Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women
Abstract
BACKGROUND: Frailty, as defined by the index derived from the Cardiovascular Health Study (CHS index), predicts risk of adverse outcomes in older adults. Use of this index, however, is impractical in clinical practice. METHODS: We conducted a prospective cohort study in 6701 women 69 years or older to compare the predictive validity of a simple frailty index with the components of weight loss, inability to rise from a chair 5 times without using arms, and reduced energy level (Study of Osteoporotic Fractures [SOF index]) with that of the CHS index with the components of unintentional weight loss, poor grip strength, reduced energy level, slow walking speed, and low level of physical activity. Women were classified as robust, of intermediate status, or frail using each index. Falls were reported every 4 months for 1 year. Disability (> or =1 new impairment in performing instrumental activities of daily living) was ascertained at 4(1/2) years, and fractures and deaths were ascertained during 9 years of follow-up. Area under the curve (AUC) statistics from receiver operating characteristic curve analysis and -2 log likelihood statistics were compared for models containing the CHS index vs the SOF index. RESULTS: Increasing evidence of frailty as defined by either the CHS index or the SOF index was similarly associated with an increased risk of adverse outcomes. Frail women had a higher age-adjusted risk of recurrent falls (odds ratio, 2.4), disability (odds ratio, 2.2-2.8), nonspine fracture (hazard ratio, 1.4-1.5), hip fracture (hazard ratio, 1.7-1.8), and death (hazard ratio, 2.4-2.7) (P < .001 for all models). The AUC comparisons revealed no differences between models with the CHS index vs the SOF index in discriminating falls (AUC = 0.61 for both models; P = .66), disability (AUC = 0.64; P = .23), nonspine fracture (AUC = 0.55; P = .80), hip fracture (AUC = 0.63; P = .64), or death (AUC = 0.72; P = .10). Results were similar when -2 log likelihood statistics were compared. CONCLUSION: The simple SOF index predicts risk of falls, disability, fracture, and death as well as the more complex CHS index and may provide a useful definition of frailty to identify older women at risk of adverse health outcomes in clinical practice.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The development of frailty frequently results in a spiral of decline leading to increasing frailty and risk of worsening disability, falls, hospital admission and death.
“the development of frailty frequently results in a spiral of decline that leads to increasing frailty and risk of worsening disability, falls, admission to hospital and death (94).”
From Frailty in elderly people (2013) · cites this paper as [94]
Cites
An Introduction to the Bootstrap
Efron, B., & Tibshirani, R. J. (1994) · doi:10.1201/9780429246593 · Cited by 40,500 · see citing works
Frailty in Older Adults: Evidence for a Phenotype
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., et al. (2001) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/56.3.m146 · Cited by 24,907 · see citing works
Classification and Regression Trees.
Gordon, A. D., Breiman, L., Friedman, J. H., Olshen, R. A., & Stone, C. J. (1984) · Biometrics · doi:10.2307/2530946 · Cited by 23,834 · see citing works
Classification and Regression Trees.
