type of cancer did not . CONCLUSION At present , there is no universal screening test that adequately identifies frailty in at risk older patients . The results of this study showed that the aCGA and G8 were the best screens for older patients with cancer that qualified for elective abdominal surgery ; the G8 had the highest sensitivity and negative predictive value and the aCGA was a good overall assessment tool 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 Background and aims : Frailty and mortality in psychogeriatric patients are hard to predict but important in counselling and therapeutic decision making . We have therefore developed a simple frailty risk score to predict mortality this population . Study design : Prospect i ve observational study including 401 community dwelling psychogeriatric patients ( 249 women ; mean ( SD ) age 78.0 ( 6.5 ) years ) , who had been referred to a multidisciplinary diagnostic observation centre . We used Cox proportional hazards regression models to identify and select baseline characteristics for the development and validation of a risk score for the prediction of 3 year mortality . Results : A total of 116 subjects died during follow-up ( median follow-up duration of 26 months ) . Baseline characteristics associated with mortality were : age ( hazard ratio ( HR ) 1.44 , 95 % confidence interval (CI)1.02 to 2.04 ) , male sex ( HR 2.93 , 95 % CI 1.89 to 4.59 ) , living alone ( HR 1.53 , 95 % CI 0.99 to 2.38 ) , body mass index ( BMI ) < 18.5 kg/m2 ( HR 4.09 , 95 % CI 2.06 to 8.14 ) , cardiovascular disease ( HR 1.42 , 95 % CI 0.94 to 2.15 ) , elderly mobility score < 20 ( HR 1.92 , 95 % CI 1.24 to 2.98 ) , number of medicines ⩾2 ( HR 2.28 , 95 % CI 1.21 to 4.31 ) , and impaired motor ( HR 1.47 , 95 % CI 0.93 to 2.32 ) and process skills ( HR 1.92 , 95 % CI 1.12 to 2.98 ) in activities of daily living . These predictors were translated into an easy-to-use frailty risk score and patients were stratified into very good ( < 45 points ) , good ( 45–50 ) moderate ( 51–55 ) , poor ( 56–61 ) and very poor ( > 61 ) prognosis groups . Three year mortality rates across these groups were 8.0 % , 15.9 % , 25.9 % , 41.5 % , and 68.8 % , respectively ( p<0.001 ) . The area under the receiver operating characteristic curve ( AUC ) of the risk score was 0.78 ( 95 % CI 0.73 to 0.82 ) , indicating good discriminative performance . Conclusions : We developed and vali date d a risk score for the prediction of 3 year mortality . This risk score can be used to stratify patients into different risk categories , thereby informing patient counselling and tailored diagnostic and therapeutic decisions in clinical practice Most definitions of frailty utilize US population s in their development . The concept of frailty has not been well studied in Japan , which has the largest percentage of older patients ( per capita ) in the world . We created a 5-year prospect i ve cohort study of community-dwelling older Japanese adults . Participants were not frail at baseline , based on our definition adapted from the Canadian Study for Health and Aging Clinical Frailty Scale . Participants underwent a comprehensive geriatric assessment ( CGA ) at baseline , and final assessment s were either in person or via mailed survey .  We enrolled 407 individuals ( 184 men , mean age 78 ± 4 years ; 223 women , mean age 77 ± 4 years ) . Sixty-five participants met criteria for frailty by the end of the study . In univariate analyses , eighteen separate parameters were associated with frailty , some of which included : age , gender , h and grip , timed walk , systolic blood pressure , pulse pressure , cognitive status , living alone , and hearing deficits . In multivariate analyses , the following elements remained associated with frailty : timed walk , pulse pressure , cognition deficits and hearing deficits . We established cut-off points for timed walk ( 5m/3s ) and pulse pressure ( 60 mmHg ) . We then created a simple additive score for these four factors ( present = 1 ; absent = 0 ) . A score of 0 had a 93 % negative predictive value for frailty while a score of 4 had a 70 % positive predictive value . While further study is needed , this work creates an easy-to-administer tool that may be generalizable to other population
target: Conclusions The TFI has the most robust evidence of reliability and validity and has been the most extensively examined in terms of psychometric properties .
  However , there is insufficient evidence at present to determine the best tool for use in research and clinical practice .
background: Background Frailty is widely recognised as a distinct multifactorial clinical syndrome that implies vulnerability .
  The links between frailty and adverse outcomes such as death and institutionalisation have been widely evidence d. There is currently no gold st and ard frailty assessment tool ; optimizing the assessment of frailty in older people therefore remains a research priority .
  The objective of this systematic review is to identify existing multi-component frailty assessment tools that were specifically developed to assess frailty in adults aged ≥60 years old and to systematic ally and critically evaluate the reliability and validity of these tools .