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Operationalization of Frailty Using Eight Commonly Used Scales and Comparison of Their Ability to Predict All‐Cause Mortality
Open accessAbstract
Objectives: To operationalize frailty using eight scales and to compare their content validity, feasibility, prevalence estimates of frailty, and ability to predict all‐cause mortality. Design: Secondary analysis of the Survey of Health, Ageing and Retirement in Europe ( SHARE ). Setting: Eleven European countries. Participants: Individuals aged 50 to 104 (mean age 65.3 ± 10.5, 54.8% female, N = 27,527). Measurements: Frailty was operationalized using SHARE data based on the Groningen Frailty Indicator, the Tilburg Frailty Indicator, a 70‐item Frailty Index ( FI ), a 44‐item FI based on a Comprehensive Geriatric Assessment ( FI ‐ CGA ), the Clinical Frailty Scale, frailty phenotype (weighted and unweighted versions), the Edmonton Frail Scale, and the FRAIL scale. Results: All scales had fewer than 6% of cases with at least one missing item, except the SHARE ‐frailty phenotype (11.1%) and the SHARE ‐Tilburg (12.2%). In the SHARE ‐Groningen, SHARE ‐Tilburg, SHARE ‐frailty phenotype, and SHARE ‐ FRAIL scales, death rates were 3 to 5 times as high in excluded cases as in included ones. Frailty prevalence estimates ranged from 6% ( SHARE ‐ FRAIL ) to 44% ( SHARE ‐Groningen). All scales categorized 2.4% of participants as frail. Of unweighted scales, the SHARE ‐ FI and SHARE ‐Edmonton scales most accurately predicted mortality at 2 ( SHARE ‐ FI area under the receiver operating characteristic curve ( AUC ) = 0.77, 95% confidence interval ( CI ) = 0.75–0.79); SHARE ‐Edmonton AUC = 0.76, 95% CI = 0.74–0.79) and 5 (both AUC = 0.75, 95% CI = 0.74–0.77) years. The continuous score of the weighted SHARE ‐frailty phenotype ( AUC = 0.77, 95% CI = 0.75–0.78) predicted 5‐year mortality better than the unweighted SHARE ‐frailty phenotype ( AUC = 0.70, 95% CI = 0.68–0.71), but the categorical score of the weighted SHARE ‐frailty phenotype did not ( AUC = 0.70, 95% CI = 0.68–0.72). Conclusion: Substantive differences exist between scales in their content validity, feasibility, and ability to predict all‐cause mortality. These frailty scales capture related but distinct groups. Weighting items in frailty scales can improve their predictive ability, but the trade‐off between specificity, predictive power, and generalizability requires additional evaluation.
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“Our cutpoints were as follows: Robust/Non-frail: 0.0 < 0.2; Pre-frail: 0.2 < 0.35; Frail: ≥ 0.35.”
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 [17]
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A Comparison of Two Mouse Frailty Assessment Tools
Kane, A. E., Huizer‐Pajkos, A., Mach, J., Mitchell, S. J., de Cabo, R., Couteur, D. G. L., Howlett, S. E., & Hilmer, S. N. (2017) · The Journals of Gerontology Series A · doi:10.1093/gerona/glx009 · Cited by 41
Frailty in a racially and socioeconomically diverse sample of middle-aged Americans in Baltimore
Griffin, F. R., Mode, N. A., Ejiogu, N., Zonderman, A. B., & Evans, M. K. (2018) · PLoS ONE · doi:10.1371/journal.pone.0195637 · Cited by 41
Elsamadicy, A. A., Koo, A. B., Reeves, B. C., Pennington, Z. A., Yu, J. B., Goodwin, C. R., Kolb, L. E., Laurans, M. S. H., Lo, S.-F. L., Shin, J. H., et al. (2022) · Journal of Neurosurgery Spine · doi:10.3171/2022.1.spine21987 · Cited by 41
Comparison of 3 Frailty Instruments in a Geriatric Acute Care Setting in a Low-Middle Income Country
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Lim, J. P., Low, K., Lin, N. J. J., Lim, C. Z. Q., Ong, S. W. X., Tan, W. Y. T., Tay, W. C., Tan, H. N., Young, B. E., Lye, D. C., et al. (2020) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2020.104331 · Cited by 39