Ryzin, J. V., Breiman, L., Friedman, J. H., Olshen, R. A., & Stone, C. J. (1986) · Journal of the American Statistical Association · doi:10.2307/2288003 · Cited by 21,028 · see citing works
Sheikh (1986) · doi:10.1300/j018v05n01_09 · Cited by 7,236 · see citing works
Fried, L. P., Ferrucci, L., Darer, J., Williamson, J. D., & Anderson, G. (2004) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/59.3.m255 · Cited by 4,032 · see citing works
Risk Factors for Hip Fracture in White Women
Cummings, S. R., Nevitt, M. C., Browner, W. S., Stone, K., Fox, K. M., Ensrud, K. E., Cauley, J., Black, D., & Vogt, T. M. (1995) · New England Journal of Medicine · doi:10.1056/nejm199503233321202 · Cited by 3,595 · see citing works
Self-citationPHYSICAL ACTIVITY AS AN INDEX OF HEART ATTACK RISK IN COLLEGE ALUMNI1
PAFFENBARGER, R. S., WING, A. L., & HYDE, R. T. (1978) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a112608 · Cited by 1,980 · see citing works
The Mini-Mental State Examination
Folstein, M. F. (1983) · Archives of General Psychiatry · doi:10.1001/archpsyc.1983.01790060110016 · Cited by 1,975 · see citing works
Walston, J., Hadley, E. C., Ferrucci, L., Guralnik, J. M., Newman, A. B., Studenski, S. A., Ershler, W. B., Harris, T., & Fried, L. P. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00745.x · Cited by 1,605 · see citing works
Kanis, J. A., Odén, A., Johnell, O., Johansson, H., Laet, C. E. D. H. D., Brown, J. P., Burckhardt, P., Cooper, C. C., Christiansen, C., Cummings, S. R., et al. (2007) · Osteoporosis International · doi:10.1007/s00198-007-0343-y · Cited by 1,222 · see citing works
Phenotype of frailty: characterization in the women's health and aging studies
Bandeen-Roche, K., Xue, Q.-L., Ferrucci, L., Walston, J., Guralnik, J. M., Chaves, P., Zeger, S. L., & Fried, L. P. (2006) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/61.3.262 · Cited by 1,215 · see citing works
Prevention of falls and consequent injuries in elderly people
Kannus, P., Sievänen, H. T., Palvanen, M., Järvinen, T. L. N., & Parkkari, J. P. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67604-0 · Cited by 1,127 · see citing works
Fugate Woods, N., LaCroix, A. Z., Gray, S. L., Aragaki, A., Cochrane, B. B., Brunner, R. L., Masaki, K., Murray, A., & Newman, A. B. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53405.x · Cited by 1,040 · see citing works
Ferrucci, L., Guralnik, J. M., Studenski, S., Fried, L. P., Cutler, G. B., Walston, J. D., & The Interventions on Frailty Working Group (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52174.x · Cited by 1,027 · cited 1× · see citing works
“Individual SOF index components Weight lossb 1017 (15) Inability to rise from chairc 779 (12)”
BackgroundCummings, S. R. (1990) · JAMA · doi:10.1001/jama.263.5.665 · Cited by 1,014 · see citing works
Walston, J. (2002) · Archives of Internal Medicine · doi:10.1001/archinte.162.20.2333 · Cited by 940 · see citing works
Ensrud, K. E., Ewing, S. K., Taylor, B. C., Fink, H. A., Stone, K. L., Cauley, J. A., Tracy, J. K., Hochberg, M. C., Rodondi, N., & Cawthon, P. M. (2007) · The Journals of Gerontology Series A · doi:10.1093/gerona/62.7.744 · Cited by 760 · see citing works
Self-citationOperationalizing a frailty index from a standardized comprehensive geriatric assessment
Jones, D. M., Song, X., & Rockwood, K. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52521.x · Cited by 605 · see citing works
Weight Change in Old Age and its Association with Mortality
Newman, A. B., Yanez, D., Harris, T., Duxbury, A., Enright, P. L., Fried, L. P., & for the Cardiovascular Study Research Group (2001) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2001.49258.x · Cited by 566 · see citing works
Mitnitski, A., Song, X., Skoog, I., Broe, G., Cox, J. L., Grunfeld, E., & Rockwood, K. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.00506.x · Cited by 547 · see citing works
Frailty in Older Men: Prevalence, Progression, and Relationship with Mortality
Cawthon, P. M., Marshall, L. M., Michael, Y., Dam, T.-T. L., Ensrud, K. E., Barrett-Connor, E. L., & ORWOLL, E. S. (2007) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01259.x · Cited by 500 · see citing works
Self-citationToward an Understanding of Frailty
Hamerman, D. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-130-11-199906010-00022 · Cited by 441 · see citing works
Relationship of changes in physical activity and mortality among older women.
