Frailty Intervention Trial (FIT) Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Frail Patients Are at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery Dietary quality is related to frailty in community-dwelling older adults. Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. Antecedents of frailty over three decades in an older cohort. A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study. The prevalence of frailty syndrome in an older population from Spain. The Toledo study for healthy aging The association between obesity and the frailty syndrome in older women: the Women's Health and Aging Studies. 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 How should we grade frailty in nursing home patients? A pilot trial to predict frailty syndrome: The Japanese Health Research Volunteer Study Frailty as a predictor of surgical outcomes in older patients. Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. Adverse outcomes of frailty in the elderly: the Rotterdam Study A new operational definition of frailty: the Frailty Trait Scale.
Background Frailty is a term commonly used to describe the condition of an older person who has chronic health problems , has lost functional abilities and is likely to deteriorate further . However , despite its common use , only a small number of studies have attempted to define the syndrome of frailty and measure its prevalence . The criteria Fried and colleagues used to define the frailty syndrome will be used in this study ( i.e. weight loss , fatigue , decreased grip strength , slow gait speed , and low physical activity ) . Previous studies have shown that clinical outcomes for frail older people can be improved using multi-factorial interventions such as comprehensive geriatric assessment , and single interventions such as exercise programs or nutritional supplementation , but no interventions have been developed to specifically reverse the syndrome of frailty . We have developed a multidisciplinary intervention that specifically targets frailty as defined by Fried et al. We aim to establish the effects of this intervention on frailty , mobility , hospitalisation and institutionalisation in frail older people . Methods and Design A single centre r and omised controlled trial comparing a multidisciplinary intervention with usual care . The intervention will target identified characteristics of frailty , functional limitations , nutritional status , falls risk , psychological issues and management of chronic health conditions .  Two hundred and thirty people aged 70 and over who meet the Fried definition of frailty will be recruited from clients of the aged care service of a metropolitan hospital . Participants will be followed for a 12-month period . Discussion This research is an important step in the examination of specifically targeted frailty interventions . This project will assess whether an intervention specifically targeting frailty can be implemented , and whether it is effective when compared to usual care . If successful , the study will establish a new approach to the treatment of older people at risk of further functional decline and institutionalisation . The strategies to be examined are readily transferable to routine clinical practice and are applicable broadly in the setting of aged care health services . Trial Registration Australian New Zeal and Clinical Trails Registry : ACTRN12608000250336 BACKGROUND The clinical syndrome of frailty identified through the assessment of weight loss , gait speed , grip strength , physical activity , and physical exhaustion has been used to identify patients with reduced reserves . We hypothesized that frailty is useful in predicting adverse outcomes in optimized elective elderly colorectal surgery patients . METHODS A prospect i ve study was conducted at 2 centers ( Singapore and Japan ) . All patients over 75 years of age undergoing colorectal resection were assessed for the presence of the syndrome of frailty .  All these patients had already had their comorbidities optimized for surgery . The outcome measure was postoperative major complications ( defined as Clavien-Dindo type II and above complications ) . RESULTS Eighty-three patients were studied from February 2008 to April 2010 . The mean age was 81.5 years ( range 75 - 93 years ) . The mean comorbidity index was 3.37 ( range 0 - 11 ) . Twenty-six ( 31.3 % ) patients were an American Society of Anesthesiologists ( ASA ) score of 3 and above . Chi-square analysis revealed that the odds ratio of postoperative major complications was 4.083 ( 95 % confidence interval , 1.433 - 11.638 ) when the patient satisfied the criteria for frailty . Albumin < 35 , ASA > 3 , comorbidity index > 5 , and Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity ( POSSUM ) scores were not predictive of postoperative major complications . CONCLUSIONS Preliminary findings show that frailty is a potent adjunctive tool of predicting postoperative morbidity . Frailty can be used to identify elderly patients needing further optimization before major surgery Background — Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery . Where elderly patients are increasingly referred for cardiac surgery , the prevalence of a frail group among these is also on the rise . We assessed frailty as a risk factor for adverse outcomes after cardiac surgery . Methods and Results — Functional measures of frailty and clinical data were collected prospect ively for all cardiac surgery patients at a single center . Frailty was defined as any impairment in activities of daily living ( Katz index ) , ambulation , or a documented history of dementia .  