Development, Construct Validity, and Predictive Validity of a Continuous Frailty Scale: Results From 2 Large US Cohorts
Open accessAbstract
Frailty is an age-related clinical syndrome of decreased resilience to stressors. Among numerous assessments of frailty, the frailty phenotype (FP) scale proposed by Fried et al. has been the most widely used. We aimed to develop a continuous frailty scale that could overcome limitations facing the categorical FP scale and to evaluate its construct validity, predictive validity, and measurement properties. Data were from the Cardiovascular Health Study (n = 4,243) and Health and Retirement Study (n = 7,600), both conducted in the United States. Frailty was conceptualized as a continuous construct, assessed by 5 measures used in the FP scale: gait speed, grip strength, exhaustion, physical activity, and weight loss. We used confirmatory factor analysis to investigate the relationship between the 5 indicators and the latent frailty construct. We examined the association of the continuous frailty scale with mortality and disability. The unidimensional model fit the data satisfactorily; similar factor structure was observed across 2 cohorts. Gait speed and weight loss were the strongest and weakest indicators, respectively; grip strength, exhaustion, and physical activity had similar strength in measuring frailty. In each cohort, the continuous frailty scale was strongly associated with mortality and disability and continued to be associated with outcomes among robust and prefrail persons classified by the FP scale.
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Dichotomous outcomes are restricted to examining transitions or progression over time.
“Furthermore, dichotomous outcomes are restricted to examining transitions or progression over time [18].”
From Sarcopenic Obesity Phenotype Index (SOP <i>i</i> ): A Population‐Based Study (2025) · cites this paper as [18]
The Introduction says dichotomizing frailty indicators can lose precision, and the Discussion says a continuous frailty scale may better describe frailty trajectories over time. The paper does not say that dichotomous outcomes are restricted to examining transitions or progression; it discusses dichotomous frailty criteria and a three-category frailty scale instead. The indexed passages provide no page numbers. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThe current binary approach for SO diagnosis is limited in capturing the spectrum of SO or its progression over time.
“The current binary approach for SO diagnosis is limited in capturing the spectrum of SO or its progression over time.”
From Sarcopenic Obesity Phenotype Index (SOP <i>i</i> ): A Population‐Based Study (2025) · cites this paper as [18]
The Discussion (page unavailable) says a continuous measure is more sensitive than a categorical frailty scale and may better describe frailty trajectories over time. It does not address sarcopenic obesity (SO) diagnosis, and the frailty scale it compares has three categories, not two. The claim applies the paper’s reasoning to a different condition and a binary approach it did not study. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSimilar to frailty continuous scores, SOPi may serve as a precise tool for identifying factors and biomarkers that hold clinical or functional significance for patients.
“Similar to frailty continuous scores, SOPi may serve as a precise tool for identifying factors and biomarkers that hold clinical or functional significance for patients [18].”
From Sarcopenic Obesity Phenotype Index (SOP <i>i</i> ): A Population‐Based Study (2025) · cites this paper as [18]
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Sarcopenic Obesity Phenotype Index (SOP <i>i</i> ): A Population‐Based Study
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“Furthermore, dichotomous outcomes are restricted to examining transitions or progression over time [18].”
- Authors
- Wu, C., Geldhof, G. J., Xue, Q.-L., Kim, D. H., Newman, A. B., & Odden, M. C.
- Affiliations
- Oregon State University (US)
- Johns Hopkins University (US)
- Beth Israel Deaconess Medical Center (US)
- Duke Kunshan University (CN)
- Corresponding author
- Wu, Chenkai
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-04-24
- Volume
- 187
- Issue
- 8
- Pages
- 1752-1762
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- PMC
- PMC6070050
- OpenAlex
- W2802367223
- Cited by
- 45
- References
- 35
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 5 · 2023: 5 · 2022: 8 · 2021: 6 · 2020: 5 · 2019: 5
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Touro Scholar (Touro College) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute
- National Institute of Neurological Disorders and Stroke (HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, U01HL080295, U01HL130114)
- National Institute on Aging (R01AG023629, R03AG048541, K08AG051187, P30AG013679)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- frailty, walking speed, grip strength, exhaustion, physical activity, weight loss, mortality, disability, pre-frailty, older adults, scale development, construct validity, predictive validity
- MeSH terms
- Aged, Aged, 80 and over, Factor Analysis, Statistical, Female, Humans, Male, Phenotype, Predictive Value of Tests, United States, Geriatric Assessment, Frail Elderly
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