A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial A global clinical measure of fitness and frailty in elderly people One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial; “Continuum of care for frail older people” Frailty Intervention Trial (FIT) Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study. Adverse outcomes of frailty in the elderly: the Rotterdam Study How should we grade frailty in nursing home patients? A new operational definition of frailty: the Frailty Trait Scale. Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Transitions in cognitive status in relation to frailty in older adults: A Comparison of three frailty measures Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. Hierarchical components of physical frailty predicted incidence of dependency in a cohort of elderly women. Frailty is a predictive factor of readmission within 90 days of hospitalization for acute exacerbations of chronic obstructive pulmonary disease: a longitudinal study Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians Development of an easy prognostic score for frailty outcomes in the aged.
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 : 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 The intervention ; “ Continuum of Care for Frail Older People ” , was design ed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person ’s own home . The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living ( ADL ) . Methods The study is a non-blinded controlled trial with participants r and omised to either the intervention group or a control group with follow-ups at three- , six- and 12 months . The intervention involved collaboration between a nurse with geriatric competence at the emergency department , the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub . Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal , Sweden were asked to participate . Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL . Analyses were made on the basis of the intention-to-treat principle . Outcome measures were ADL independence and eight frailty indicators . These were analysed , using Chi-square and odds ratio ( OR ) . Results A total of 161 participated in the study , 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study . There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up . At both the three- and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control ( OR 2.37 , 95 % CI ; 1.20 – 4.68 ) and ( 2.04 , 95 % CI ; 1.03 – 4.06 ) respectively . At six months the intervention group had halved their odds for decreased ADL independence ( OR 0.52 , 95 % CI ; 0.27 – 0.98 ) compared to the control group . Conclusions The intervention has the potential to reduce dependency in ADLs , a valuable benefit both for the individual and for society . Trial registration Clinical Trials.gov : 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 OBJECTIVES To measure relative fitness and frailty in older people without specific frailty instruments and to relate that measurement to long-term health outcomes . DESIGN Retrospective cohort studies . SETTING Two population -based studies of people aged approximately 70 at baseline and followed up to 10 years ( in the Canadian Study of Health and Aging ( CSHA ) ) or 26 years in the Gothenburg H-70 cohort study . PARTICIPANTS Nine hundred sixty-two men and 1,178 women . MEASUREMENTS  Deficit accumulation ( the exposure ) was counted using self-reported ( CSHA ) or clinical ly design ated ( H-70 ) symptoms , signs , diseases , and disabilities . Relative fitness and frailty were measured in relation to the degree of deficit accumulation evaluated in four quartiles , representing those most fit to those most frail . The items that made up the frailty index were selected r and omly without replacement in 1,000 iterations . The outcomes were risks of death or residential long-term care . RESULTS Worse frailty , however measured , was associated with worse survival ; the Kaplan-Meier curves of r and om iterations of the frailty definition showed virtually no interquartile overlap for mortality . For any given level of frailty , men died younger than women . Worse frailty was also associated with a higher risk of institutionalization . CONCLUSION Frailty appears to be a robust concept that is readily operationalized , with the risk of adverse outcomes being largely established by age 70 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 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 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 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 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 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 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 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 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 Background : Readmission after hospital discharge is common in patients with acute exacerbations ( AE ) of chronic obstructive pulmonary disease ( COPD ) . Although frailty predicts hospital readmission in patients with chronic nonpulmonary diseases , no multidimensional frailty measures have been vali date d to stratify the risk for patients with COPD . Aim : The aim of this study was to explore multidimensional frailty as a potential risk factor for readmission due to a new exacerbation episode during the 90 days after hospitalization for AE- COPD and to test whether frailty could improve the identification of patients at high risk of readmission . We hypothesized that patients with moderate-to-severe frailty would be at greater risk for readmission within that period of follow up . A secondary aim was to test whether frailty could improve the accuracy with which to discriminate patients with a high risk of readmission . Our investigation was part of a wider study protocol with additional aims on the same study population . Methods :  Frailty , demographics , and disease-related factors  were measured prospect ively in 102 patients during hospitalization for AE- COPD . Some of the baseline data reported were collected as part of a previously study . Readmission data were obtained on the basis of the discharge summary from patients ’ electronic files by a research er blinded to the measurements made in the previous hospitalization . The association between frailty and readmission was assessed using bivariate analyses and multivariate logistic regression models . Whether frailty better identifies patients at high risk for readmission was evaluated by area under the receiver operator curve ( AUC ) . Results : Severely frail patients were much more likely to be readmitted than nonfrail patients ( 45 % versus 18 % ) . After adjusting for age and relevant disease-related factors in a final multivariate model , severe frailty remained an independent risk factor for 90-day readmission ( odds ratio = 5.19 ; 95 % confidence interval : 1.26–21.50 ) . Age , number of hospitalizations for exacerbations in the previous year and length of stay were also significant in this model . Additionally , frailty improved the predictive accuracy of readmission by improving the AUC . Conclusions : Multidimensional frailty predicts the risk of early hospital readmission in patients hospitalized for AE- COPD . Frailty improved the accuracy of discriminating patients at high risk for readmission . Identifying patients with frailty for targeted interventions may reduce early readmission rates 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 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
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 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 .