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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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Self-citationA standard procedure for creating a frailty index
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Self-citationPrevalence of frailty in community-dwelling older persons: a systematic review
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“With how many of the following activities do you require help? (meal preparation, shopping, transportation, telephone, housekeeping, laundry, managing money, taking medications) 0–1 activities = 0; 2–4 activities = 1; 5–8 activities = 2 Please tell me if you have any difficulty with these because of a physical, mental…”
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Makary, M. A., Segev, D. L., Pronovost, P. J., Syin, D., Bandeen-Roche, K., Patel, P., Takenaga, R., Devgan, L., Holzmueller, C. G., Tian, J., et al. (2010) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2010.01.028 · Cited by 2,184
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Gilbert, T., Neuburger, J., Kraindler, J., Keeble, E., Smith, P., Ariti, C. A., Arora, S., Street, A., Parker, S. G., Roberts, H. C., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30668-8 · Cited by 1,567
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“The characteristics of the FI and its ability to predict all-cause mortality have been confirmed by multiple studies of older cohorts from different cultural backgrounds (Garcia-Gonzalez et al., 2009; Goggins et al., 2005; Mitnitski et al., 2001, 2004; Theou et al., 2013).”
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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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