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Cited by 665Frailty in Older AdultsPharmaceutical Practices and Patient OutcomesChronic Disease Management Strategies

The DOI matches its Crossref record; 49 of the 49 references it cites were found in a registry or an index.

Operationalization of Frailty Using Eight Commonly Used Scales and Comparison of Their Ability to Predict All‐Cause Mortality

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Theou, Olga, Brothers, Thomas D., Mitnitski, Arnold, Rockwood, Kenneth·2013·Journal of the American Geriatrics Society
DOI 10.1111/jgs.12420
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Abstract

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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Research works printed but not linked: 4

  1. Börsch‐Supan A, 2005, The Survey of Health, Ageing and Retirement in Europe—Methodology
  2. Börsch‐Supan A, 2005, Health, ageing and retirement in Europe—First results from the Survey of Health, Ageing and Retirement in Europe
  3. World Health Organization Programme on Mental Health, 1996, WHOQOL‐BREF Introduction, Administration and Scoring
  4. Romero‐Ortuno R, 2011, The Frailty Instrument for primary care of the Survey of Health, Ageing and Retirement in Europe (SHARE‐FI): Results of the Spanish sample, Rev Esp Geriatr Gerontol, 46, 243

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Metadata

Authors
Theou, O., Brothers, T. D., Mitnitski, A., & Rockwood, K.
Affiliations
Dalhousie University (CA)
Corresponding author
Rockwood, Kenneth
ORCID
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
DOI
10.1111/jgs.12420
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
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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