Meyers, B. M., Al-Shamsi, H. O., Rask, S., Yelamanchili, R., Phillips, C., Παπαϊωάννου, Α., Pond, G. R., Jeyabalan, N., Zbuk, K. M., & Dhesy‐Thind, S. (2017) · Journal of Gastrointestinal Oncology · doi:10.21037/jgo.2016.11.12 · Cited by 39
“In a study comparing eight frailty scales (the Groningen Frailty Indicator, the Tilburg Frailty Indicator, a 70-item and a 44-item Frailty Index, the Clinical Frailty Scale, a frailty phenotype score, the Edmonton Frailty Scale, and the FRAIL scale), mortality was best predicted by the Frailty Index and Edmonton scale…”
Poulton, A., Shaw, J. F., Nguyen, F., Wong, C. L., Lampron, J., Tran, A., Lalu, M. M., & McIsaac, D. I. (2020) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000004687 · Cited by 39
Closing the Osteoporosis Care Gap
Åkesson, K., & McGuigan, F. E. (2021) · Current Osteoporosis Reports · doi:10.1007/s11914-020-00644-w · Cited by 41
Frailty implications for exercise participation and outcomes in patients with heart failure
Mudge, A., Pelecanos, A. M., & Adsett, J. A. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17145 · Cited by 39
“Participants with five or more missing items were excluded.(27) Other descriptive participant characteristics including demographics (age, sex, and ethnicity) and disease characteristics (New York Heart Association [NYHA] symptom class, HF cause, and left ventricular ejection fraction) were collected from interview an…”
Methodvan Gameren, M., Hoogendijk, E. O., van Schoor, N. M., Bossen, D., Visser, B., Bosmans, J. E., & Pijnappels, M. A. G. M. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03383-y · Cited by 44
Maddocks, M. M., Brighton, L. J., Alison, J. A., ter Beek, L., Bhatt, S. P., Brummel, N. E., Burtin, C., Cesari, M., Evans, R. A., Ferrante, L. E., et al. (2023) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202302-129st · Cited by 40
Lee, W., Chen, L., Liang, C., Peng, L., Chiou, S.-T., & Chou, P. (2016) · PLoS ONE · doi:10.1371/journal.pone.0157877 · Cited by 38
“Frail older adults have a higher risk for adverse health outcomes, including falling, hospitalization, and mortality [1, 3].”
BackgroundRothrock, R. J., Steinberger, J. M., Badgery, H. E., Hecht, A. C., Cho, S. K.-W., Caridi, J. M., & Deiner, S. G. (2018) · The Spine Journal · doi:10.1016/j.spinee.2018.05.026 · Cited by 38
“[16,24] Although there is a fair amount of heterogeneity between frailty screening tools (components, sensitivity, and specificity), the FRAIL scale has generally compared favorably to other indices.[25,26] It may be worthwhile to undertake future studies to compare predictive ability of different frailty indices to p…”
Quach, J., Theou, O., Pérez‐Zepeda, M. U., Godin, J., Rockwood, K. J., & Kehler, D. S. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17941 · Cited by 37
“This criterion allows for maximum use of available data and minimizes reliance on imputation procedures.(22) An FI was calculated by dividing the total number of deficits by the total number of items measured, resulting in a score between 0 (no deficits) and 1 (all deficits).”
MethodSelf-citationHealth, frailty and disability after ninety: Results of an observational study in France
Herr, M., Arvieu, J., Robine, J., & Ankri, J. (2016) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2016.06.002 · Cited by 38
“In particular, measures of grip strength and slow walking speed were replaced by self-reported variables, as previously observed in other epidemiological settings [44, 45].”
ResultPredictors of transitions in frailty severity and mortality among people aging with HIV
Brothers, T. D., Kirkland, S., Theou, O., Zona, S., Malagoli, A., Wallace, L. M. K., Stentarelli, C., Mussini, C., Falutz, J., Guaraldi, G., et al. (2017) · PLoS ONE · doi:10.1371/journal.pone.0185352 · Cited by 38
Self-citationBartosch, P., McGuigan, F. E., & Åkesson, K. (2018) · Osteoporosis International · doi:10.1007/s00198-018-4593-7 · Cited by 37
“How to best measure frailty is widely discussed and many instruments have been suggested [4, 23].”
