Cited by 1,141Frailty in Older AdultsNutrition and Health in AgingPharmaceutical Practices and Patient Outcomes

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Transitions Between Frailty States Among Community-Living Older Persons

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Gill, Thomas M., Gahbauer, Evelyne A., Allore, Heather G., Han, Ling·2006·Archives of Internal Medicine

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Abstract

BACKGROUND: Little is known about the natural course of frailty. We performed a prospective study to determine the transition rates between frailty states and to evaluate the effect of the preceding frailty state on subsequent frailty transitions. METHODS: We studied 754 community-living persons, aged 70 years or older, who were nondisabled in 4 essential activities of daily living. Frailty, assessed every 18 months for 54 months, was defined on the basis of weight loss, exhaustion, low physical activity, muscle weakness, and slow walking speed. Participants were classified as frail if they met 3 or more of these criteria, as prefrail if they met 1 or 2 of the criteria, and as nonfrail if they met none of the criteria. RESULTS: Of the 754 participants, 434 (57.6%) had at least 1 transition between any 2 of the 3 frailty states during 54 months. The rates were 36.8%, 21.5%, and 9.2% for 1, 2, and 3 transitions, respectively. During the 18-month intervals, transitions to states of greater frailty were more common (rates up to 43.3%) than transitions to states of lesser frailty (rates up to 23.0%), and the probability of transitioning from being frail to nonfrail was very low (rates, 0%-0.9%), even during an extended period. The likelihood of transitioning between frailty states was highly dependent on one's preceding frailty state. CONCLUSIONS: Frailty among older persons is a dynamic process, characterized by frequent transitions between frailty states over time. Our findings suggest ample opportunity for the prevention and remediation of frailty.

