Journal ArticleDOI
Frailty in Older Adults Evidence for a Phenotype
Linda P. Fried,Catherine M. Tangen,Jeremy D. Walston,Anne B. Newman,Calvin H. Hirsch,John S. Gottdiener,Teresa E. Seeman,Russell P. Tracy,Willem J. Kop,B Gregory Burke,Mary Ann McBurnie +10 more
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TLDR
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.read more
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Associations of frailty with health care costs – results of the ESTHER cohort study
Jens-Oliver Bock,Hans-Helmut König,Hermann Brenner,Hermann Brenner,Walter E. Haefeli,Renate Quinzler,Herbert Matschinger,Herbert Matschinger,Kai Uwe Saum,Ben Schöttker,Dirk Heider +10 more
TL;DR: Evidence is provided that frailty is associated with increased health care costs and that the overlapping concepts of multimorbidity and frailty are both necessary to explain health care use and corresponding costs among older adults.
Journal ArticleDOI
Sarcopenia as the biological substrate of physical frailty
Francesco Landi,Riccardo Calvani,Matteo Cesari,Matteo Tosato,Anna Maria Martone,Roberto Bernabei,Graziano Onder,Emanuele Marzetti +7 more
TL;DR: A conceptual model in which sarcopenia is proposed as the biological substrate and the pathway whereby the consequences of physical frailty develop is introduced, which may open new venues for the design of interventions against physicalFrailty and promote the translation of findings to the clinical arena.
Journal ArticleDOI
Social Frailty in Community-Dwelling Older Adults as a Risk Factor for Disability
Hyuma Makizako,Hiroyuki Shimada,Kota Tsutsumimoto,Sanyoon Lee,Takehiko Doi,Sho Nakakubo,Ryo Hotta,Takao Suzuki +7 more
TL;DR: Social frailty, assessed using simple questions regarding living alone, going out less frequently compared with the prior year, visiting friends sometimes, feeling helpful to friends or family, and talking with someone every day, has a strong impact on the risk of future disability among community-dwelling older people.
Journal ArticleDOI
Validity and usefulness of hand-held dynamometry for measuring muscle strength in community-dwelling older persons.
Pedro Abizanda,José Luis Navarro,María Isabel García-Tomás,Esther López-Jiménez,Esther Martínez-Sánchez,Gema Paterna +5 more
TL;DR: It is concluded that hand-held dynamometry is valid and useful for determining functionality and it is recommended to perform three attempts for all strength measurements, except for pinch and grip, in which one is sufficient.
Journal ArticleDOI
Quality of life and physical components linked to sarcopenia: The SarcoPhAge study
Charlotte Beaudart,Jean-Yves Reginster,Jean Petermans,Sophie Gillain,A Quabron,Médéa Locquet,Justine Slomian,Fanny Buckinx,Olivier Bruyère +8 more
TL;DR: Sarcopenic subjects had a worse physical health-related quality of life, were at higher risk of falls, were more frail, and presented more often tiredness for the achievement of activities of daily living in the domain of physical functioning.
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