title: Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study Adverse outcomes of frailty in the elderly: the Rotterdam Study A global clinical measure of fitness and frailty in elderly people Executive function, memory, and gait speed decline in well-functioning older adults. A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial Usefulness of frailty profile for targeting older heart failure patients in disease management programs: a cost-effectiveness, pilot study A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study. Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians
abstract: Purpose Frailty is a recent concept used for evaluating elderly individuals . Our study determined the prevalence of frailty in intensive care unit ( ICU ) patients and its impact on the rate of mortality . Methods A multicenter , prospect i ve , observational study performed in four ICUs in France included 196 patients aged ≥65 years hospitalized for > 24 h during a 6-month study period . Frailty was determined using the frailty  phenotype ( FP ) and the  clinical frailty score  ( CFS ) . The patients were separated as follows : FP score <3 or ≥3 and CFS < 5 or ≥5 . Results Frailty was observed in 41 and 23 % of patients on the basis of an FP score ≥3 and a CFS ≥5 , respectively . At admission to the ICU , the Simplified Acute Physiology Score II ( SAPS II ) and Sequential Organ Failure Assessment ( SOFA ) scores did not differ between the frail and nonfrail patients . In the multivariate analysis , the risk factors for ICU mortality were FP score ≥3 [ hazard ratio ( HR ) , 3.3 ; 95 % confidence interval ( CI ) , 1.6–6.6 ; p < 0.001 ] , male gender ( HR , 2.4 ; 95 % CI , 1.1–5.3 ; p = 0.026 ) , cardiac arrest before admission ( HR , 2.8 ; 95 % CI , 1.1–7.4 ; p = 0.036 ) , SAPS II score ≥46 ( HR , 2.6 ; 95 % CI , 1.2–5.3 ; p = 0.011 ) , and brain injury before admission ( HR , 3.5 ; 95 % CI , 1.6–7.7 ; p = 0.002 ) . The risk factors for 6-month mortality were a CFS ≥5 ( HR , 2.4 ; 95 % CI , 1.49–3.87 ; p < 0.001 ) and a SOFA score ≥7 ( HR , 2.2 ; 95 % CI , 1.35–3.64 ; p = 0.002 ) . An increased CFS was associated with significant incremental hospital and 6-month mortalities . Conclusions Frailty is a frequent occurrence and is independently associated with increased ICU and 6-month mortalities . Notably , the CFS predicts outcomes more effectively than the commonly used ICU illness scores To investigate the prevalence of frailty in a Dutch elderly population and to identify adverse health outcomes associated with the frailty phenotype independent of the comorbidities . Cross-sectional and longitudinal analyses within the Rotterdam Study ( the Netherl and s ) , a prospect i ve population -based cohort study in persons aged ≥55 years . Frailty was defined as meeting three or more of five established criteria for frailty , evaluating nutritional status , physical activity , mobility , grip strength and exhaustion . Intermediate frailty was defined as meeting one or two frailty criteria . Comorbidities were objective ly measured . Health outcomes were assessed by means of question naires , physical examinations and continuous follow-up through general practitioners and municipal health authorities for mortality . Of 2,833 participants ( median age 74.0 years , inter quartile range 9 ) with sufficiently evaluated frailty criteria , 163 ( 5.8 % ) participants were frail and 1,454 ( 51.3 % ) intermediate frail . Frail elderly were more likely to be older and female , to have an impaired quality of life and to have fallen or to have been hospitalized . 108 ( 72.0 % ) frail participants  had ≥2 comorbidities , compared to 777 ( 54.4 % ) intermediate frail and 522 ( 44.8 % ) non-frail participants . Adjusted for age , sex and comorbidities , frail elderly had a significantly increased risk of dying within 3 years ( HR 3.4 ; 95 % CI 1.9–6.4 ) , compared to the non-frail elderly . This study in a general Dutch population of community-dwelling elderly able to perform the frailty tests , demonstrates that frailty is common and that frail elderly are at increased risk of death independent of comorbidities 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 BACKGROUND In community-dwelling older adults , global cognitive function predicts longitudinal gait speed decline . Few prospect i ve studies have evaluated whether specific executive cognitive deficits in aging may account for gait slowing over time . METHODS Multiple cognitive tasks were administered at baseline in 909 participants in the Health , Aging , and Body Composition Study Cognitive Vitality Sub study ( mean age 75.2 ± 2.8 years , 50.6 % women , 48.4 % black ) . Usual gait speed ( m/s ) over 20 minutes was assessed at baseline and over a 5-year follow-up . RESULTS Poorer performance in each cognitive task was cross-sectionally associated with slower gait independent of demographic and health characteristics . In longitudinal analyses , each 1 SD poorer performance in global function , verbal memory , and executive function was associated with 0.003 - 0.004 m/s greater gait speed decline per year ( p = .03-.05 ) after adjustment for baseline gait speed , demographic , and health characteristics . CONCLUSIONS In this well-functioning cohort , several cognitive tasks were associated with gait speed cross-sectionally and predicted longitudinal gait speed decline . These data are consistent with a shared pathology underlying cognitive and motor declines but do not suggest that specific executive cognitive deficits account for slowing of usual gait in aging Background Frailty is a well known and accepted term to clinicians working with older people . The study aim was to determine whether an intervention could reduce frailty and improve mobility . Methods We conducted a single center , r and omized , controlled trial among older people who were frail in Sydney , Australia . One group received an intervention targeting the identified characteristics of frailty , whereas the comparison group received the usual health care and support services . Outcomes were assessed by raters masked to treatment allocation at 3 and 12 months after study entry . The primary outcomes were frailty as assessed by the Cardiovascular Health Study criteria , and mobility as assessed by the Short Physical Performance Battery . Secondary outcome measures included disability , depressive symptoms and health-related quality of life . Results A total of 216 participants ( 90 % ) completed the study . Overall , 68 % of participants were women and the mean age was 83.3 years ( st and ard deviation , 5.9 ) . In the intention-to-treat analysis , the between-group difference in frailty was 14.7 % at 12 months ( 95 % confidence interval : 2.4 % , 27.0 % ; P = 0.02 ) . The score on the Short Physical Performance Battery , in which higher scores indicate better physical status , was stable in the intervention group and had declined in the control group ; with the mean difference between groups being 1.44 ( 95 % confidence interval , 0.80 , 2.07 ; P < 0.001 ) at 12 months . There were no major differences between the groups with respect to secondary outcomes . The few adverse events that occurred were exercise-associated musculoskeletal symptoms . Conclusions Frailty and mobility disability can be successfully treated using an interdisciplinary multifaceted treatment program . