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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.

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Qu T Yang H Walston JD Fedarko NS Leng SX Upregulated monocytic expression of CXC chemokine ligand 10 (CXCL-10) and its relationship with serum interleukin-6 levels in the syndrome of frailtyCytokine2009 46319324
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Raji MA Al Snih S Ostir GV Markides KS Ottenbacher KJ Cognitive status and future risk of frailty in older Mexican AmericansJ Gerontol A Biol Sci Med Sci2010 6512281234
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Romero-Ortuno R Cogan L Foran T Kenny RA Fan CW Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older peopleJ Am Geriatr Soc2011 59655665
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Ronning B Wyller TB Seljeflot I Jordhoy MS Skovlund E Nesbakken A Frailty measures, inflammatory biomarkers and post-operative complications in older surgical patientsAge Ageing2010 39758761
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Schmaltz HN Fried LP Xue QL Walston J Leng SX Semba RD Chronic cytomegalovirus infection and inflammation are associated with prevalent frailty in community-dwelling older womenJ Am Geriatr Soc2005 53747754
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Semba RD Margolick JB Leng S Walston J Ricks MO Fried LP T cell subsets and mortality in older community-dwelling womenExp Gerontol2005 408187
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Semba RD Bartali B Zhou J Blaum C Ko CW Fried LP Low serum micronutrient concentrations predict frailty among older women living in the communityJ Gerontol A Biol Sci Med Sci2006 61594599
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Serra-Prat M Palomera E Clave P Puig-Domingo M Effect of age and frailty on ghrelin and cholecystokinin responses to a meal testAm J Clin Nutr2009 8914101417
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Serviddio G Romano AD Greco A Rollo T Bellanti F Altomare E Frailty syndrome is associated with altered circulating redox balance and increased markers of oxidative stressInt J Immunopathol Pharmacol2009 22819827
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Shardell M Hicks GE Miller RR Kritchevsky S Andersen D Bandinelli S Association of low vitamin D levels with the frailty syndrome in men and womenJ Gerontol A Biol Sci Med Sci2009 646975
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Terzian AS Holman S Nathwani N Robison E Weber K Young M Factors Associated with Preclinical Disability and Frailty among HIV-Infected and HIV-Uninfected Women in the Era of cARTJ Womens Health (Larchmt )2009 1819651974
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Theou O Jones GR Vandervoort AA Jakobi JM Daily muscle activity and quiescence in non-frail, pre-frail, and frail older womenExp Gerontol2010 45909917
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Varadhan R Walston J Cappola AR Carlson MC Wand GS Fried LP Higher levels and blunted diurnal variation of cortisol in frail older womenJ Gerontol A Biol Sci Med Sci2008 63190195
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Varadhan R Chaves PH Lipsitz LA Stein PK Tian J Windham BG Frailty and impaired cardiac autonomic control: new insights from principal components aggregation of traditional heart rate variability indicesJ Gerontol A Biol Sci Med Sci2009 64682687
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Vaz Fragoso CA Gahbauer EA Van Ness PH Gill TM Sleep-wake disturbances and frailty in community-living older personsJ Am Geriatr Soc2009 5720942100
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Voznesensky M Walsh S Dauser D Brindisi J Kenny AM The association between dehydroepiandosterone and frailty in older men and womenAge Ageing2009 38401406
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Walston J McBurnie MA Newman A Tracy RP Kop WJ Hirsch CH Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health StudyArch Intern Med2002 16223332341
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Wang GC Kao WH Murakami P Xue QL Chiou RB Detrick B Cytomegalovirus infection and the risk of mortality and frailty in older women: a prospective observational cohort studyAm J Epidemiol2010 17111441152
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Wang GC Talor MV Rose NR Cappola AR Chiou RB Weiss C Thyroid autoantibodies are associated with a reduced prevalence of frailty in community-dwelling older womenJ Clin Endocrinol Metab2010 9511611168
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Wilhelm-Leen ER Hall YN Deboer IH Chertow GM Vitamin D deficiency and frailty in older AmericansJ Intern Med2010 268171180
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Wu CH Chen CY Wu YC Weng LJ Baai-Shyun H Diabetes mellitus and functional impairment in Taiwanese older men and womenArch Gerontol Geriatr2010 50Suppl 1S610
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Hubbard RE Lang IA Llewellyn DJ Rockwood K Frailty, body mass index, and abdominal obesity in older peopleJ Gerontol A Biol Sci Med Sci2010 65377381
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Wu IC Shiesh SC Kuo PH Lin XZ High oxidative stress is correlated with frailty in elderly chineseJ Am Geriatr Soc2009 5716661671
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Boxer RS Kleppinger A Brindisi J Feinn R Burleson JA Kenny AM Effects of dehydroepiandrosterone (DHEA) on cardiovascular risk factors in older women with frailty characteristicsAge Ageing2010 39451458