BackgroundCombined Impact of Physical Frailty and Social Isolation on Rate of Falls in Older Adults
Hayashi, T., Umegaki, H., Makino, T., Huang, C., Inoue, A., Shimada, H., & Kuzuya, M. (2020) · The journal of nutrition health & aging · doi:10.1007/s12603-020-1316-5 · Cited by 37
Oxidative stress, genomic features and DNA repair in frail elderly: A systematic review
Sánchez-Flores, M., Marcos-Pérez, D., Costa, S., Teixeira, J. P., Bonassi, S., Pásaro, E., Laffón, B., & Valdiglesias, V. (2017) · Ageing Research Reviews · doi:10.1016/j.arr.2017.05.001 · Cited by 36
“…that the predictive value of frailty for negative health outcomes, including falls, hospitalizations, disability, institutionalization, and mortality, is consistently confirmed for most assessment tools, target populations, and settings (Clegg et al., 2013; Fried et al., 2009; Theou et al., 2013).”
BackgroundWhat is the duration of life expectancy in the state of frailty? Estimates in the SIPAF study
Herr, M., Arvieu, J., Ankri, J., & Robine, J. (2017) · European Journal of Ageing · doi:10.1007/s10433-017-0438-z · Cited by 36
“In particular, measures of grip strength and slow walking speed were replaced by self-reported variables, as previously done in other epidemiological settings (Castrejon-Perez et al. 2012; Theou et al. 2013).”
ResultAmbagtsheer, R. C., Visvanathan, R., Cesari, M., Yu, S., Archibald, M. M., Schultz, T., Karnon, J. D., Kitson, A. A., & Beilby, J. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016663 · Cited by 36
“The original study does not provide a specification for frailty cut-point; this study will consequently follow previous studies in adopting a cut-point of 8 or more points to define frailty.(43) 44”
ResultSublethal whole-body irradiation causes progressive premature frailty in mice
Fielder, E., Weigand, M., Agneessens, J., Griffin, B., Parker, C., Miwa, S., & von Zglinicki, T. (2019) · Mechanisms of Ageing and Development · doi:10.1016/j.mad.2019.03.006 · Cited by 37
“While the Fried and Rockwood concepts are overlapping and both scales are able to predict mortality, sensitivity and specificity regarding the classification of individuals as frail/non-frail are somewhat different between the scoring systems (Collerton et al., 2012; Ravindrarajah et al., 2013; Theou et al., 2013).”
BackgroundFrailty in lung transplantation: a systematic review
MONTGOMERY, E. E., Macdonald, P. S., Newton, P. J., Jha, S. R., & Malouf, M. A. (2019) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2020.1702527 · Cited by 36
Chong, E. K. C., Chia, J. Q., Law, F., Chew, J. L., Chan, M. Y., & Lim, W. S. (2019) · Annals of the Academy of Medicine Singapore · doi:10.47102/annals-acadmedsg.v48n4p115 · Cited by 36
Frailty affects prognosis in patients with colorectal cancer: A systematic review and meta-analysis
Cai, M., Gao, Z., Liao, J., Jiang, Y., & He, Y. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.1017183 · Cited by 36
“The prevalence of frailty varies slightly from study to study depending on the frailty tool used; furthermore, the varying tools often do not identify exactly the same group of people (30, 31).”
BackgroundFrailty and solid-organ transplant candidates: a scoping review
Kao, J., Reid, N., Hubbard, R. E., Homes, R., Hanjani, L. S., Pearson, E., Logan, B., King, S. J., Fox, S. T., & Gordon, E. H. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03485-7 · Cited by 37
“While there is some overlap in identification of frailty, it is likely that the phenotypic and multidimensional models (and their associated measurement tools) capture different patient groups [130].”
BackgroundHanlon, P., Burton, J. K., Quinn, T. J., Mair, F. S., McAllister, D., Lewsey, J., & Gallacher, K. (2023) · International Journal of Stroke · doi:10.1177/17474930231151847 · Cited by 36
Claims-Based Frailty Index and Its Relationship With Commonly Used Clinical Frailty Measures
Sison, S. D. M., Shi, S., Oh, G., Jeong, S., McCarthy, E. P., & Kim, D. H. (2024) · The Journals of Gerontology Series A · doi:10.1093/gerona/glae094 · Cited by 35
The need of operational paradigms for frailty in older persons: the SPRINTT project
Cesari, M., Marzetti, E., Calvani, R., Vellas, B. J., Bernabei, R., Bordes, P., Roubenoff, R., Landi, F., & Cherubini, A. (2017) · Aging Clinical and Experimental Research · doi:10.1007/s40520-016-0712-5 · Cited by 35
Siejka, T. P., Srikanth, V. K., Hubbard, R. E., Moran, C., Beare, R. J., WOOD, A. G., Phan, T. G., Balogun, S. A., & Callisaya, M. L. (2020) · The Journals of Gerontology Series A · doi:10.1093/gerona/glaa024 · Cited by 35
Idiosyncratic Drug-Induced Neutropenia and Agranulocytosis in Elderly Patients
Lorenzo-Villalba, N., Ortiz, M. B. A., Maouche, Y., Zulfiqar, A., & Andrès, E. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9061808 · Cited by 37
“It has been validated and has a higher predictive ability of adverse clinical events than other frailty scores in both hospital and community settings [85,86], but it is time consuming.”