Gregg, E., Cauley, J., Stone, K., Thompson, T., Bauer, D., Cummings, S., & Ensrud, K. (2003) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.289.18.2379 · Cited by 405 · see citing works
Self-citationFrailty, hospitalization, and progression of disability in a cohort of disabled older women
Boyd, C. M., Xue, Q., Simpson, C. F., Guralnik, J. M., & Fried, L. P. (2005) · The American Journal of Medicine · doi:10.1016/j.amjmed.2005.01.062 · Cited by 402 · see citing works
Leng, S., Chaves, P., Koenig, K., & Walston, J. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.50315.x · Cited by 387 · see citing works
The presence of frailty in elderly persons with chronic renal insufficiency
Shlipak, M. G., Stehman‐Breen, C. O., Fried, L. F., Song, X., Siscovick, D. S., Fried, L. P., Psaty, B. M., & Newman, A. B. (2004) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2003.12.049 · Cited by 364 · see citing works
Depression, Falls, and Risk of Fracture in Older Women
Whooley, M. A. (1999) · Archives of Internal Medicine · doi:10.1001/archinte.159.5.484 · Cited by 348 · see citing works
Intentional and Unintentional Weight Loss Increase Bone Loss and Hip Fracture Risk in Older Women
Ensrud, K. E., Ewing, S. K., Stone, K. L., Cauley, J. A., Bowman, P. J., Cummings, S. R., & for the Study of Osteoporotic Fractures Research Group (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51558.x · Cited by 336 · see citing works
Self-citationAssociation Between Depressive Symptoms and Mortality in Older Women
Whooley, M., & Browner, W. (1998) · Archives of Internal Medicine · doi:10.1001/archinte.158.19.2129 · Cited by 290 · see citing works
Frailty and Its Definition: A Worthy Challenge
Rockwood, K. J. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53312.x · Cited by 288 · see citing works
Correlates of Impaired Function in Older Women
Ensrud, K. E., Nevitt, M. C., Yunis, C., Cauley, J. A., Seeley, D. G., Fox, K. M., & Cummings, S. R. (1994) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1994.tb04968.x · Cited by 262 · see citing works
Self-citationEditorial: Something About Frailty
Morley, J. E., Perry, H. M., & Miller, D. K. (2002) · The Journals of Gerontology Series A · doi:10.1093/gerona/57.11.m698 · Cited by 262 · see citing works
Studenski, S., Hayes, R. P., Leibowitz, R. Q., Bode, R., Lavery, L., Walston, J., Duncan, P., & Perera, S. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52423.x · Cited by 252 · see citing works
Weight Change and Fractures in Older Women
Ensrud, K. E. (1997) · Archives of Internal Medicine · doi:10.1001/archinte.1997.00440290041004 · Cited by 189 · see citing works
Self-citationEnsrud, K. E., Fullman, R. L., Barrett-Connor, E. L., Cauley, J. A., Stefanick, M. L., Fink, H. A., Lewis, C. E., & ORWOLL, E. S. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1805 · Cited by 156 · see citing works
Self-citationWeight change and fractures in older women. Study of Osteoporotic Fractures Research Group
Ensrud, K. E. (1997) · Archives of Internal Medicine · doi:10.1001/archinte.157.8.857 · Cited by 144 · see citing works
Self-citationCharacteristics of Older Men Who Lose Weight Intentionally or Unintentionally
Wannamethee, S. G., Shaper, A. G., Whincup, P. H., & Walker, M. (2000) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a010261 · Cited by 86 · see citing works
Frailty—and Its Dangerous Effects—Might Be Preventable
Wilson, J. F. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-141-6-200409210-00035 · Cited by 67 · see citing works