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Aging in HIV-Infected Subjects: A New Scenario and a New View
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MethodSelf-citation
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Background
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Background
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Background
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Background
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Background
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“tions were progression of frailty and only 2 persons went from frail to non-frail.(89) Finally, the setting, both of where the patient resides,”
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BackgroundMethodSelf-citation
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Background
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“Frailty can be reversed spontaneously [29, 31] or by exercise-based interventions [32].”
Background
A bio-psycho-social approach for frailty amongst Singaporean Chinese community-dwelling older adults – evidence from the Singapore Longitudinal Aging Study
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Prevalence of Frailty Indicators and Association with Socioeconomic Status in Middle-Aged and Older Adults in a Swiss Region with Universal Health Insurance Coverage: A Population-Based Cross-Sectional Study
Guessous, I., Luthi, J., Bowling, C. B., Theler, J., Paccaud, F., Gaspoz, J., & McClellan, W. (2014) · Journal of Aging Research · doi:10.1155/2014/198603 · Cited by 55
Fenótipo de fragilidade: influência de cada item na determinação da fragilidade em idosos comunitários – Rede Fibra
da Silva, S. L. A., Neri, A. L., Ferriolli, E., Lourenço, R. A., & Dias, R. C. (2016) · Ciência & Saúde Coletiva · doi:10.1590/1413-812320152111.23292015 · Cited by 55
Nutrition and Physical Activity Clinical Practice Guidelines for Older Adults Living with Frailty
Lorbergs, A. L., Prorok, J. C., Holroyd-Leduc, J. M., B̀ouchard, D. R., Giguere, A. M. C., Gramlich, L. M., Keller, H., Tang, A., Racey, M., Ali, M. U., et al. (2021) · The Journal of Frailty & Aging · doi:10.14283/jfa.2021.51 · Cited by 58
“Since the ability to reduce frailty severity is more likely in its early stages, preventing frailty in the first place or intervening when pre-frailty is present are considered the most effective means of preserving older adults’ independence and quality of life (9, 11).”
Background
The independent role of inflammation in physical frailty among older adults with mild cognitive impairment and mild-to-moderate Alzheimer's disease
Tay, L. B. G., Lim, W. S., Chan, M. Y., Ye, R. J., & Chong, M. S. (2015) · The journal of nutrition health & aging · doi:10.1007/s12603-015-0617-6 · Cited by 57
“Unlike AD where there is a lack of effective disease-modifying therapies, the development of physical frailty is a dynamic process with potential for reversibility (9, 10).”
Systematic review on the predictive ability of frailty assessment measures in cardiac surgery
Abdullahi, Y. S., Athanasopoulos, L. V., Casula, R., Moscarelli, M., Bagnall, N. M., Ashrafian, H., & Athanasiou, T. (2016) · Interactive Cardiovascular and Thoracic Surgery · doi:10.1093/icvts/ivw374 · Cited by 54
Sensor-based characterization of daily walking: a new paradigm in pre-frailty/frailty assessment
Kumar, D. P., Toosizadeh, N., Mohler, J. M., Ehsani, H., Mannier, C., & Laksari, K. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01572-1 · Cited by 57
Preserved Ratio Impaired Spirometry and COPD Accelerate Frailty Progression
He, D., Yan, M., Zhou, Y., Ge, H., Zhang, X., Xu, Y., Liu, C., Ying, K., & Zhu, Y. (2023) · CHEST Journal · doi:10.1016/j.chest.2023.07.020 · Cited by 53
Multi-component health promotion and disease prevention for community-dwelling frail elderly persons: a systematic review
Gustafsson, S., Edberg, A., Johansson, B. E. A., & Dahlin‐Ivanoff, S. (2009) · European Journal of Ageing · doi:10.1007/s10433-009-0132-x · Cited by 54
Effects of a Modified Hospital Elder Life Program on Frailty in Individuals Undergoing Major Elective Abdominal Surgery
Chen, C., Chen, C., Lai, I., Huang, G., Saczynski, J. S., & Inouye, S. K. (2014) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12651 · Cited by 53
Healthy ageing: Evidence that improvement is possible at every age
Michel, J., DREUX, C., & Vacheron, A. (2016) · European Geriatric Medicine · doi:10.1016/j.eurger.2016.04.014 · Cited by 54
“3%) [85].”
Specifying the content of home-based health behaviour change interventions for older people with frailty or at risk of frailty: an exploratory systematic review
Gardner, B., Jovicić, A., Belk, C., Kharicha, K., Iliffe, S., Manthorpe, J., Goodman, C. M., Drennan, V. M., & Walters, K. R. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-014127 · Cited by 54
Frailty and the gut
Sabatino, A. D., Lenti, M. V., Cammalleri, L., Corazza, G. R., & Pilotto, A. (2018) · Digestive and Liver Disease · doi:10.1016/j.dld.2018.03.010 · Cited by 55
An exploration of the association between frailty and muscle fatigue
Theou, O., Jones, G. R., Overend, T. J., Kloseck, M., & Vandervoort, A. A. (2008) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/h08-058 · Cited by 59
“Early stages of frailty are more common in community-dwelling older adults, whereas end stages of frailty are more common in nursing home populations (Fried et al. 2001; Gill et al. 2006).”
Background
Construction of the secondary care administrative records frailty (SCARF) index and validation on older women with operable invasive breast cancer in England and Wales: a cohort study
Jauhari, Y., Gannon, M. R., Dodwell, D. J., Horgan, K. J., Clements, K., Medina, J., Tsang, C., Robinson, T. G., Tang, S. S.-K., Pettengell, R., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-035395 · Cited by 53
The effects of a home-based exercise program on physical function in frail older adults.
Matsuda, P. N., Shumway‐Cook, A., & Ciol, M. A. (2010) · PubMed · Cited by 52
Rationale and Study Design of a Randomized Clinical Trial of Metformin to Prevent Frailty in Older Adults With Prediabetes
Espinoza, S. E., Musi, N., Wang, C.-P., Michalek, J. E., Orsak, B., Romo, T. Q., Powers, B., Conde, A., Moris, M., Bair‐Kelps, D., et al. (2019) · The Journals of Gerontology Series A · doi:10.1093/gerona/glz078 · Cited by 52
“Power analysis A prior study has shown that 44%–53% of nondisabled, communitydwelling older adults will worsen in frailty status over an 18-month period (32).”
Depressive symptoms and frailty
St. John, P. D., Tyas, S. L., & Montgomery, P. R. (2013) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.3866 · Cited by 51
“Without multiple measurements over time, it is difficult to establish the causal nature of this association or to account for bidirectional associations: Frailty may be a dynamic process with a fluctuating course, similar to disability (Gill et al., 2006; Hardy and Gill, 2004).”
Background
Frailty transitions and cognitive function among South Korean older adults
Nari, F., Jang, B. N., Youn, H. M., Jeong, W., Jang, S., & Park, E. (2021) · Scientific Reports · doi:10.1038/s41598-021-90125-6 · Cited by 55
Biomarkers of frailty
Assar, M. E., Rodríguez-Sánchez, I., Álvarez‐Bustos, A., & Rodríguez‐Mañas, L. (2024) · Molecular Aspects of Medicine · doi:10.1016/j.mam.2024.101271 · Cited by 53