BackgroundDevelopment of Korean Frailty Index for Primary Care (KFI-PC) and Its Criterion Validity
Won, C. W., Lee, Y., Lee, S., & Kim, M. (2020) · Annals of Geriatric Medicine and Research · doi:10.4235/agmr.20.0021 · Cited by 35
Cumulative Deficits Frailty Index Predicts Outcomes for Solid Organ Transplant Candidates
Varughese, R. A., Theou, O., Li, Y., Huang, X., Chowdhury, N., Famure, O., Selzner, N., MacIver, J., Mathur, S., Kim, S. J., et al. (2021) · Transplantation Direct · doi:10.1097/txd.0000000000001094 · Cited by 36
Self-citationFrailty and biological age. Which best describes our aging and longevity?
Félix, J., de Toda, I. M., Cerro, E. D., González-Sánchez, M., & la Fuente, M. D. (2024) · Molecular Aspects of Medicine · doi:10.1016/j.mam.2024.101291 · Cited by 39
Ritt, M., Rádi, K. H., Schwarz, C., Bollheimer, L. C., Sieber, C. C., & Gaßmann, K. (2015) · The journal of nutrition health & aging · doi:10.1007/s12603-015-0644-3 · Cited by 34
“Different FIs based on data from a standardized CGA (FI-CGA) have been developed and validated (9-14).”
Koo, A. B., Elsamadicy, A. A., Renedo, D. B., Sarkozy, M., Sherman, J. J. Z., Reeves, B. C., Havlik, J., Antonios, J. P., Sujijantarat, N., Hebert, R. M., et al. (2022) · Journal of NeuroInterventional Surgery · doi:10.1136/neurintsurg-2021-018484 · Cited by 33
Development of the Lung Transplant Frailty Scale (LT-FS)
Singer, J. P., Christie, J. D., Diamond, J. M., Anderson, M. A., Benvenuto, L. J., Gao, Y., Arcasoy, S. M., Lederer, D. J., Calabrese, D. R., Wang, P., et al. (2023) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2023.02.006 · Cited by 33
Hoogendijk, E. O., Stenholm, S., Ferrucci, L., Bandinelli, S., Inzitari, M., & Cesari, M. (2020) · Aging Clinical and Experimental Research · doi:10.1007/s40520-020-01478-3 · Cited by 32
Zahiri, M., Wang, C., Gardea‐Resendez, M., Nguyen, H., Shahbazi, M., Sharafkhaneh, A., Ruiz, I. P. T., Nguyen, C. K., Bryant, M., & Najafi, B. (2020) · IEEE Access · doi:10.1109/access.2020.3042451 · Cited by 32
“In addition, incomplete phenotype assessment, compromises the predictive power of the tool [9], [10].”
BackgroundTabue-Teguo, M., Barreto de Souza, P., Cantet, C., Andrieu, S., Simo, N., Fougère, B., Dartigues, J. F., & Vellas, B. (2018) · The Journal of nutrition, health and aging · doi:10.1007/s12603-018-1024-6 · Cited by 41
Franse, C. B., van Grieken, A., Li, Q., Melis, R. J. F., Rietjens, J. A. C., & Raat, H. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-022241 · Cited by 31
“8 Theou et al found that of eight commonly used approaches to measure frailty, frailty measured with a Frailty Index most accurately predicted mortality.(1) A standard procedure to construct a Frailty Index was developed by Searle et al, who recommended to include the following components in the index: morbidities, di…”
BackgroundMethodInfluentialTian, X., Qiao, X., Dong, L., Liu, N., Si, H., Jin, Y., Liu, X., & Wang, C. (2019) · Geriatric Nursing · doi:10.1016/j.gerinurse.2019.10.002 · Cited by 31
Elsamadicy, A. A., Havlik, J. L., Reeves, B. C., Sherman, J. J. Z., Koo, A. B., Pennington, Z. A., Hersh, A. M., Sandhu, M. R. S., Kolb, L. E., Lo, S.-F. L., et al. (2022) · World Neurosurgery · doi:10.1016/j.wneu.2022.05.101 · Cited by 31
Mousai, O., Tafoureau, L., Yovell, T., Flaatten, H. K., Guidet, B., Jung, C., de Lange, D. W., Leaver, S. K., Szczeklik, W., Fjølner, J., et al. (2022) · Intensive Care Medicine · doi:10.1007/s00134-022-06868-x · Cited by 31
Frail Elders in an Urban District Setting in Malaysia
Sathasivam, J., Kamaruzzaman, S. B., Hairi, F. M., Ng, C., & Chinna, K. (2015) · Asia Pacific Journal of Public Health · doi:10.1177/1010539515583332 · Cited by 31
Dent, E., & Pérez‐Zepeda, M. U. (2014) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2014.09.011 · Cited by 31
“Our finding of no ceiling effect for each index was similar to the finding of Theou et al. (2013) who reported no ceiling effect in mortality prediction for any Frailty Index, including the FI (Theou et al., 2013).”
