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Measures of frailty in population-based studies: an overview

Kim Bouillon, Mika Kivimaki, Mark Hamer and 5 more

BMC Geriatrics · 2013 · Review

Abstract

Background. Although research productivity in the field of frailty has risen exponentially in recent years, there remains a lack of consensus regarding the measurement of this syndrome. This overview offers three services: first, we provide a comprehensive catalogue of current frailty measures; second, we evaluate their reliability and validity; third, we report on their popularity of use.

Methods. In order to identify relevant publications, we searched MEDLINE (from its inception in 1948 to May 2011); scrutinized the reference sections of the retrieved articles; and consulted our own files. An indicator of the frequency of use of each frailty instrument was based on the number of times it had been utilized by investigators other than the originators.

Results. Of the initially retrieved 2,166 papers, 27 original articles described separate frailty scales. The number (range: 1 to 38) and type of items (range of domains: physical functioning, disability, disease, sensory impairment, cognition, nutrition, mood, and social support) included in the frailty instruments varied widely. Reliability and validity had been examined in only 26% (7/27) of the instruments. The predictive validity of these scales for mortality varied: for instance, hazard ratios/odds ratios (95% confidence interval) for mortality risk for frail relative to non-frail people ranged from 1.21 (0.78; 1.87) to 6.03 (3.00; 12.08) for the Phenotype of Frailty and 1.57 (1.41; 1.74) to 10.53 (7.06; 15.70) for the Frailty Index. Among the 150 papers which we found to have used at least one of the 27 frailty instruments, 69% (n = 104) reported on the Phenotype of Frailty, 12% (n = 18) on the Frailty Index, and 19% (n = 28) on one of the remaining 25 instruments.

Conclusions. Although there are numerous frailty scales currently in use, reliability and validity have rarely been examined. The most evaluated and frequently used measure is the Phenotype of Frailty.