Of 3826 patients , 157 ( 4.1 % ) were frail . Frail patients were older , were more likely to be female , and had risk factors for adverse surgical outcomes . By logistic regression , frailty was an independent predictor of in-hospital mortality ( odds ratio 1.8 , 95 % CI 1.1 to 3.0 ) , as well as institutional discharge ( odds ratio 6.3 , 95 % CI 4.2 to 9.4 ) . Frailty was an independent predictor of reduced midterm survival ( hazard ratio 1.5 , 95 % CI 1.1 to 2.2 ) . Conclusions — Frailty is a risk for postoperative complications and an independent predictor of in-hospital mortality , institutional discharge , and reduced midterm survival . Frailty screening improves risk assessment in cardiac surgery patients and may identify a subgroup of patients who may benefit from innovative processes of care BACKGROUND The etiology of the geriatric syndrome frailty is multifactorial . Besides hormonal and inflammatory processes , nutritional influences may be of major relevance . In this cross-sectional study , the association between dietary quality and frailty was investigated . METHODS In 192 community-dwelling older volunteers ( > 75 years ) , an interview-based food frequency question naire was used to assess nutritional data . A Mediterranean diet ( MED ) score ( maximum 9 points ) was used to evaluate dietary quality . Frailty was defined as the presence of at least three and prefrailty as the presence of one or two of the following criteria : weight loss , exhaustion , low physical activity , low h and grip strength , and slow walking speed . Older adults without any of these attributes were defined as " nonfrail " Binomial logistic regression analysis was used to assess the risk of being frail ( vs prefrail and nonfrail ) in each quartile ( vs lowest quartile ) of the MED score . RESULTS The mean ( SD ) age of the participants was 83 ( 4 ) years ; 41.1 % were prefrail and 15.1 % were frail . The risk of being frail was significantly reduced in the highest quartile of the MED score ( OR 0.26 ; 95 % CI 0.07 - 0.98 ) . CONCLUSIONS A healthy dietary pattern is associated with a lower risk of being frail . Larger , prospect i ve and interventional studies are needed to clarify the association between dietary quality and frailty 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 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 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 Objective To assess the prevalence of the frailty syndrome and its associated variables among the older adult population in the province of Toledo ( Spain ) . Methods Data were taken from the Toledo Study for Healthy Aging , a population -based study conducted on 2,488 individuals aged 65 years and older . Study participants were selected by a two-stage r and om sampling from the municipal census of Toledo , covering both institutionalized and community dwelling persons from rural and urban setting s. Data were collected from 2006 to 2009 , and included information on social support , activities of daily living , comorbidity , physical activity , quality of life , depressive symptoms , and cognitive function . In addition , a nurse collected  anthropometric data  , conducted tests of physical performance ( walk speed , upper and lower extremities strength , and the st and - and -sit from a chair test ) and obtained a blood sample . The diagnosis of the frailty syndrome was based on the Fried criteria ( weakness , low speed , low physical activity , exhaustion , and weight loss ) . Results In total , 41.8 % ( 95 % confidence interval [ CI ] 39.4–44.2 % ) of the study participants were prefrail , and 8.4 % ( 95 % CI 7.1–9.8 % ) were frail . There were no differences in the prevalence of frailty by sex , level of education , occupation , marital status , or place of residence . The frequency of the frailty syndrome increased with age , and was higher in those with disability , depression , hip fracture and other comorbidity , such as cardiovascular disease and disorders of the central nervous system . Conclusions The prevalence of the frailty syndrome in older Spanish adults is high and similar to that reported in other population s in the Mediterranean basin OBJECTIVES To determine whether obesity is associated with the frailty phenotype and , if so , whether comorbid conditions or inflammatory markers explain this association . DESIGN Cross-sectional analysis of baseline data from the Women 's Health and Aging Studies I ( 1992 ) and II ( 1994 ) , complementary population -based studies . SETTING Twelve contiguous ZIP code areas in Baltimore , Maryl and . PARTICIPANTS Five hundred ninety-nine community-dwelling women aged 70 to 79 with a body mass index ( BMI ) greater than 18.5 kg/m(2 ) . MEASUREMENTS The dependent variables were the frailty syndrome , including prefrailty , defined as presence of one or two of five frailty indicators ( weakness , slowness , weight loss , low physical activity , exhaustion ) , and frailty , defined as three or more indicators . Independent variables included BMI , categorized using World Health Organization criteria as normal ( 18.5 to < 25 kg/m(2 ) ) , overweight ( 25 to < 30 kg/m(2 ) ) , and obese ( > /=30 kg/m(2 ) ) ; chronic diseases ; C-reactive protein ; and serum carotenoids . RESULTS Being overweight was significantly associated with prefrailty , and obesity was associated with prefrailty and frailty . In all frail women , regardless of BMI group , a similar pattern of three defining frailty indicators was found : slowness , weakness , and low activity ( with the addition of weight loss in the normal weight group . ) In multinomial regression models , obesity was significantly associated with prefrailty ( odds ratio (OR)=2.23 , 95 % confidence interval (CI)=1.29 - 3.84 ) and frailty ( OR=3.52 , 95 % CI=1.34 - 9.13 ) , even when controlling for covariates . CONCLUSION Obesity is associated with the frailty syndrome in older women in cross-sectional data . This association remains significant even when multiple conditions associated with frailty are considered . Prospect i ve studies are needed to confirm this finding 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 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 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 BACKGROUND 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 design ed a study to determine if frailty predicts surgical complications and enhances current perioperative risk models . STUDY DESIGN We prospect ively 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 vali date d 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 . RESULTS 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 ) . CONCLUSIONS 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 st and ardized definition can help patients and physicians make more informed decisions 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 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 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
RESULTS Severity of frailty syndrome significantly correlated with post-surgical mortality rates and with many although not all post-surgical complications .
These relationships emerge in different type of surgical procedures and patients ' features .
BACKGROUND Frailty is a geriatric syndrome characterized by the clinical presentation of identifiable physical alterations and decreased physiological reserve .
The assessment of frailty syndrome has been recently related with post-surgical outcomes and overall mortality in older individuals .