BackgroundResultInfluentialGeritz, J., Mätzold, S., Steffen, M., Pilotto, A., Corrà, M. F., Moscovich, M., Rizzetti, M. C., Borroni, B., Padovani, A., Alpes, A., et al. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-1445-z · Cited by 30
Sepehri, K., Braley, M., Chinda, B., Zou, M., Tang, B., Park, G. S. H., Garm, A., McDermid, R. C., Rockwood, K. J., & Song, X. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.00089 · Cited by 27
“Several frailty-screening tools exist, including the Frailty Phenotype and the Clinical Frailty Scale (CFS) (8–12).”
MethodSelf-citationInflammation as a risk factor for the development of frailty in the Lothian Birth Cohort 1936
Welstead, M., Terrera, G. M., Russ, T. C., Corley, J., Taylor, A. M., Galé, C. R., & Luciano, M. (2020) · Experimental Gerontology · doi:10.1016/j.exger.2020.111055 · Cited by 33
“Polypharmacy (self-reported) > 4 medications (1), ≤4 medications (0) Previous literature (Theou et al., 2013) Body Mass Index (BMI) 18.”
Najafi, B., Veranyan, N., Zulbaran‐Rojas, A., Park, C., Nguyen, H., Nakahara, Q. K., Elizondo-Adamchik, H., Chung, J., Mills, J. L., Montero-Baker, M. F., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.20161 · Cited by 30
“86) Height, mean (SD), cm 165 (14) 168 (11) .”
Lahoud, R. N., Chongthammakun, V., Wu, Y., Hawwa, N., Brennan, D. M., & Cho, L. (2017) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2017.05.026 · Cited by 30
“026 tests used as risk stratification tools [27,28].”
MethodFrailty and health service use in rural South Australia
Dent, E., Hoon, E. A., Karnon, J. D., Newbury, J., Kitson, A. A., & Beilby, J. (2015) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2015.09.012 · Cited by 29
Ramírez, J. U. R., Cadena-Sanabria, M. O., & Ochoa, M. (2017) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2017.04.001 · Cited by 29
Associations between frailty and cancer-specific mortality among older women with breast cancer
Yan, C. H., Coleman, C., Nabulsi, N., Chiu, B., Ko, N., Hoskins, K., & Calip, G. (2021) · Breast Cancer Research and Treatment · doi:10.1007/s10549-021-06323-3 · Cited by 21
Discriminative value of frailty screening instruments in end-stage renal disease
Munster, B. C. V., Drost, D., Kalf, A., & Vogtländer, N. P. J. (2016) · Clinical Kidney Journal · doi:10.1093/ckj/sfw061 · Cited by 30
“Data from participants were excluded from the analysis of an instrument if they hadmissing values for >20% per instrument [11].”
BackgroundResultAndreasen, J., Aadahl, M., Sørensen, E. E., Eriksen, H. H., Lund, H., & Overvad, K. (2018) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2018.01.013 · Cited by 29
Long-run improvements in human health: Steady but unequal
Abeliansky, A. L., & Strulik, H. (2019) · The Journal of the Economics of Ageing · doi:10.1016/j.jeoa.2019.01.003 · Cited by 31
“We thus the confirm for health deficits, the postponement of senescence emphasized by Vaupel (2010) in the context of mortality.”