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : Background Disease management programs ( DMP ) improve outcomes in patients with heart failure . Because older heart failure patients represent a heterogeneous population , the aim of this study was to determine which patients benefit mostly from a DMP , by means of their frailty profile . Setting Heart failure outpatient clinic . Methods Consecutive ( n = 173 ) patients aged more than 70 years were r and omized to a  multidisciplinary DMP  ( n = 86 ) or usual care ( n = 87 ) . A modified frailty score ( range 1–6 ) was used as an index of global functional impairment . Results Mild to moderate frailty ( frailty score = 2–3 ) was associated with significant improvements in outcomes ( death and /or heart failure admission , heart failure admissions and all-cause admissions ) in DMP patients vs. usual care . Even in more frail patients ( frailty score = 4–6 ) a significant reduction in heart failure admissions was observed . By contrast , nonfrail patients ( frailty score = 1 ) did not derive significant benefit . In the cost-effectiveness analysis , the mean savings per patient , stratified according to their frailty score , were & U20AC ; −1003.31 for frailty score 1 ( 95 % confidence interval −3717.00–1709.00 ) , & U20AC ; 1104.72 for frailty score 2 ( −280.6–2491.00 ) , & U20AC ; 2635.42 for frailty score 3 ( 352.60–4917.00 , P = 0.025 ) and & U20AC ; 419.53 for frailty score 4–6 ( −1909.00–2749.00 ) . Intervention was therefore significantly cost saving in moderately frail , but not in nonfrail or severely frail patients . Thus , DMP was dominant ( i.e. both less costly and more effective than usual care ) in moderately frail patients . At sensitivity analysis ,  DMP  remained dominant even to changes in cost of intervention and hospitalizations . Conclusion This suggests that an intensive , hospital-based DMP appears to be more effective in older patients with mild-to-moderate levels of frailty . Thus , a multidimensional assessment of frailty seems to be a useful tool for appropriate selection of model of care BACKGROUND The frailty syndrome is as a well-established condition of risk for disability . Aim of the study is to explore whether a physical activity ( PA ) intervention can reduce prevalence and severity of frailty in a community-dwelling elders at risk of disability . METHODS Exploratory analyses from the Lifestyle Interventions and Independence for Elders pilot , a r and omized controlled trial enrolling 424 community-dwelling persons ( mean age=76.8 years ) with sedentary lifestyle and at risk of mobility disability . Participants were r and omized to a 12-month PA intervention versus a successful aging education group . The frailty phenotype ( ie , ≥3 of the following defining criteria : involuntary weight loss , exhaustion , sedentary behavior , slow gait speed , poor h and grip strength ) was measured at baseline , 6 months , and 12 months . Repeated measures generalized linear models were conducted . RESULTS A significant ( p = .01 ) difference in frailty prevalence was observed at 12 months in the PA intervention group ( 10.0 % ; 95 % confidence interval = 6.5 % , 15.1 % ) , relative to the successful aging group ( 19.1 % ; 95 % confidence interval = 13.9%,15.6 % ) . Over follow-up , in comparison to successful aging participants , the mean number of frailty criteria in the PA group was notably reduced for younger subjects , blacks , participants with frailty , and those with multimorbidity . Among the frailty criteria , the sedentary behavior was the one most affected by the intervention . CONCLUSIONS Regular PA may reduce frailty , especially in individuals at higher risk of disability . Future studies should be aim ed at testing the possible benefits produced by multidomain interventions on 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
target: The Frailty Index was examined in almost all these dimensions , with the exception of reliability , and its diagnostic and predictive characteristics were shown to be satisfactory .
  Gait speed showed high sensitivity , but only moderate specificity , and excellent predictive ability for future disability in activities of daily living .
  The Tilburg Frailty Indicator was shown to be a reliable and valid measure for frailty screening , but its diagnostic accuracy was not evaluated .
  Screening Letter , Timed-up- and -go test and PRISMA 7 ( Preferred Reporting Items for Systematic Review s and Meta-Analyses ) demonstrated high sensitivity and moderate specificity for identifying frailty .
  In general , low physical activity , variously measured , was one of the most powerful predictors of future decline in activities of daily living .
  Conclusion Only a few frailty measures seem to be demonstrably valid , reliable and diagnostically accurate , and have good predictive ability .
  Nevertheless , it was clear that no suitable tool for assessing frailty appropriately in emergency departments was identified
background: Background A scoping search identified systematic review s on diagnostic accuracy and predictive ability of frailty measures in older adults .
  In most cases , research was confined to specific assessment measures related to a specific clinical model .
  Objectives To summarize the best available evidence from systematic review s in relation to reliability , validity , diagnostic accuracy and predictive ability of frailty measures in older adults .