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Cited by 547Frailty in Older AdultsChronic Disease Management StrategiesAging and Gerontology Research

Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality

Mitnitski, Arnold, Song, Xiaowei, Skoog, Ingmar, Broe, GA, Cox, Jafna L., Grunfeld, Eva, Rockwood, Kenneth·2005·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.2005.00506.x
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Abstract

Objectives: To investigate the relationship between accumulated health‐related problems (deficits), which define a frailty index in older adults, and mortality in population‐based and clinical/institutional‐based samples. Design: Cross‐sectional and cohort studies. Setting: Seven population‐based and four clinical/institutional surveys in four developed countries. Participants: Thirty‐six thousand four hundred twenty‐four people (58.5% women) aged 65 and older. Measurements: A frailty index was constructed as a proportion of all potential deficits (symptoms, signs, laboratory abnormalities, disabilities) expressed in a given individual. Relative frailty is defined as a proportion of deficits greater than average for age. Measures of deficits differed across the countries but included common elements. Results: In each country, community‐dwelling elderly people accumulated deficits at about 3% per year. By contrast, people from clinical/institutional samples showed no relationship between frailty and age. Relative fitness/frailty in both sexes was highly correlated (correlation coefficient >0.95, P <.001) with mortality, although women, at any given age, were frailer and had lower mortality. On average, each unit increase in deficits increased by 4% the hazard rate for mortality (95% confidence interval=0.02–0.06). Conclusion: Relative fitness and frailty can be defined in relation to deficit accumulation. In population studies from developed countries, deficit accumulation is robustly associated with mortality and with age. In samples (e.g., clinical/institutional) in which most people are frail, there is no relationship with age, suggesting that there are maximal values of deficit accumulation beyond which survival is unlikely.

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  • The phenotype and cumulative deficit models show considerable statistical convergence.

    “and considerable statistical convergence (83).”

    From Frailty in elderly people (2013) · cites this paper as [83]

  • 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 [6]

  • An index with 30-40 variables has been shown to be sufficiently accurate for predicting adverse outcomes.

    “Even so, an index with 30–40 variables has been shown to be sufficiently accurate for predicting adverse outcomes [6,14].”

    From A standard procedure for creating a frailty index (2008) · cites this paper as [6]

  • 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 [6]

  • The follow up cohort had frailty index characteristics - frailty index values, rate and limit similar to those of previously studied community dwelling random samples.

    “Here, we noted that the follow up cohort had frailty index characteristics – frailty index values, rate and limit similar to those of previously studied community dwelling random samples.”

    From A standard procedure for creating a frailty index (2008) · cites this paper as [6]

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Authors
Mitnitski, A., Song, X., Skoog, I., Broe, G., Cox, J. L., Grunfeld, E., & Rockwood, K.
Affiliations
Dalhousie University (CA)
Corresponding author
Rockwood, Kenneth
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2005-10-18
Volume
53
Issue
12
Pages
2184-2189
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.2005.00506.x
OpenAlex
W1600610440
Cited by
547
References
43
Citations by year
2026: 5 · 2025: 25 · 2024: 16 · 2023: 21 · 2022: 23 · 2021: 37 · 2020: 40 · 2019: 34 · 2018: 31 · 2017: 30 · 2016: 34 · 2015: 36 · 2014: 30 · 2013: 35 · 2012: 30
FWCI
9.92
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Alzheimer Society
  • Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Aging and Gerontology Research
Keywords
frailty, frailty index, relative fitness, mortality, older adults, deficit accumulation, sex differences, community-dwelling older adults, institutionalized elderly, aging
MeSH terms
Aged, Cross-Sectional Studies, Female, Health Status, Humans, Male, Mortality, Physical Fitness, Cohort Studies, Geriatric Assessment, Multivariate Analysis, Proportional Hazards Models, Frail Elderly, Age Distribution, Sex Distribution, Developed Countries

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