BackgroundAmbagtsheer, R. C., Thompson, M. Q., Archibald, M. M., Casey, M. G., & Schultz, T. (2019) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.13810 · Cited by 30
Jazbar, J., Locatelli, I., & Kos, M. (2021) · BMC Geriatrics · doi:10.1186/s12877-020-01969-y · Cited by 28
“In the current study, we adjusted the previously published SHARE-FI for use in data from Waves 5 and 6, in accordance with the guidelines published by Searle et al. [25] The age-related deficits from which the FI is calculated are listed in Additional file 2.”
MethodSia, T., Wen, T., Cham, S., Friedman, A. M., & Wright, J. D. (2021) · Gynecologic Oncology · doi:10.1016/j.ygyno.2021.02.022 · Cited by 28
Frailty Is Associated with Impaired Diabetic Foot Ulcer Healing and All-Cause Re-Hospitalization
Maltese, G., Basile, G., Meehan, H., Fuller, M., Cesari, M., Fountoulakis, N., & Karalliedde, J. J. (2022) · The journal of nutrition health & aging · doi:10.1007/s12603-022-1726-7 · Cited by 29
“As such, the FI has unsurprisingly shown to be associated with the risk of adverse outcomes in older persons across clinical settings (8-10).”
Imamura, K., Yamamoto, S., Suzuki, Y., Yoshikoshi, S., Harada, M., Osada, S., Kamiya, K., Matsuzawa, R., & Matsunaga, A. (2022) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfac047 · Cited by 28
Orkaby, A. R., Huan, T., Intrator, O. K., Cai, S., Schwartz, A. W., Wieland, D., Hall, D. E., Figueroa, J. F., Strom, J. B., Kim, D. H., et al. (2023) · The Journals of Gerontology Series A · doi:10.1093/gerona/glad157 · Cited by 28
Xie, X., Que, J., Sun, L., Sun, T., & Yang, F. (2025) · BMC Medicine · doi:10.1186/s12916-025-03961-y · Cited by 30
“In this study, participants were excluded from scale analysis if they had missing values for more than 20% of the items on that scale [32].”
Amblàs-Novellas, J., Espaulella‐Panicot, J., Inzitari, M., Rexach, L., Fontecha, B., & Romero‐Ortuño, R. (2017) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2016.07.005 · Cited by 27
Jung, Y., Lyu, J., & Kim, G. (2021) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2021.104533 · Cited by 27
Aging Successfully: The Key to Aging in Place
Morley, J. E. (2015) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2015.09.011 · Cited by 26
O’Donovan, M. R., Sezgin, D., Ó’Caoimh, R., & Liew, A. (2021) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2021.104448 · Cited by 26
Sun, L. Y., Jabagi, H., Fang, J., & Lee, D. S. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.30959 · Cited by 26
Frailty in Men Living with HIV: A Cross-Sectional Comparison of Three Frailty Instruments
Yeoh, H., Cheng, A. C., Palmer, C. S., Crowe, S., & Hoy, J. (2018) · Antiviral Therapy · doi:10.3851/imp3185 · Cited by 23
“This model attempts to grade the nuances of frailty severity [4,5].”
MethodAbeliansky, A. L., & Strulik, H. (2018) · Economics & Human Biology · doi:10.1016/j.ehb.2018.03.005 · Cited by 25
“A handful of studies have investigated the health deficit index (frailty index) using the SHARE dataset (Romero-Ortuno and Kenny, 2012; Harttgen et al., 2013; Theou et al., 2013; Romero-Ortuno, 2014; Abeliansky and Strulik, 2018).”
The Effect of Sarcopenia on Outcomes in Geriatric Blunt Trauma
Malekpour, M., Bridgham, K., Jaap, K., Erwin, R., Widom, K., Rapp, M., Leonard, D., Baro, S., Dove, J., Hunsinger, M., et al. (2017) · The American surgeon · doi:10.1177/000313481708301120 · Cited by 25
Todorovic, S. T., Lončarević‐Vasiljković, N., Jović, M., Sokanovic, S. J., Kanazir, S., & Mladenović, A. (2019) · Mechanisms of Ageing and Development · doi:10.1016/j.mad.2019.111195 · Cited by 26
Runzer-Colmenares, F. M., Urrunaga‐Pastor, D., Roca-Moscoso, M. A., Noriega, J. D., Rosas‐Carrasco, Ó., & Parodi, J. F. (2020) · The journal of nutrition health & aging · doi:10.1007/s12603-020-1404-6 · Cited by 26
Bai, Y., Zhang, X., Sun, X., Li, J., Cao, J., & Wu, X. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03369-w · Cited by 25
“Frailty increases the risk of mortality and adverse health outcomes [13, 15, 16] due to a person’s vulnerability to stressors [14].”
