Comparison of alternate scoring of variables on the performance of the frailty index
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Background: The frailty index (FI) is used to measure the health status of ageing individuals. An FI is constructed as the proportion of deficits present in an individual out of the total number of age-related health variables considered. The purpose of this study was to systematically assess whether dichotomizing deficits included in an FI affects the information value of the whole index. Methods: Secondary analysis of three population-based longitudinal studies of community dwelling individuals: Nova Scotia Health Survey (NSHS, n = 3227 aged 18+), Survey of Health, Ageing and Retirement in Europe (SHARE, n = 37546 aged 50+), and Yale Precipitating Events Project (Yale-PEP, n = 754 aged 70+). For each dataset, we constructed two FIs from baseline data using the deficit accumulation approach. In each dataset, both FIs included the same variables (23 in NSHS, 70 in SHARE, 33 in Yale-PEP). One FI was constructed with only dichotomous values (marking presence or absence of a deficit); in the other FI, as many variables as possible were coded as ordinal (graded severity of a deficit). Participants in each study were followed for different durations (NSHS: 10 years, SHARE: 5 years, Yale PEP: 12 years). Results: Within each dataset, the difference in mean scores between the ordinal and dichotomous-only FIs ranged from 0 to 1.5 deficits. Their ability to predict mortality was identical; their absolute difference in area under the ROC curve ranged from 0.00 to 0.02, and their absolute difference between Cox Hazard Ratios ranged from 0.001 to 0.009. Conclusions: Analyses from three diverse datasets suggest that variables included in an FI can be coded either as dichotomous or ordinal, with negligible impact on the performance of the index in predicting mortality.
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Studies have shown that regardless of which items are included, the points at which pre-frailty and frailty appear are remarkably similar.
“Moreover a number of studies have shown that regardless of which items are included, there is a remarkable similarity of the points at which pre-frailty and frailty appear.(4,22,23)”
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 [22]
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- Authors
- Peña, F. G., Theou, O., Wallace, L., Brothers, T. D., Gill, T. M., Gahbauer, E. A., Kirkland, S., Mitnitski, A., & Rockwood, K.
- Affiliations
- Dalhousie University (CA)
- Yale University (US)
- Corresponding author
- Rockwood, Kenneth
- ORCID
- Venue
- BMC Geriatrics
- Published
- 2014-02-24
- Volume
- 14
- Issue
- 1
- Pages
- 25-25
- ISSN
- 1471-2318 (ISSN-L)
- PMC
- PMC3938909
- OpenAlex
- W2026733709
- Cited by
- 96
- References
- 21
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 9 · 2023: 15 · 2022: 8 · 2021: 14 · 2020: 7 · 2019: 4 · 2018: 6 · 2017: 8 · 2016: 6 · 2015: 11 · 2014: 4
- FWCI
- 4.93
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Geriatrics (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- Funders
- Dalhousie Medical Research Foundation
- European Commission (261982, IAG BSR06-11, QLK6‐CT‐2001‐ 00360, RII-CT- 2006-062193, P01_AG08291, SHARE-I3: RII-CT-2006-062193, SHARE M4, SHARE-I3, U01 AG09740-13S2, CT-2001-00360, P30 AG12815, CIT5-CT-2005- 028857, R21_AG025169, P01 AG005842, OGHA 04-064, CIT4-CT-2006-028812, Y1-AG-4553-01, 227822, COMPARE: CIT5‐CT‐2005‐028857, SHARELIFE: CIT4-CT-2006–028812)
- Dalhousie University
- National Institutes of Health (2p30ag012815-16)
- Canadian Institutes of Health Research
- National Institute on Aging (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, R21 AG025169, Y1-AG-4553-01, IAG BSR06-11 and OGHA 04-064, OGHA 04- 064, CIT5-CT-2005-028857, R37AG017560, IAG BSR06-11 and OGHA 04-064, U01 AG09740‐13S2, P30AG12815, P01AG08291, AG09740, 261982, QLK6-CT-2001-00360, U01 AG 09740, K07AG043587, R37AG17560, BSR06-11, CIT4-CT-2006-028812, 227822, IAG BSR06- 11, R21AG025169, AG005842, RII-CT-2006-062193, P01AG005842, U01AG009740, P30AG021342, Y1-AG-4553–01)
- 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 index, deficit accumulation, variable coding, mortality prediction, aging, health status measurement, community-dwelling older adults
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Animals, Cats, Health Surveys, Humans, Longitudinal Studies, Middle Aged, Nova Scotia, Population Surveillance, Geriatric Assessment, Frail Elderly, Young Adult
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