A comparison of two approaches to measuring frailty in elderly people
Abstract
BACKGROUND: Many definitions of frailty exist, but few have been directly compared. We compared the relationship between a definition of frailty based on a specific phenotype with one based on an index of deficit accumulation. METHODS: The data come from all 2305 people 70 years old and older who composed the clinical examination cohort of the second wave of the Canadian Study of Health and Aging. We tested convergent validity by correlating the measures with each other and with other health status measures, and analyzed cumulative index distributions in relation to phenotype. To test criterion validity, we evaluated survival (institutionalization and all-cause mortality) by frailty index (FI) score, stratified by the phenotypic definitions as "robust," "pre-frail," and "frail." RESULTS: The measures correlated moderately well with each other (R=0.65) and with measures of function (phenotypic definition R=0.66; FI R=0.73) but less well with cognition (phenotypic definition R=-0.35; FI R=-0.58). The median FI scores increased from 0.12 for the robust to 0.30 for the pre-frail and 0.44 for the frail. Survival was also lower with increasing frailty, and institutionalization was more common, but within each phenotypic class, there were marked differences in outcomes based on the FI values-e.g., among robust people, the median 5-year survival for those with lower FI values was 85%, compared with 55% for those with higher FI values. CONCLUSION: The phenotypic definition of frailty, which offers ready clinical operationalization, discriminates broad levels of risk. The FI requires additional clinical translation, but allows the risk of adverse outcomes to be defined more precisely.
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A 2011 study re-scaled the phenotype model to make it more continuous, providing better discriminatory capacity.
“a 2011 study re-scaled the phenotype model to make it more continuous, providing better discriminatory capacity (85).”
From Frailty in elderly people (2013) · cites this paper as [85]
Physiological measurements to identify older people at risk of frailty may help guide development of earlier preventative interventions.
“physiological measurements to identify older people at risk of frailty may help guide the development of earlier preventative interventions (85).”
From Frailty in elderly people (2013) · cites this paper as [85]
The results yielded by the frailty index have been consistent between surveys evaluated by our group and by others even though not every frailty index considers the same deficits or number of deficits.
“the results yielded by the frailty index have been consistent between surveys evaluated by our group [4-7] and by others [8-11] even though not every frailty index considers the same deficits, or even the same number of deficits.”
From A standard procedure for creating a frailty index (2008) · cites this paper as [7]
We selected variables at random (boot-strapping) from a list of eligible variables to make up the Frailty Index and have again shown that the results are insensitive to the precise composition of the index.
“Here, as in some earlier studies, [7,19,31] we have selected variables at random (boot-strapping) from a list of eligible variables to make up the Frailty Index and have again shown that the results are insensitive to the precise composition of the index.”
From A standard procedure for creating a frailty index (2008) · cites this paper as [7]
It does not matter if study A considered 40 deficits from set X and study B considered 60 deficits from set Y; the estimates from each (e.g. rate of deficit accumulation, relationship with mortality, limit) appear to be similar.
“it does not matter if study A considered 40 deficits from set X of deficits and study B considered 60 deficits from set Y of deficits; the estimates from each (e.g. the rate of deficit accumulation, the relationship between deficit accumulation and mortality, or the limit to deficit accumulation) appear to be similar.”
From A standard procedure for creating a frailty index (2008) · cites this paper as [7]
The value 0.2 on the frailty index is recognized by multiple frailty measures as approaching a frail state.
“The value 0.2 on the frailty index is recognized by multiple frailty measures as approaching a frail state [7,8,22]”
From A standard procedure for creating a frailty index (2008) · cites this paper as [7]
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- Authors
- Rockwood, K., Andrew, M., & Mitnitski, A.
- Affiliations
- Dalhousie University (CA)
- Corresponding author
- Rockwood, K.
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-07-01
- Volume
- 62
- Issue
- 7
- Pages
- 738-743
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- OpenAlex
- W2108688205
- Cited by
- 1,291
- References
- 40
- Citations by year
- 2026: 49 · 2025: 79 · 2024: 103 · 2023: 95 · 2022: 90 · 2021: 108 · 2020: 88 · 2019: 94 · 2018: 65 · 2017: 101 · 2016: 89 · 2015: 67 · 2014: 45 · 2013: 52 · 2012: 42
- FWCI
- 12.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed (publishedVersion)
- 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, Fried frailty phenotype, frailty index, pre-frailty, older adults, convergent validity, criterion validity, survival, institutionalization, all-cause mortality, cognitive function, Canadian Study of Health and Aging
- MeSH terms
- Aged, Humans, Institutionalization, Models, Theoretical, Phenotype, Survival Rate, Frail Elderly
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