BackgroundSun, L., Deng, G., Lu, X., Xie, X., Kang, L., Sun, T., & Dai, X. (2024) · The journal of nutrition health & aging · doi:10.1016/j.jnha.2024.100398 · Cited by 27
Prince, C. S., Hooten, N. N., Mode, N. A., Zhang, Y., Ejiogu, N., Becker, K. G., Zonderman, A. B., & Evans, M. K. (2019) · Aging · doi:10.18632/aging.102135 · Cited by 25
“Frailty was assessed previously [10] using the FRAIL scale [9] with adaptions for the loss of weight domain [10, 44].”
MethodValidation of “(fr)AGILE”: a quick tool to identify multidimensional frailty in the elderly
Liguori, I., Russo, G., Bulli, G., Curcio, F., Flocco, V., Galizia, G., Della‐Morte, D., Gargiulo, G., Testa, G., Cacciatore, F., et al. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01788-1 · Cited by 25
Tew, Y. Y., Chan, J. H., Keeling, P., Shenkin, S. D., MacLullich, A. M. J., Mills, N. L., Denvir, M. A., & Anand, A. (2021) · Age and Ageing · doi:10.1093/ageing/afab043 · Cited by 25
“However, tools to measure frailty are numerous [8], often poorly correlate with each other [9, 10] and frequently require specialist equipment or specific bedside assessment.”
BackgroundMcElhaney, J. E., Andrew, M. K., & McNeil, S. (2017) · Vaccine · doi:10.1016/j.vaccine.2017.09.084 · Cited by 26
Frailty in cardiovascular disease: Screening tools
Zão, A., Magalhães, S., & Santos, M. (2019) · Revista Portuguesa de Cardiologia · doi:10.1016/j.repc.2018.05.019 · Cited by 25
“performance in some of these tools,(54,55) other studies found significant differences.(56) In 2013, a consensus conference identified some of these tools as allowing physicians to objectively recognize frail persons.”
Frailty Viewed From a Nursing Perspective
Gobbens, R. J. J., & Uchmanowicz, I. (2023) · SAGE Open Nursing · doi:10.1177/23779608221150598 · Cited by 24
“In other studies conducted in the Netherlands (Gobbens et al., 2020b), Brazil (Santiago et al., 2018b), and 11 European countries (Theou et al., 2013) using the TFI, the results for predicting mortality were at least acceptable; only a study among 2,420 Dutch community-dwelling people aged ≥65…”
MethodQiao, X., Wang, C., Tian, X., Dong, L., Liu, N., Jin, Y., & Si, H. (2017) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.13183 · Cited by 24
Calle, A., Onder, G., Morandi, A., Bellelli, G., Ortolani, E., Pérez, L. M., Cervilla, M. M., Sanniti, A., Mazzanti, P., Platto, C., et al. (2018) · The journal of nutrition health & aging · doi:10.1007/s12603-018-1060-2 · Cited by 24
“Therefore, the ability to cope with internal and external stressful factors is compromised, increasing the risk of falls, disability, hospital admission, longer length of stay, readmis-sions, institutionalization and mortality (2, 3).”
