A standard procedure for creating a frailty index
TL;DR: A systematic process for creating a frailty index, which relates deficit accumulation to the individual risk of death, showed reproducible properties in the Yale Precipitating Events Project cohort study.
Abstract: Background
Frailty can be measured in relation to the accumulation of deficits using a frailty index. A frailty index can be developed from most ageing databases. Our objective is to systematically describe a standard procedure for constructing a frailty index.
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TL;DR: Developing more efficient methods to detect frailty and measure its severity in routine clinical practice would greatly inform the appropriate selection of elderly people for invasive procedures or drug treatments and would be the basis for a shift in the care of frail elderly people towards more appropriate goal-directed care.
5,456 citations
Katholieke Universiteit Leuven1, University of Sheffield2, Charité3, Medical University of Vienna4, University of Bologna5, Vita-Salute San Raffaele University6, University of Manchester7, University of Lugano8, Netherlands Cancer Institute9, Monash University10, St James's University Hospital11, Erasmus University Medical Center12, University of Aberdeen13, Aberdeen Royal Infirmary14, Wrightington, Wigan and Leigh NHS Foundation Trust15, Cardiff University16, University of Amsterdam17, University of Lyon18, Utrecht University19, University of Liverpool20
TL;DR: The 2020 EAU-EANM-ESTRO-ESUR-SIOG guidelines on PCa guidelines summarise the most recent findings and advice for their use in clinical practice and include a strong recommendation to consider moderate hypofractionation in intermediate-risk patients.
1,369 citations
TL;DR: To evaluate the prevalence and 10‐year outcomes of frailty in older adults in relation to deficit accumulation, a large number of older adults diagnosed with frailty have a history of deficit accumulation.
Abstract: OBJECTIVES: To evaluate the prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation.
DESIGN: Prospective cohort study.
SETTING: The National Population Health Survey of Canada, with frailty estimated at baseline (1994/95) and mortality follow-up to 2004/05.
PARTICIPANTS: Community-dwelling older adults (N=2,740, 60.8% women) aged 65 to 102 from 10 Canadian provinces. During the 10-year follow-up, 1,208 died.
MEASUREMENTS: Self-reported health information was used to construct a frailty index (Frailty Index) as a proportion of deficits accumulated in individuals. The main outcome measure was mortality.
RESULTS: The prevalence of frailty increased with age in men and women (correlation coefficient=0.955–0.994, P<.001). The Frailty Index estimated that 622 (22.7%, 95% confidence interval (CI)=21.0–24.4%) of the sample was frail. Frailty was more common in women (25.3%, 95% CI=23.2–27.5%) than in men (18.6%, 95% CI=15.9–21.3%). For those aged 85 and older, the Frailty Index identified 39.1% (95% CI=31.3–46.9%) of men as frail, compared with 45.1% (95% CI=39.7–50.5%) of women. Frailty significantly increased the risk of death, with an age- and sex-adjusted hazard ratio for the Frailty Index of 1.57 (95% CI=1.41–1.74).
CONCLUSION: The prevalence of frailty increases with age and at any age lessens survival. The Frailty Index approach readily identifies frail people at risk of death, presumably because of its use of multiple health deficits in multidimensional domains.
820 citations
Cites background from "A standard procedure for creating a..."
...7) to the percentage of deficits that any person can accumulate; after that limit, death becomes inevitable.(35,43) Here, by age 95, virtually everyone in the sample had a Frailty Index value of 0....
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..., presbyopia, which is almost universal at age 55).(15,35) Data were coded so that a 1 represented the presence of a problem and 0 represented the absence of the problem....
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TL;DR: Understanding people and their needs as deficits accumulate is an exciting challenge for clinical research on frailty and its management by geriatricians.
749 citations
Cites background or methods from "A standard procedure for creating a..."
...A frailty index can be generated from almost any set of health-related variables, as long as a few criteria are met.(9) The criteria for an item to be considered as a deficit are that the item needs to be acquired, age-associated, and associated with an adverse outcome and should not saturate too early....
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...A method has been proposed for how a frailty index can be derived from existing health databases by proposing criteria for deficits and procedures for counting deficits.(9) We count deficits as a whole range of health problems, which come in many forms: symptoms, signs, laboratory abnormalities, diseases, and disabilities....
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TL;DR: How well these measurements operationalise frailty according to Clegg's guidelines for frailty classification is examined - that is: their accuracy in identifying frailty; their basis on biological causative theory; and their ability to reliably predict patient outcomes and response to potential therapies.
740 citations
References
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TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
76,181 citations
"A standard procedure for creating a..." refers background in this paper
...For the MMSE, we recoded deficits according to severity of impairment [20]....
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...5%) were white, with a mean Mini-Mental State Examination (MMSE) [17] score of 26....
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...%) were white, with a mean Mini-Mental State Examination (MMSE) [17] score of 26.8 (SD = 2.50)....
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01 Jan 2002
TL;DR: The Mini-Mental State (MMS) as mentioned in this paper is a simplified version of the standard WAIS with eleven questions and requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Abstract: EXAMINATION of the mental state is essential in evaluating psychiatric patients.1 Many investigators have added quantitative assessment of cognitive performance to the standard examination, and have documented reliability and validity of the several “clinical tests of the sensorium”.2*3 The available batteries are lengthy. For example, WITHERS and HINTON’S test includes 33 questions and requires about 30 min to administer and score. The standard WAIS requires even more time. However, elderly patients, particularly those with delirium or dementia syndromes, cooperate well only for short periods.4 Therefore, we devised a simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely. It is “mini” because it concentrates only on the cognitive aspects of mental functions, and excludes questions concerning mood, abnormal mental experiences and the form of thinking. But within the cognitive realm it is thorough. We have documented the validity and reliability of the MMS when given to 206 patients with dementia syndromes, affective disorder, affective disorder with cognitive impairment “pseudodementia”5T6), mania, schizophrenia, personality disorders, and in 63 normal subjects.
70,887 citations
Book•
01 Jan 1993TL;DR: This article presents bootstrap methods for estimation, using simple arguments, with Minitab macros for implementing these methods, as well as some examples of how these methods could be used for estimation purposes.
Abstract: This article presents bootstrap methods for estimation, using simple arguments. Minitab macros for implementing these methods are given.
37,183 citations
TL;DR: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition, and finds that there is an intermediate stage identifying those at high risk of frailty.
Abstract: Background: Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established.
Methods: To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality.
Results: Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline).
Conclusions: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.
16,255 citations