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Drey M Pfeifer K Sieber CC Bauer JM The Fried frailty criteria as inclusion criteria for a randomized controlled trial: personal experience and literature reviewGerontology2011 571118
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Fairhall N Aggar C Kurrle SE Sherrington C Lord S Lockwood K Frailty Intervention Trial (FIT)BMC Geriatr2008 827
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Kenny AM Kleppinger A Annis K Rathier M Browner B Judge JO Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels, low bone mass, and physical frailtyJ Am Geriatr Soc2010 5811341143
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Li CM Chen CY Li CY Wang WD Wu SC The effectiveness of a comprehensive geriatric assessment intervention program for frailty in community-dwelling older people: a randomized, controlled trialArch Gerontol Geriatr2010 50Suppl 1S39S42
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Lustosa LP Coelho FM Silva JP Pereira DS Parentoni AN Dias JM The effects of a muscle resistance program on the functional capacity, knee extensor muscle strength and plasma levels of IL-6 and TNF-alpha in pre-frail elderly women: a randomized crossover clinical trial - a study protocolTrials2010 1182
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Hogan DB MacKnight C Bergman H Steering Committee Canadian Initiative on Frailty and Aging.: Models, definitions, and criteria of frailtyAging Clin Exp Res2003 15129
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Morris JN Sherwood S Mor V An assessment tool for use in identifying functionally vulnerable persons in the communityGerontologist1984 24373379
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Matthews M Lucas A Boland R Hirth V Odenheimer G Wieland D Use of a questionnaire to screen for frailty in the elderly: an exploratory studyAging Clin Exp Res2004 163440
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The psychometric properties of three self-report screening instruments for identifying frail older people in the community · 2010
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Goggins WB Woo J Sham A Ho SC Frailty index as a measure of biological age in a Chinese populationJ Gerontol A Biol Sci Med Sci2005 6010461051
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Yashin AI Arbeev KG Kulminski A Akushevich I Akushevich L Ukraintseva SV Cumulative index of elderly disorders and its dynamic contribution to mortality and longevityRejuvenation Res2007 107586
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Hastings SN Purser JL Johnson KS Sloane RJ Whitson HE Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency departmentJ Am Geriatr Soc2008 5616511657
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Dupre ME Gu D Warner DF Yi Z Frailty and type of death among older adults in China: prospective cohort studyBMJ2009 338b1175
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Gu D Dupre ME Sautter J Zhu H Liu Y Yi Z Frailty and mortality among Chinese at advanced agesJ Gerontol B Psychol Sci Soc Sci2009 64279289
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Garcia-Gonzalez JJ Garcia-Pena C Franco-Marina F Gutierrez-Robledo LM A frailty index to predict the mortality risk in a population of senior Mexican adultsBMC Geriatr2009 947
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Armstrong JJ Stolee P Hirdes JP Poss JW Examining three frailty conceptualizations in their ability to predict negative outcomes for home-care clientsAge Ageing2010 39755758
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Mitnitski A Song X Skoog I Broe GA Cox JL Grunfeld E Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortalityJ Am Geriatr Soc2005 5321842189
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Rockwood K Mitnitski A Song X Steen B Skoog I Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70J Am Geriatr Soc2006 54975979
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Lucicesare A Hubbard RE Fallah N Forti P Searle SD Mitnitski A Comparison of two frailty measures in the Conselice Study of Brain AgeingJ Nutr Health Aging2010 14278281
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Song X Mitnitski A Rockwood K Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulationJ Am Geriatr Soc2010 58681687
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Chan DC Tsou HH Chen CY Chen CY Validation of the Chinese-Canadian study of health and aging clinical frailty scale (CSHA-CFS) telephone versionArch Gerontol Geriatr2010 50e74e80
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Ma SL Oyler J Glavin S Alavi A Vokes T Self-reported frailty is associated with low calcaneal bone mineral density in a multiracial population of community-dwelling elderlyOsteoporos Int2009 2018371846
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Mohile SG Xian Y Dale W Fisher SG Rodin M Morrow GR Association of a cancer diagnosis with vulnerability and frailty in older Medicare beneficiariesJ Natl Cancer Inst2009 10112061215
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Gallucci M Ongaro F Amici GP Regini C Frailty, disability and survival in the elderly over the age of seventy: Evidence from "The Treviso Longeva (TRELONG) Study"Arch Gerontol Geriatr2009 48281283
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Gill TM Allore H Holford TR Guo Z The development of insidious disability in activities of daily living among community-living older personsAm J Med2004 117484491
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Folsom AR Boland LL Cushman M Heckbert SR Rosamond WD Walston JD Frailty and risk of venous thromboembolism in older adultsJ Gerontol A Biol Sci Med Sci2007 627982
