Measurement of organ structure and function enhances understanding of the physiological basis of frailty: the Cardiovascular Health Study
Open accessAbstract
OBJECTIVES: To determine whether disease burden is associated with frailty independent of diagnosed chronic disease and whether physiological measurements provide greater understanding of the etiology of frailty. DESIGN: Cross‐sectional. SETTING: Community. PARTICIPANTS: Two thousand four hundred thirty‐seven participants in the Cardiovascular Health Study, 1992/93 examination (mean age 74.8±4.8, 43.4% male, 95.8% white). MEASUREMENTS: Disease burden and frailty were tabulated using 10‐point scales (0=healthy, 10=unhealthy). Disease burden was the sum of measurements characterizing the vasculature, brain, kidneys, lungs, and glucose metabolism. Frailty was assessed using the frailty index reported by Fried. Multivariate linear models were used to determine the association between disease burden (predictor) and frailty (outcome). RESULTS: Unadjusted, 1‐point‐higher disease burden was associated with a 0.28‐point‐higher frailty score ( P <.001). White matter grade, forced vital capacity, and cystatin‐C were particularly strongly and significantly associated with frailty. Disease burden attenuated the association between frailty and age by 29%, and disease burden and age had similar associations with frailty. Disease burden attenuated the association between frailty and fibrinogen, Factor VIII, and C‐reactive protein by 32%, 56%, and 83%, respectively. Frailty was associated with diagnosed depression, stroke, cognitive impairment, arthritis, and pulmonary disease but not coronary heart disease, diabetes mellitus, or kidney disease in the presence of a summary of disease burden. In the adjusted model, disease burden remained significantly associated with frailty (β=0.11, P <.001). CONCLUSION: Disease burden was independently and significantly associated with frailty. These results emphasize that typically unrecognized physiological changes may contribute significantly to frailty.
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When restricted to studies using the phenotype model, the weighted average frailty prevalence was 9.9% (95% CI 9.6-10.2).
“the weighted average frailty prevalence rate was 9.9% (95% CI 9.6-10.2)”
From Frailty in elderly people (2013) · cites this paper as [87]
A recent systematic review identified 21 community-based cohort studies involving 61,500 older people.
“Twenty-one community based cohort studies involving 61,500 older people were identified.”
From Frailty in elderly people (2013) · cites this paper as [87]
Frailty was statistically more prevalent in women (9.6%, 95% CI 9.2-10) than men (5.2%, 95% CI 4.9-5.5).
“Frailty was statistically more prevalent in women (11 studies, 9.6%, 95% CI 9.2-10) than men (5.2%; 95% CI 4.9-5.5).”
From Frailty in elderly people (2013) · cites this paper as [87]
Frailty prevalence increased steadily with age: 4% at 65-69 years, 7% at 70-74, 9% at 75-79, 16% at 80-84, and 26% at >85.
“Frailty increased steadily with age: 65-69 years: 4%; 70-74 years: 7%; 75-79 years: 9% 80-84 years: 16%; >85 years: 26%.”
From Frailty in elderly people (2013) · cites this paper as [87]
When restricted to studies using the phenotype model, the weighted average pre-frailty prevalence was 44.2% (95% CI 44.2-44.7).
“and 44.2% for pre-frailty prevalence (95% CI 44.2-44.7).”
From Frailty in elderly people (2013) · cites this paper as [87]
Variation in operational definitions and inclusion/exclusion criteria across studies largely explained the considerable variation in reported frailty prevalence rates of 4.0 to 59.1%.
“The operational definitions for frailty and the inclusion/exclusion criteria varied between the studies, which largely explained the considerable variation in reported frailty prevalence rates of 4.0 to 59.1%.”
From Frailty in elderly people (2013) · cites this paper as [87]
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Espinoza, S. E., Hazuda, H. P., Maruthur, N. M., Bray, G. A., Johnson, K., Synyer, X. P., Newman, A. B., Wing, R. R., Yanovski, S. Z., Gaussoin, S. A., et al. (2021) · The Journals of Gerontology Series A · doi:10.1093/gerona/glab312 · Cited by 14 · see citing works
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- Authors
- Sanders, J. L., Boudreau, R. M., Fried, L. P., Walston, J. D., Harris, T. B., & Newman, A. B.
- Affiliations
- National Institutes of Health (US)
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2011-08-24
- Volume
- 59
- Issue
- 9
- Pages
- 1581-1588
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC3282048
- OpenAlex
- W1539036959
- Cited by
- 71
- References
- 45
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 4 · 2022: 1 · 2021: 5 · 2020: 5 · 2019: 10 · 2018: 3 · 2017: 4 · 2016: 7 · 2015: 10 · 2014: 6 · 2013: 5 · 2012: 5
- FWCI
- 2.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc045133-001, n01hc085079-024, n01hc015103-009, n01hc085086-022, UL1TR000005, n01hc55222-0-0-0, n01hc075150-004, n01hc035129-010)
- National Institute on Aging (R01AG023629, P30AG024827)
- National Heart, Lung, and Blood Institute (N01 HC085086, N01HC15103, N01 HC085079, N01HC‐75150, N01 HC85086, N01 HC035129, N01 HC015103, N01 HC55222, U01HL080295, N01 HC055222, N01 HC075150, N01 HC045133, N01-HC85079)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- frailty, disease burden, frailty index, physiological measures, white matter hyperintensities, forced vital capacity, cystatin C, fibrinogen, C-reactive protein, factor VIII, aging, older adults, cardiovascular health
- MeSH terms
- Aged, 80 and over, Cardiovascular Diseases, Chronic Disease, Cross-Sectional Studies, Female, Humans, Male, Frail Elderly, Cost of Illness
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