Comparing models of frailty: the Health and Retirement Study
Open accessAbstract
OBJECTIVES: To operationalize and compare three models of frailty, each representing a distinct theoretical view of frailty: as deficiencies in function (Functional Domains model), as an index of health burden (Burden model), and as a biological syndrome (Biologic Syndrome model). DESIGN: Cross‐sectional analysis. SETTING: 2004 wave of the Health and Retirement Study, a nationally representative, longitudinal health interview survey. PARTICIPANTS: Adults aged 65 and older (N=11,113) living in the community and in nursing homes in the United States. MEASUREMENTS: The outcome measure was the presence of frailty, as defined according to each frailty model. Covariates included chronic diseases and sociodemographic characteristics. RESULTS: Almost one‐third (30.2%) of respondents were frail according to at least one model; 3.1% were frail according to all three models. The Functional Domains model showed the least overlap with the other models. In contrast, 76.1% of those classified as frail according to the Biologic Syndrome model and 72.1% of those according to the Burden model were also frail according to at least one other model. Older adults identified as frail according to the different models differed in sociodemographic and chronic disease characteristics. For example, the Biologic Syndrome model demonstrated substantial associations with older age (adjusted odds ratio (OR)=10.6, 95% confidence interval (CI)=6.1–18.5), female sex (OR=1.7, 95% CI=1.2–2.5), and African‐American ethnicity (OR=2.1, % CI=1.0–4.4). CONCLUSION: Different models of frailty, based on different theoretical constructs, capture different groups of older adults. The different models may represent different frailty pathways or trajectories to adverse outcomes such as disability and death.
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The continuous frailty index demonstrated greater discriminatory ability for people with moderate and severe frailty than the categorical phenotype model.
“The continuous FI demonstrated greater discriminatory ability for people with moderate and severe frailty when compared to the categorical phenotype model”
From Frailty in elderly people (2013) · cites this paper as [84]
The finding of greater discriminatory ability of the continuous frailty index has been independently validated.
“a finding that has been independently validated (84).”
From Frailty in elderly people (2013) · cites this paper as [84]
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- Authors
- Cigolle, C. T., Ofstedal, M. B., Tian, Z., & Blaum, C. S.
- Affiliations
- University of Michigan (US)
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2009-04-28
- Volume
- 57
- Issue
- 5
- Pages
- 830-839
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W1525217260
- Cited by
- 286
- References
- 48
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 11 · 2023: 13 · 2022: 15 · 2021: 16 · 2020: 22 · 2019: 23 · 2018: 20 · 2017: 20 · 2016: 23 · 2015: 25 · 2014: 19 · 2013: 21 · 2012: 17
- FWCI
- 10.67
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- National Institutes of Health (1f32ag027649-01)
- National Institute on Aging (R01 AG021493A, R01AG021493, 1F32AG027649-01, F32 AG027649)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- frailty, frailty models, older adults, chronic disease, nursing home residents, health burden, disability, mortality
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Chronic Disease, Cross-Sectional Studies, Demography, Disability Evaluation, Health Surveys, Humans, Interviews as Topic, Models, Theoretical, United States, Geriatric Assessment, Logistic Models, Frail Elderly
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