A simple validated questionnaire predicted functional decline in community-dwelling older persons: prospective cohort studies
Suijker, J. J., Buurman, B. M., van Rijn, M., van Dalen, M. T., ter Riet, G., van Geloven, N., de Haan, R. J., van Charante, E. P. M., & de Rooij, S. E. (2014) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2014.05.014 · Cited by 51
Short Communication: The Veterans Aging Cohort Study Index Is an Effective Tool to Assess Baseline Frailty Status in a Contemporary Cohort of HIV-Infected Persons
Escota, G. V., Patel, P., Brooks, J. T., Bush, T. J., Conley, L. J., Baker, J. V., Kojic, E. M., Hammer, J., Önen, N. F., & for the SUN Study Investigators (2014) · AIDS Research and Human Retroviruses · doi:10.1089/aid.2014.0225 · Cited by 51
Fragilidade em idosos no município de São Paulo: prevalência e fatores associados
Duarte, Y. A. D. O., Nunes, D. P., de Andrade, F. B., Corona, L. P., de Brito, T. R. P., Santos, J. L. F., & Lebrão, M. L. (2018) · Revista Brasileira de Epidemiologia · doi:10.1590/1980-549720180021.supl.2 · Cited by 51
Effects of home telemonitoring on transitions between frailty states and death for older adults: a randomized controlled trial
Upatising, B., Hanson, Kim, Cha, Yih, Y., & Takahashi, P. Y. (2013) · International Journal of General Medicine · doi:10.2147/ijgm.s40576 · Cited by 50
“A previous study of frailty transition lasted longer with extended intervals between follow-ups (every 18 months for a total of 54 months).(2) Thus, over a longer period, one might observe a gradual decline in functional status, whereas a shorter observation period highlights a potential improvement from baseline.”
Influential
Prefrailty and Chronic Morbidity in the Youngest Old: An Insight from the Lausanne Cohort Lc65+
Danon‐Hersch, N., Rodondi, N., Spagnoli, J., & Santos‐Eggimann, B. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.04113.x · Cited by 49
“The stage of prefrailty also deserves special interest because frailty is a continuous process that may be partly reversible, especially in its initial phases.(10) Whereas the association between cardiovascular disease and frailty has been demonstrated,(11,12) the current From the *Institute of Social and Preventive M…”
Background
Emerging biomarkers and screening for cognitive frailty
Ruan, Q., D’Onofrio, G., Sancarlo, D., Greco, A., Lozupone, M., Seripa, D., Panza, F., & Yu, Z. (2017) · Aging Clinical and Experimental Research · doi:10.1007/s40520-017-0741-8 · Cited by 53
“Frailty has been shown to be a dynamic process in older age, characterized by frequent transitions between frailty states over time [28].”
Background
Validity and Responsiveness of the FRAIL Scale in Middle-Aged Women
Susanto, M., Hubbard, R. E., & Gardiner, P. A. (2017) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.08.003 · Cited by 50
Sex Differences in Mortality among Older Frail Mexican Americans
Bergés, I.-M., Graham, J. E., Ostir, G. V., Markides, K. S., & Ottenbacher, K. J. (2009) · Journal of Women s Health · doi:10.1089/jwh.2008.1083 · Cited by 50
Evaluative Frailty Index for Physical Activity (EFIP): A Reliable and Valid Instrument to Measure Changes in Level of Frailty
de Vries, N. M., Staal, J. B., Rikkert, M. G. M. O., & der Sanden, M. W. G. N. (2012) · Physical Therapy · doi:10.2522/ptj.20120127 · Cited by 49
Mobility training for increasing mobility and functioning in older people with frailty
Treacy, D., Hassett, L. M., Schurr, K., Fairhall, N., Cameron, I. D., & Sherrington, C. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010494.pub2 · Cited by 59
Framingham cardiovascular disease risk scores and incident frailty: the English longitudinal study of ageing
Galé, C. R., Cooper, C. C., & Sayer, A. A. (2014) · AGE · doi:10.1007/s11357-014-9692-6 · Cited by 50
“Whereas transitions to a state of greater frailty are more common than movement in the reverse direction, there is sufficient evidence of the latter to suggest that frailty is potentially reversible, at least in the less severe stage (Espinoza et al. 2012; Gill et al. 2006).”
Should Frailty Status Always Be Considered When Treating the Elderly Patient?
Theou, O., & Rockwood, K. J. (2012) · Aging Health · doi:10.2217/ahe.12.8 · Cited by 50
Factors Associated With Recovery of Prehospital Function Among Older Persons Admitted to a Nursing Home With Disability After an Acute Hospitalization
Gill, T. M., Gahbauer, E. A., Han, L., & Allore, H. G. (2009) · The Journals of Gerontology Series A · doi:10.1093/gerona/glp115 · Cited by 49
Self-citation
The Italian Version of the Tilburg Frailty Indicator
Mulasso, A., Roppolo, M., Gobbens, R. J. J., & Rabaglietti, E. (2015) · Research on Aging · doi:10.1177/0164027515606192 · Cited by 49
“Studies that investigate a TFI cutoff for identifying prefrail individuals are also suggested, since the likelihood of transitioning from the prefrailty status to the robust one is higher compared to that from frailty to robust (Gill, Gahbauer, Allore, & Han, 2006).”
Rationale and design of the allogeneiC human mesenchymal stem cells (hMSC) in patients with aging fRAilTy via intravenoUS delivery (CRATUS) study: A phase I/II, randomized, blinded and placebo controlled trial to evaluate the safety and potential efficacy of allogeneic human mesenchymal stem cell infusion in patients with aging frailty
Golpanian, S., DiFede, D. L., Pujol, M. V., Lowery, M. H., Levis-Dusseau, S., Goldstein, B. J., Schulman, I. H., Longsomboon, B., Wolf, A., Khan, A., et al. (2016) · Oncotarget · doi:10.18632/oncotarget.7727 · Cited by 48
The impact of age-related cataract on measures of frailty in an aging global population
Fukuoka, H., & Afshari, N. A. (2016) · Current Opinion in Ophthalmology · doi:10.1097/icu.0000000000000338 · Cited by 49
Recurrent Measurement of Frailty Is Important for Mortality Prediction: Findings from the North West Adelaide Health Study
Thompson, M. Q., Theou, O., Tucker, G. R. R., Adams, R., & Visvanathan, R. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16066 · Cited by 49
“Despite the negative perceptions associated with frailty, it is possible for frailty status to improve or to remain stable over time.(3,4) This finding is pertinent because interventions exist that may slow or reverse the frailty process.”
Background
Prefrailty in older adults: A concept analysis
Rasiah, J., Cummings, G. G., Gruneir, A., Oelke, N. D., Estabrooks, C. A., & Holroyd-Leduc, J. M. (2020) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2020.103618 · Cited by 49
Definition of frailty in older men according to questionnaire data (RAND-36/SF-36): The Helsinki Businessmen study
Sirola, J., Pitkälä, K. H., Tilvis, R. S., Miettinen, T. A., & Strandberg, T. E. (2011) · The journal of nutrition health & aging · doi:10.1007/s12603-011-0131-4 · Cited by 50
“Finally, because frailty may be a dynamic process ( 16 ), it was important that we also had endpoints other than mortality (further weight loss, later gait speed) during follow-up.”
Prospective longitudinal study of frailty transitions in a community-dwelling cohort of older adults with cognitive impairment
Chong, M. S., Tay, L. B. G., Chan, M. Y., Lim, W. S., Ye, R., Tan, E. K., & Ding, Y. Y. (2015) · BMC Geriatrics · doi:10.1186/s12877-015-0174-1 · Cited by 50
“Frailty among older persons have been shown to be a dynamic process, characterized by frequent transitions between frailty states over time [15, 17].”
Background