Choosing between predictors of fractures
Hui, S. L., Slemenda, C. W., Carey, M. A., & Johnston, C. C. (1995) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650101126 · Cited by 47 · see citing works
Correa‐de‐Araujo, R. (2006) · ACP Journal Club · doi:10.7326/acpjc-2006-144-1-023 · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013) · The Lancet · doi:10.1016/s0140-6736(12)62167-9 · Cited by 9,503 · see citing works
Prevalence of frailty in community-dwelling older persons: a systematic review
Collard, R. M., Boter, H., Schoevers, R. A., & Oude Voshaar, R. C. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.04054.x · Cited by 3,073 · see citing works
Compston, J. E., McClung, M. R., & Leslie, W. D. (2019) · The Lancet · doi:10.1016/s0140-6736(18)32112-3 · Cited by 2,449 · see citing works
Objectively measured physical capability levels and mortality: systematic review and meta-analysis
Cooper, R., Kuh, D., Hardy, R., Mortality Review Group, & teams, O. B. O. T. F. A. H. S. (2010) · BMJ · doi:10.1136/bmj.c4467 · Cited by 1,166 · see citing works
Sarcopenia with limited mobility: an international consensus
Morley, J. E., Abbatecola, A. M., Argiles, J. M., Baracos, V., Bauer, J., Bhasin, S., Cederholm, T., Stewart Coats, A. J., Cummings, S. R., Evans, W. J., et al. (2011) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2011.04.014 · Cited by 1,125 · see citing works
Prevalence and 10‐Year Outcomes of Frailty in Older Adults in Relation to Deficit Accumulation
Song, X., Mitnitski, A., & Rockwood, K. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.02764.x · Cited by 1,104 · see citing works
Prevalence of Frailty in Middle-Aged and Older Community-Dwelling Europeans Living in 10 Countries
Santos-Eggimann, B., Cuenoud, P., Spagnoli, J., & Junod, J. (2009) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/glp012 · Cited by 963 · see citing works
Decoster, L., Van Puyvelde, K., Mohile, S., Wedding, U., Basso, U., Colloca, G., Rostoft, S., Overcash, J., Wildiers, H., Steer, C., et al. (2015) · Annals of Oncology · doi:10.1093/annonc/mdu210 · Cited by 794 · see citing works
Ensrud, K. E., Ewing, S. K., Cawthon, P. M., Fink, H. A., Taylor, B. C., Cauley, J. A., Dam, T., Marshall, L. M., Orwoll, E. S., Cummings, S. R., et al. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2009.02137.x · Cited by 636 · see citing works
Self-citationEpidemiology of fracture risk with advancing age
Ensrud, K. E. (2013) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/glt092 · Cited by 456 · see citing works
Self-citationPrognostic significance of potential frailty criteria
Rothman, M. D., Leo‐Summers, L., & Gill, T. M. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.02008.x · Cited by 428 · see citing works
Protein Intake and Incident Frailty in the Women's Health Initiative Observational Study
Beasley, J. M., LaCroix, A. Z., Neuhouser, M. L., Huang, Y., Tinker, L., Woods, N., Michael, Y., Curb, J. D., & Prentice, R. L. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.02866.x · Cited by 337 · see citing works
Comparing models of frailty: the Health and Retirement Study
Cigolle, C. T., Ofstedal, M. B., Tian, Z., & Blaum, C. S. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2009.02225.x · Cited by 286 · see citing works
Hirani, V., Naganathan, V., Blyth, F., Le Couteur, D. G., Seibel, M. J., Waite, L. M., Handelsman, D. J., & Cumming, R. G. (2017) · Age and Ageing · doi:10.1093/ageing/afw214 · Cited by 246 · see citing works
Frailty in childhood cancer survivors