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Chang CI Chan DC Kuo KN Hsiung CA Chen CY Prevalence and correlates of geriatric frailty in a northern taiwan communityJournal of the Formosan Medical Association2011 110247257
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Masel MC Graham JE Reistetter TA Markides KS Ottenbacher KJ Frailty and health related quality of life in older Mexican AmericansHealth Qual Life Outcomes2009 770
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Berges IM Graham JE Ostir GV Markides KS Ottenbacher KJ Sex differences in mortality among older frail Mexican AmericansJ Womens Health (Larchmt)2009 1816471651
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Chen CY Wu SC Chen LJ Lue BH The prevalence of subjective frailty and factors associated with frailty in TaiwanArch Gerontol Geriatr2010 50Suppl 1S43S47
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Makary MA Segev DL Pronovost PJ Syin D Bandeen-Roche K Patel P Frailty as a predictor of surgical outcomes in older patientsJ Am Coll Surg2010 210901908
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Samper-Ternent R Al Snih S Raji MA Markides KS Ottenbacher KJ Relationship between frailty and cognitive decline in older Mexican AmericansJ Am Geriatr Soc2008 5618451852
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Fabricio-Wehbe SC Schiaveto FV Vendrusculo TR Haas VJ Dantas RA Rodrigues RA Cross-cultural adaptation and validity of the 'Edmonton Frail Scale - EFS' in a Brazilian elderly sampleRev Lat Am Enfermagem2009 1710431049
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Bilotta C Bowling A Case A Nicolini P Mauri S Castelli M Dimensions and correlates of quality of life according to frailty status: a cross-sectional study on community-dwelling older adults referred to an outpatient geriatric service in ItalyHealth Qual Life Outcomes2010 856
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Kellen E Bulens P Deckx L Schouten H Van Dijk M Verdonck I Identifying an accurate pre-screening tool in geriatric oncologyCrit Rev Oncol Hematol2010 75243248
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Metzelthin SF van Rossum E de Witte LP Hendriks MR Kempen GI The reduction of disability in community-dwelling frail older people: design of a two-arm cluster randomized controlled trialBMC Public Health2010 10511
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Kulminski A Yashin A Ukraintseva S Akushevich I Arbeev K Land K Accumulation of health disorders as a systemic measure of aging: Findings from the NLTCS dataMech Ageing Dev2006 127840848
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Kulminski AM Ukraintseva SV Akushevich IV Arbeev KG Yashin AI Cumulative index of health deficiencies as a characteristic of long lifeJ Am Geriatr Soc2007 55935940
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Kulminski A Yashin A Arbeev K Akushevich I Ukraintseva S Land K Cumulative index of health disorders as an indicator of aging-associated processes in the elderly: results from analyses of the National Long Term Care SurveyMech Ageing Dev2007 128250258
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Ridda I Lindley R MacIntyre RC The challenges of clinical trials in the exclusion zone: the case of the frail elderlyAustralas J Ageing2008 276166
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Ridda I Macintyre CR Lindley R Gao Z Sullivan JS Yuan FF Immunological responses to pneumococcal vaccine in frail older peopleVaccine2009 2716281636
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Woo J Chan R Leung J Wong M Relative contributions of geographic, socioeconomic, and lifestyle factors to quality of life, frailty, and mortality in elderlyPLoS ONE2010 5e8775
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Yang Y Lee LC Dynamics and heterogeneity in the process of human frailty and aging: evidence from the U.S. older adult populationJ Gerontol B Psychol Sci Soc Sci2010 65B246255
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Wong RY Miller WC Adverse outcomes following hospitalization in acutely ill older patientsBMC Geriatr2008 810
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Burns JM Cronk BB Anderson HS Donnelly JE Thomas GP Harsha A Cardiorespiratory fitness and brain atrophy in early Alzheimer diseaseNeurology2008 71210216
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Delbaere K Crombez G Vanderstraeten G Willems T Cambier D Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort studyAge Ageing2004 33368373
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Peterson MJ Giuliani C Morey MC Pieper CF Evenson KR Mercer V Physical activity as a preventative factor for frailty: the health, aging, and body composition studyJ Gerontol A Biol Sci Med Sci2009 646168
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Beauchet O Dubost V Gonthier R Kressig RW Dual-task-related gait changes in transitionally frail older adults: the type of the walking-associated cognitive task mattersGerontology2005 514852
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Kressig RW Wolf SL Sattin RW O'Grady M Greenspan A Curns A Associations of demographic, functional, and behavioral characteristics with activity-related fear of falling among older adults transitioning to frailtyJ Am Geriatr Soc2001 4914561462
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Kressig RW Gregor RJ Oliver A Waddell D Smith W O'Grady M Temporal and spatial features of gait in older adults transitioning to frailtyGait Posture2004 203035