References 239

1.
World Health OrganizationAgeing and life course2011 http://www.who.int/ageing/age_friendly_cities/en/index.html
Not in our library
2.
A multidisciplinary systematic literature review on frailty: Overview of the methodology used by the Canadian Initiative on Frailty and Aging · 2009
Not checked
3.
Walston J Hadley EC Ferrucci L Guralnik JM Newman AB Studenski SA Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older AdultsJ Am Geriatr Soc2006 549911001
Not in our library10.1111/j.1532-5415.2006.00745.x
4.
Boyd CM Xue QL Simpson CF Guralnik JM Fried LP Frailty, hospitalization, and progression of disability in a cohort of disabled older womenAm J Med2005 11812251231
Not in our library10.1016/j.amjmed.2005.01.062
5.
Woods NF LaCroix AZ Gray SL Aragaki A Cochrane BB Brunner RL Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational StudyJ Am Geriatr Soc2005 5313211330
Not in our library10.1111/j.1532-5415.2005.53405.x
6.
Bandeen-Roche K Xue QL Ferrucci L Walston J Guralnik JM Chaves P Phenotype of frailty: characterization in the women’s health and aging studiesJ Gerontol A Biol Sci Med Sci2006 61262266
Not in our library10.1093/gerona/61.3.262
7.
Cawthon PM Marshall LM Michael Y Dam TT Ensrud KE Barrett-Connor E Frailty in older men: prevalence, progression, and relationship with mortalityJ Am Geriatr Soc2007 5512161223
Not in our library10.1111/j.1532-5415.2007.01259.x
8.
Ensrud KE Ewing SK Taylor BC Fink HA Stone KL Cauley JA Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fracturesJ Gerontol A Biol Sci Med Sci2007 62744751
Not in our library10.1093/gerona/62.7.744
9.
Avila-Funes JA Helmer C Amieva H Barberger-Gateau P Le Goff M Ritchie K Frailty among community-dwelling elderly people in France: the three-city studyJ Gerontol A Biol Sci Med Sci2008 6310891096
Not in our library10.1093/gerona/63.10.1089
10.
Kulminski AM Ukraintseva SV Kulminskaya IV Arbeev KG Land K Yashin AI Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health StudyJ Am Geriatr Soc2008 56898903
Not in our library10.1111/j.1532-5415.2008.01656.x
11.
Sarkisian CA Gruenewald TL Boscardin WJ Seeman TE Preliminary evidence for subdimensions of geriatric frailty: the MacArthur study of successful agingJ Am Geriatr Soc2008 5622922297
Not in our library10.1111/j.1532-5415.2008.02041.x
12.
Al Snih S Graham JE Ray LA Samper-Ternent R Markides KS Ottenbacher KJ Frailty and incidence of activities of daily living disability among older Mexican AmericansJ Rehabil Med2009 41892897
Not in our library10.2340/16501977-0424
13.
Buchman AS Wilson RS Bienias JL Bennett DA Change in frailty and risk of death in older personsExp Aging Res2009 356182
Not in our library10.1080/03610730802545051
14.
Graham JE Al Snih S Berges IM Ray LA Markides KS Ottenbacher KJ Frailty and 10-year mortality in community-living Mexican American older adultsGerontology2009 55644651
Not in our library10.1159/000235653
15.
Kiely DK Cupples LA Lipsitz LA Validation and comparison of two frailty indexes: the MOBILIZE Boston StudyJ Am Geriatr Soc2009 5715321539
Not in our library10.1111/j.1532-5415.2009.02394.x
16.
Ottenbacher KJ Graham JE Al Snih S Raji M Samper-Ternent R Ostir GV Mexican Americans and frailty: findings from the Hispanic established populations epidemiologic studies of the elderlyAm J Public Health2009 99673679
Not in our library10.2105/ajph.2008.143958
17.
Gill TM Gahbauer EA Han L Allore HG Trajectories of disability in the last year of lifeN Engl J Med2010 36211731180
Not in our library10.1056/nejmoa0909087
18.
Rochat S Cumming RG Blyth F Creasey H Handelsman D Le Couteur DG Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men ProjectAge Ageing2010 39228233
Not in our library10.1093/ageing/afp257
19.
Seematter-Bagnoud L Santos-Eggimann B Rochat S Martin E Karmaniola A Aminian K Vulnerability in high-functioning persons aged 65 to 70 years: the importance of the fear factorAging Clin Exp Res2010 22212218
Not in our library10.1007/bf03324799
20.
Wong CH Weiss D Sourial N Karunananthan S Quail JM Wolfson C Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional studyAging Clin Exp Res2010 225462
Not in our library10.1007/bf03324816
21.
Bouillon K Sabia S Jokela M Gale CR Singh-Manoux A Shipley MJ Validating a widely used measure of frailty: are all sub-components necessary? Evidence from the Whitehall II cohort studyAge (forthcoming)
Not in our library10.1007/s11357-012-9446-2
22.
Faber MJ Bosscher RJ Chin APM van Wieringen PC Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trialArch Phys Med Rehabil2006 87885896
Not in our library10.1016/j.apmr.2006.04.005
23.
Effect of Telephone Exercise Counseling on Frailty in Older Veterans: Project LIFE · 2007
Not checked
24.
Kenny AM Boxer RS Kleppinger A Brindisi J Feinn R Burleson JA Dehydroepiandrosterone combined with exercise improves muscle strength and physical function in frail older womenJ Am Geriatr Soc2010 5817071714
Not in our library10.1111/j.1532-5415.2010.03019.x
25.
Srinivas-Shankar U Roberts SA Connolly MJ O’Connell MD Adams JE Oldham JA Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled studyJ Clin Endocrinol Metab2010 95639650
Not in our library10.1210/jc.2009-1251
26.
Stroup DF Berlin JA Morton SC Olkin I Williamson GD Rennie D Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) groupJAMA2000 28320082012
Not in our library10.1001/jama.283.15.2008
27.
Streiner DL Norman GR Health measurement scales: a practical guide to their development and use2008 4Oxford, UK: Oxford University Press
Not in our library
28.
Rockwood K What would make a definition of frailty successful?Age Ageing2005 34432434
Not in our library10.1093/ageing/afi146
29.
Elsevier. Scopus2011 http://www.scopus.com
Not in our library
30.
Dayhoff NE Suhrheinrich J Wigglesworth J Topp R Moore S Balance and muscle strength as predictors of frailty among older adultsJ Gerontol Nurs1998 241827
Not in our library10.3928/0098-9134-19980701-06
31.
Strawbridge WJ Shema SJ Balfour JL Higby HR Kaplan GA Antecedents of frailty over three decades in an older cohortJ Gerontol B Psychol Sci Soc Sci1998 53S916
Not in our library10.1093/geronb/53b.1.s9
32.
Rockwood K Stadnyk K MacKnight C McDowell I Hebert R Hogan DB A brief clinical instrument to classify frailty in elderly peopleLancet1999 353205206
Not in our library10.1016/s0140-6736(98)04402-x
33.
Steverink N Slaets JPJ Schuurmans H van Lis M Measuring frailty: developing and testing the GFI (Groningen Frailty Indicator) [abstract]Gerontologist2001 41236237
Not in our library
34.
Mitnitski AB Graham JE Mogilner AJ Rockwood K Frailty, fitness and late-life mortality in relation to chronological and biological ageBMC Geriatr2002 21
Not in our library10.1186/1471-2318-2-1
35.
Gerdhem P Ringsberg KA Magnusson H Obrant KJ Akesson K Bone mass cannot be predicted by estimations of frailty in elderly ambulatory womenGerontology2003 49168172
Not in our library10.1159/000069169
36.
Cacciatore F Abete P Mazzella F Viati L Della Morte D D’Ambrosio D Frailty predicts long-term mortality in elderly subjects with chronic heart failureEur J Clin Invest2005 35723730
Not in our library10.1111/j.1365-2362.2005.01572.x
37.
Rockwood K Song X MacKnight C Bergman H Hogan DB McDowell I A global clinical measure of fitness and frailty in elderly peopleCMAJ2005 173489495
Not in our library10.1503/cmaj.050051
38.
Amici A Baratta A Linguanti A Giudice G Servello A Scalise C The Marigliano-Cacciafesta polypathological scale: a tool for assessing fragilityArch Gerontol Geriatr2008 46327334
Not in our library10.1016/j.archger.2007.05.007
39.
Kanauchi M Kubo A Kanauchi K Saito Y Frailty, health-related quality of life and mental well-being in older adults with cardiometabolic risk factorsInt J Clin Pract2008 6214471451
Not in our library10.1111/j.1742-1241.2008.01830.x
40.
Gobbens RJ van Assen MA Luijkx KG Wijnen-Sponselee MT Schols JM The Tilburg Frailty Indicator: psychometric propertiesJ Am Med Dir Assoc2010 11344355
Not in our library10.1016/j.jamda.2009.11.003

All 239 references

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