Ness, K. K., Armstrong, G. T., Kundu, M., Wilson, C. L., Tchkonia, T., & Kirkland, J. L. (2015) · Cancer · doi:10.1002/cncr.29211 · Cited by 188 · see citing works
Frailty and muscle metabolism dysregulation in the elderly
Evans, W. J., Paolisso, G., Abbatecola, A. M., Corsonello, A., Bustacchini, S., Strollo, F., & Lattanzio, F. (2010) · Biogerontology · doi:10.1007/s10522-010-9297-0 · Cited by 173 · see citing works
Osteoporosis, frailty and fracture: implications for case finding and therapy
van den Bergh, J. P., van Geel, T. A., & Geusens, P. P. (2012) · Nature Reviews Rheumatology · doi:10.1038/nrrheum.2011.217 · Cited by 179 · see citing works
Biomarkers of oxidative stress are associated with frailty: the Framingham Offspring Study
Liu, C. K., Lyass, A., Larson, M. G., Massaro, J. M., Wang, N., D’Agostino, R. B., Benjamin, E. J., & Murabito, J. M. (2016) · AGE · doi:10.1007/s11357-015-9864-z · Cited by 157 · see citing works
Cellular Senescence and the Biology of Aging, Disease, and Frailty
LeBrasseur, N. K., Tchkonia, T., & Kirkland, J. L. (2015) · Nestlé Nutrition Institute Workshop Series · doi:10.1159/000382054 · Cited by 147 · see citing works
Arrieta, H., Rezola‐Pardo, C., Gil, S. M., Virgala, J., Iturburu, M., Antón, I., González‐Templado, V., Irazusta, J., & Rodriguez‐Larrad, A. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15824 · Cited by 111 · see citing works
Lv, Y., Mao, C., Gao, X., Ji, J. S., Kraus, V. B., Yin, Z., Yuan, J., Chen, H., Luo, J., Zhou, J., et al. (2022) · Nature Aging · doi:10.1038/s43587-022-00201-3 · Cited by 102 · see citing works
Aging, immune senescence, and immunotherapy: a comprehensive review
Elias, R., Hartshorn, K., Rahma, O., Lin, N., & Snyder-Cappione, J. E. (2018) · Seminars in Oncology · doi:10.1053/j.seminoncol.2018.08.006 · Cited by 96 · see citing works
Mondor, L., Maxwell, C. J., Hogan, D. B., Bronskill, S. E., Campitelli, M. A., Seitz, D. P., & Wodchis, W. P. (2019) · Medical Care · doi:10.1097/mlr.0000000000001139 · Cited by 39 · see citing works
Lee, J. Y., Farrell, B., & Holbrook, A. M. (2018) · Polish Archives of Internal Medicine · doi:10.20452/pamw.4391 · Cited by 32 · see citing works
- Authors
- Ensrud, K. E.
- Affiliations
- United States Department of Veterans Affairs (US)
- Corresponding author
- Ensrud, Kristine E.
- ORCID
- Ensrud, Kristine E.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2008-02-25
- Volume
- 168
- Issue
- 4
- Pages
- 382
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2136909785
- Cited by
- 975
- References
- 41
- Citations by year
- 2026: 23 · 2025: 33 · 2024: 63 · 2023: 57 · 2022: 67 · 2021: 68 · 2020: 68 · 2019: 62 · 2018: 60 · 2017: 59 · 2016: 75 · 2015: 70 · 2014: 54 · 2013: 58 · 2012: 54
- FWCI
- 13.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- National Institute on Aging (R01AG008415, AG05394, AG 08415, AG-05407)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR035584, AR35583, AR-35584, AR 35582, R01AR035582, R01AR035583)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- frailty, frailty index, older women, falls, disability, hip fracture, mortality, predictive validity, weight loss, grip strength, instrumental activities of daily living, physical activity, walking speed, energy levels, frailty assessment tools, osteoporosis risk prediction, mortality risk
- MeSH terms
- Accidental Falls, Aged, Cause of Death, Female, Persons with Disabilities, Humans, Predictive Value of Tests, Prospective Studies, Geriatric Assessment, Frail Elderly, Fractures, Bone
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