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Abou-Raya S Abou-Raya A Osteoporosis and congestive heart failure (CHF) in the elderly patient: double disease burdenArch Gerontol Geriatr2009 49250254
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Ahmed NN Sherman SJ Vanwyck D Frailty in Parkinson's disease and its clinical implicationsParkinsonism Relat Disord2008 14334337
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Alcala MV Puime AO Santos MT Barral AG Montalvo JI Zunzunegui MV Prevalence of frailty in an elderly Spanish urban population. Relationship with comorbidity and disability]. [SpanishAten Primaria2010 42520527
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Alvarado BE Zunzunegui MV Beland F Bamvita JM Life course social and health conditions linked to frailty in Latin American older men and womenJ Gerontol A Biol Sci Med Sci2008 6313991406
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Avila-Funes JA Amieva H Barberger-Gateau P Le GM Raoux N Ritchie K Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city studyJ Am Geriatr Soc2009 57453461
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Blyth FM Rochat S Cumming RG Creasey H Handelsman DJ Le Couteur DG Pain, frailty and comorbidity on older men: the CHAMP studyPain2008 140224230
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Boxer R Kleppinger A Ahmad A Annis K Hager D Kenny A The 6-minute walk is associated with frailty and predicts mortality in older adults with heart failureCongestive Heart Failure2010 16208213
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Boyle PA Buchman AS Bennett DA Purpose in life is associated with a reduced risk of incident disability among community-dwelling older personsAm J Geriatr Psychiatry2010 1810931102
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Buchman AS Boyle PA Wilson RS Tang Y Bennett DA Frailty is associated with incident Alzheimer's disease and cognitive decline in the elderlyPsychosom Med2007 69483489
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Drey M Wehr H Wehr G Uter W Lang F Rupprecht R The frailty syndrome in general practitioner care: a pilot studyZeitschrift fur Gerontologie und Geriatrie2011 444854
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Espinoza SE Hazuda HP Frailty in older Mexican-American and European-American adults: is there an ethnic disparity?J Am Geriatr Soc2008 5617441749
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Espinoza SE Jung I Hazuda H Lower frailty incidence in older Mexican Americans than in older European Americans: the San Antonio Longitudinal Study of AgingJ Am Geriatr Soc2010 5821422148
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Ewe SH Ajmone MN Pepi M Delgado V Tamborini G Muratori M Impact of left ventricular systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation for severe aortic stenosisAmerican Heart Journal2010 16011131120
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Fairhall N Sherrington C Kurrle SE Lord SR Cameron ID ICF participation restriction is common in frail, community-dwelling older people: an observational cross-sectional studyPhysiotherapy2011 972632
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Gill TM Gahbauer EA Allore HG Han L Transitions between frailty states among community-living older personsArch Intern Med2006 166418423
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Gray SL LaCroix AZ Aragaki AK McDermott M Cochrane BB Kooperberg CL Angiotensin-converting enzyme inhibitor use and incident frailty in women aged 65 and older: prospective findings from the Women's Health Initiative Observational StudyJ Am Geriatr Soc2009 57297303
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Hubbard RE O'Mahony MS Calver BL Woodhouse KW Plasma esterases and inflammation in ageing and frailtyEur J Clin Pharmacol2008 64895900
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Jurschik Gimenez P Escobar Bravo MA Nuin Orrio C Botigue Satorra T [Frailty criteria in the elderly: a pilot study]. [Spanish]Aten Primaria2011 43190196
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Kenny AM Waynik IY Smith J Fortinsky R Kleppinger A McGee D Association between level of frailty and bone mineral density in community-dwelling menJ Clin Densitom2006 9309314
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Kim MJ Yabushita N Kim MK Nemoto M Seino S Tanaka K Mobility performance tests for discriminating high risk of frailty in community-dwelling older womenArch Gerontol Geriatr2010 51192198
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Le Couteur DG Benson VL McMahon AC Blyth F Handelsman DJ Seibel MJ Determinants of serum-induced SIRT1 expression in older men: the CHAMP studyJ Gerontol A Biol Sci Med Sci2011 6638
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Leung JM Tsai TL Sands LP Brief report: preoperative frailty in older surgical patients is associated with early postoperative deliriumAnesthesia & Analgesia2011 11211991201
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Masel MC Ostir GV Ottenbacher KJ Frailty, mortality, and health-related quality of life in older Mexican AmericansJ Am Geriatr Soc2010 5821492153
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Onen NF Agbebi A Shacham E Stamm KE Frailty among HIV-infected persons in an urban outpatient care settingJ Infect2009 59346352
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Purser JL Kuchibhatla MN Fillenbaum GG Harding T Peterson ED Alexander KP Identifying frailty in hospitalized older adults with significant coronary artery diseaseJ Am Geriatr Soc2006 5416741681
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No notice
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