Romero‐Ortuño, R. (2015) · Interdisciplinary topics in gerontology and geriatrics · doi:10.1159/000381170 · Cited by 23
Sattui, S. E., Jannat‐Khah, D., Lally, L., Lieber, S. B., Mandl, L. A., & Spiera, R. (2022) · Lara D. Veeken · doi:10.1093/rheumatology/keac050 · Cited by 23
Covino, M., Salini, S., Russo, A., Matteis, G. D., Simeoni, B., Maccauro, G., Sganga, G., Landi, F., Gasbarrini, A., & Franceschi, F. (2022) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2021.12.039 · Cited by 23
O’Donoghue, P., O’Halloran, A. M., Kenny, R. A., & Romero‐Ortuño, R. (2022) · EClinicalMedicine · doi:10.1016/j.eclinm.2022.101304 · Cited by 21
Instruments to assess frailty in community dwelling older adults: A systematic review
Rasiah, J., Gruneir, A., Oelke, N. D., Estabrooks, C. A., Holroyd-Leduc, J. M., & Cummings, G. G. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104316 · Cited by 24
Rosa, F., Covino, M., Russo, A., Salini, S., Forino, R., Polla, D. A. D., Fransvea, P., Quero, G., Fiorillo, C., Greca, A. L., et al. (2022) · Digestive and Liver Disease · doi:10.1016/j.dld.2022.10.012 · Cited by 23
Childhood experiences and frailty trajectory among middle-aged and older adults in China
Yan, Y., Cai, L., & Lü, N. (2022) · European Journal of Ageing · doi:10.1007/s10433-022-00746-7 · Cited by 22
Lee, S., Wang, J., Chao, C., Chien, K., & Huang, J. (2021) · Diabetic Medicine · doi:10.1111/dme.14566 · Cited by 22
Frailty and prognosis in advanced heart failure
Boxer, R. S., Shah, K. B., & Kenny, R. A. (2013) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000027 · Cited by 22
Frailty: a new vulnerability indicator in people aging with HIV
Brothers, T. D., & Rockwood, K. J. (2018) · European Geriatric Medicine · doi:10.1007/s41999-018-0143-2 · Cited by 23
Self-citationGenes Related to Education Predict Frailty Among Older Adults in the United States
Huibregtse, B. M., Newell‐Stamper, B. L., Domingue, B. W., & Boardman, J. D. (2019) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbz092 · Cited by 22
Age, Not Sex, Modifies the Effect of Frailty on Long-term Outcomes After Cardiac Surgery
Sun, L. Y., Spence, S. D., Benton, S., Beanlands, R. S., Austin, P. C., Eddeen, A. B., & Lee, D. S. (2020) · Annals of Surgery · doi:10.1097/sla.0000000000004060 · Cited by 22
“To date, several frailty scales exist to capture related but distinct groups that form different dimensions of frailty.(35) A direct comparison of 8 commonly used frailty instruments demonstrated limited agreement between these instruments.”
BackgroundResultFrailty predicts outcomes in cystic fibrosis patients listed for lung transplantation
Koutsokera, A., Sykes, J. R., Theou, O., Rockwood, K. J., Steinack, C., Derkenne, M.-F., Benden, C., Krueger, T., Chaparro, C., Aubert, J., et al. (2022) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2022.07.017 · Cited by 21
Self-citationShang, N., Liu, H., Wang, N., Guo, S., & Ma, L. (2022) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.14469 · Cited by 21
McIsaac, D. I., Taljaard, M., Bryson, G. L., Beaulé, P. E., Gagné, S., Hamilton, G. M., Hladkowicz, E., Huang, A. R., Joanisse, J. A., Lavallée, L. T., et al. (2016) · BMC Anesthesiology · doi:10.1186/s12871-016-0276-0 · Cited by 21
“Despite its relative simplicity and ease of use, the CFS is equally discriminative in predicting mortality compared to frailty indices containing 40+ variables [4, 27].”
BackgroundMethodJäger, J., Sieber, C. C., Gaßmann, K., & Ritt, M. (2019) · Clinical Interventions in Aging · doi:10.2147/cia.s191117 · Cited by 21
Metadata
- Authors
- Theou, O., Brothers, T. D., Mitnitski, A., & Rockwood, K.
- Affiliations
- Dalhousie University (CA)
- Corresponding author
- Rockwood, Kenneth
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2013-08-26
- Volume
- 61
- Issue
- 9
- Pages
- 1537-1551
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W2037844081
- Cited by
- 665
- References
- 49
- Citations by year
- 2026: 30 · 2025: 42 · 2024: 51 · 2023: 55 · 2022: 76 · 2021: 63 · 2020: 62 · 2019: 59 · 2018: 47 · 2017: 63 · 2016: 58 · 2015: 32 · 2014: 24 · 2013: 3
- FWCI
- 18.14
- Type
- journal article
- Language
- en
- Open access
- green
- zenodo.org
- Licence
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, other-oa)
- Funders
- European Commission through the Fifth Framework Programme (QLK6-CT-2001-00360)
- U.S. National Institute (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, R21 AG025169, Y1-AG-4553-01, IAG BSR06-11, OGHA 04-064)
- German Ministry of Education and Research
- 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, frailty assessment tools, all-cause mortality prediction, frailty index, Clinical Frailty Scale, Fried frailty phenotype, Edmonton Frail Scale, FRAIL scale, Tilburg Frailty Indicator, Groningen Frailty Indicator, comprehensive geriatric assessment, frailty prevalence, SHARE survey, older adults, mortality risk stratification, content validity
- MeSH terms
- Aged, Aged, 80 and over, Cause of Death, Europe, Female, Health Surveys, Humans, Male, Middle Aged, Reproducibility of Results, Geriatric Assessment, Survival Rate, Frail Elderly
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