Authors: Gill, T. M., Gahbauer, E. A., Allore, H. G., & Han, L.
Affiliations: Yale University (US)
ORCID: Gill, Thomas M.
Allore, Heather G.
Han, Ling
Venue: Archives of Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2006-02-27
Volume: 166
Issue: 4
Pages: 418
ISSN: 0003-9926 (ISSN-L)
DOI: 10.1001/archinte.166.4.418
OpenAlex: W2022181538
Cited by: 1,141
References: 44
Citations by year: 2026: 76 · 2025: 67 · 2024: 84 · 2023: 56 · 2022: 91 · 2021: 85 · 2020: 82 · 2019: 82 · 2018: 81 · 2017: 73 · 2016: 66 · 2015: 53 · 2014: 43 · 2013: 39 · 2012: 37
FWCI: 10.04
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Archives of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Patrick and Catherine Weldon Donaghue Medical Research Foundation
Yale University (P30AG21342)
National Institute on Aging (R01AG022993, R37AG017560, K24AG021507, R37AG17560, P30 AG21342, P30AG021342)
Topics: Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords: frailty, pre-frailty, frailty transitions, community-dwelling older adults, frailty prevention, activities of daily living, weight loss, muscle weakness, physical activity, walking speed, exhaustion
MeSH terms: Aged, Aged, 80 and over, Female, Geriatrics, Humans, Male, Prospective Studies, Severity of Illness Index, Time Factors, Frail Elderly

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Transitions Between Frailty States Among Community-Living Older Persons

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