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Operationalizing a Frailty Index from a Standardized Comprehensive Geriatric Assessment
Open accessAbstract
Objectives: To construct and validate a frailty index (FI) that is clinically sensible and practical for geriatricians by basing it on a routinely used comprehensive geriatric assessment (CGA) instrument. Design: Secondary analysis of a 3‐month randomized, controlled trial of a specialized mobile geriatric assessment team. Setting: Rural Nova Scotia. Participants were seen in their homes. Participants: Frail older adults, of whom 92 were in the intervention group and 77 in the control group. Measurements: A standard CGA form that accounts for impairment, disability, and comorbidity burden was scored and summed as a frailty index (FI‐CGA). The FI‐GCA was stratified to describe three levels of frailty. Patients were followed for up to 12 months to determine how well the index predicted adverse outcomes (institutionalization or mortality, whichever came first). Results: The three levels of frailty were mild (FI‐CGA 0–7), moderate (FI‐CGA 7–13), and severe (FI‐CGA>13). Demographic and social traits were similar across groups, but greater frailty was associated with worse function ( r= 0.55) and mental status ( r= 0.33). Those with moderate and severe frailty had a greater risk of adverse outcomes than those with mild frailty (unadjusted hazard ratio=1.9 and 5.5, respectively). There was no difference between frailty groups in mean 3‐month goal‐attainment scaling scores. Intrarater reliability was 0.95. Conclusion: The FI‐CGA is a valid, reliable, and sensible clinical measure of frailty that permits risk stratification of future adverse outcomes.
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“Complex interventions based on CGA delivered to older people in the community can increase the likelihood of continuing to live at home, principally through a reduced need for care home admission and reduced falls (115, 116)”
From Frailty in elderly people (2013) · cites this paper as [116]
In the citing paper
“The Frailty Index was initially operationalized from a CGA by Jones et al and a standard procedure for creating a Frailty Index as described by Searle et al in 2008 (12,14), and shown to predict the risk of death, length of stay, and discharge to long term care in hospitalized older patients.(13)”
From Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy (2016) · cites this paper as [12]
In the citing paper
“Rockwood and colleagues have shown that a Frailty Index based on a deficits accumulation principle (i.e. using information from a substantial number of indicators of a person’s health) can be calculated from information in a CGA in non-cancer patients, and used to predict subsequent events such as length of stay, functional status and mortality.(12,13)”
From Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy (2016) · cites this paper as [12]
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“and both predict death and institutionalisation in tightly graded patterns.”
From Validity and reliability of the Edmonton Frail Scale (2006) · cites this paper as [20]
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Metadata
- Authors
- Jones, D. M., Song, X., & Rockwood, K.
- Affiliations
- Dalhousie University (CA)
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2004-10-26
- Volume
- 52
- Issue
- 11
- Pages
- 1929-1933
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W1524996874
- Cited by
- 605
- References
- 38
- Citations by year
- 2026: 17 · 2025: 28 · 2024: 29 · 2023: 30 · 2022: 37 · 2021: 38 · 2020: 48 · 2019: 48 · 2018: 31 · 2017: 41 · 2016: 27 · 2015: 26 · 2014: 28 · 2013: 36 · 2012: 28
- FWCI
- 5.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Dalhousie Medical Research Foundation
- Dalhousie University
- Health Canada
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- frailty index, comprehensive geriatric assessment, frailty assessment, institutionalization, mortality, functional status, mental status, goal attainment scaling, intra-rater reliability, older adults, rural elderly
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Male, Nova Scotia, ROC Curve, Geriatric Assessment, Proportional Hazards Models, Frail Elderly
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