A standard procedure for creating a frailty index

Samuel D Searle; Arnold Mitnitski; Evelyne A Gahbauer; Thomas M Gill; Kenneth Rockwood

doi:10.1186/1471-2318-8-24

journal article Sep 30, 2008

A standard procedure for creating a frailty index

Samuel D Searle Arnold Mitnitski Evelyne A Gahbauer Thomas M Gill Kenneth Rockwood

BMC Geriatrics Vol. 8 No. 1 · Springer Science and Business Media LLC

View at Publisher Save 10.1186/1471-2318-8-24

Abstract

AbstractBackgroundFrailty can be measured in relation to the accumulation of deficits using a frailty index. A frailty index can be developed from most ageing databases. Our objective is to systematically describe a standard procedure for constructing a frailty index.MethodsThis is a secondary analysis of the Yale Precipitating Events Project cohort study, based in New Haven CT. Non-disabled people aged 70 years or older (n = 754) were enrolled and re-contacted every 18 months. The database includes variables on function, cognition, co-morbidity, health attitudes and practices and physical performance measures. Data came from the baseline cohort and those available at the first 18-month follow-up assessment.ResultsProcedures for selecting health variables as candidate deficits were applied to yield 40 deficits. Recoding procedures were applied for categorical, ordinal and interval variables such that they could be mapped to the interval 0–1, where 0 = absence of a deficit, and 1= full expression of the deficit. These individual deficit scores were combined in an index, where 0= no deficit present, and 1= all 40 deficits present. The values of the index were well fit by a gamma distribution. Between the baseline and follow-up cohorts, the age-related slope of deficit accumulation increased from 0.020 (95% confidence interval, 0.014–0.026) to 0.026 (0.020–0.032). The 99% limit to deficit accumulation was 0.6 in the baseline cohort and 0.7 in the follow-up cohort. Multivariate Cox analysis showed the frailty index, age and sex to be significant predictors of mortality.ConclusionA systematic process for creating a frailty index, which relates deficit accumulation to the individual risk of death, showed reproducible properties in the Yale Precipitating Events Project cohort study. This method of quantifying frailty can aid our understanding of frailty-related health characteristics in older adults.

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References

34

[1]

Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, Wolfson C: Frailty: an emerging research and clinical paradigm–issues and controversies. J Gerontol A Biol Sci Med Sci. 2007, 62: 731-737. 10.1093/gerona/62.7.731

[2]

Fisher AL: Just what defines frailty?. J Am Geriatr Soc. 2005, 53: 2229-2230. 10.1111/j.1532-5415.2005.00510.x. 10.1111/j.1532-5415.2005.00510.x

[3]

Whitson HE, Purser JL, Cohen HJ: Frailty thy name is ... Phrailty?. J Gerontol A Biol Sci Med Sci. 2007, 62 (7): 728-730. 10.1093/gerona/62.7.728

[4]

Mitnitski AB, Mogilner AJ, Rockwood K: Accumulation of deficits as a proxy measure of aging. The Scientific World. 2001, 1: 323-336. 10.1100/tsw.2001.58

[5]

Frailty in Relation to the Accumulation of Deficits

K. Rockwood, A. Mitnitski

The Journals of Gerontology Series A: Biological S... 2007 10.1093/gerona/62.7.722

[6]

Mitnitski A, Xiaowei S, Skoog I, Broe GA, Cox JL, Grunfeld E, Rockwood K: Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality. J Am Geriatr Soc. 2005, 53 (12): 2184-5189. 10.1111/j.1532-5415.2005.00506.x. 10.1111/j.1532-5415.2005.00506.x

[7]

Rockwood K, Andrew M, Mitnitski A: A Comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007, 62A (No 7): 738-743. 10.1093/gerona/62.7.738

[8]

Kulminski A, Yashin A, Arbeev K, Akushevich I, Ukraintseva S, Land K: Cumulative index of health disorders as an indicator of aging-associated processes in the elderly: Results from analyses of the National Long Term Care Survey. Mech Ageing Dev. 2007, 128: 250-258. 10.1016/j.mad.2006.12.004. 10.1016/j.mad.2006.12.004

[9]

Kulminski A, Ukraintseva SV, Akushevich IV, Arbeev KG, Yashin AI: Cumulative index of health deficiencies as a characteristic of long life. J Am Geriatr Soc. 2007, 55 (6): 935-40. 10.1111/j.1532-5415.2007.01155.x. 10.1111/j.1532-5415.2007.01155.x

[10]

Goggins WB, Woo J, Sham A, Ho SC: Frailty index as a measure of personal biological age in a Chinese population. J Gerontol A Biol Sci Med Sci. 2005, 60A: 1046-1051. 10.1093/gerona/60.8.1046

[11]

Woo J, Goggins W, Sham A, Ho SC: Social determinants of frailty. Gerontology. 2005, 51: 402-408. 10.1159/000088705. 10.1159/000088705

[12]

Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, Wolfson C: Frailty: an emerging research and clinical paradigm–issues and controversies. J Gerontol A Biol Sci Med Sci. 2007, 62 (7): 731-737. 10.1093/gerona/62.7.731

[13]

Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, Ershler WB, Harris T, Fried : Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006, 54 (6): 991-1001. 10.1111/j.1532-5415.2006.00745.x. 10.1111/j.1532-5415.2006.00745.x

[14]

Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Walston JD: Interventions on frailty working group. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc. 2004, 52 (4): 625-634. 10.1111/j.1532-5415.2004.52174.x. 10.1111/j.1532-5415.2004.52174.x

[15]

Gill TM, Gahbauer EA, Allore HG, Ham L: Transitions between frailty states among community-living older persons. Arch Intern Med. 2006, 166: 418-423. 10.1001/.418. 10.1001/archinte.166.4.418

[16]

Gill TM, Desai MM, Gahbauer EA, Holford TR, Williams CS: Restricted activity among community-living older persons: incidence, precipitants, and health care utilization. Ann Intern Med. 2001, 135: 313-321. 10.7326/0003-4819-135-5-200109040-00007

[17]

Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 13 (3): 189-198. 10.1016/0022-3956(75)90026-6. 10.1016/0022-3956(75)90026-6

[18]

Mitnitski A, Rockwood K: Transitions in cognitive test scores over 5 and 10 years in elderly people: evidence for a model of age-related deficit accumulation. BMC Geriatr. 2008, 8 (1): 3-10.1186/1471-2318-8-3. 10.1186/1471-2318-8-3

[19]

Rockwood K, Mitnitski A, Song X, Steen B, Skoog I: Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc. 2006, 54 (6): 975-979. 10.1111/j.1532-5415.2006.00738.x. 10.1111/j.1532-5415.2006.00738.x

[20]

Reisberg B: Functional Assessment Staging (FAST). Psychopharmacol Bull. 1988, 24: 653-659.

[21]

Streiner D, Norman G: Health Measurement scales: A guide to their development and use. 2003, Oxford, Oxford University Press, 172-193. 3 10.1093/oso/9780198528470.003.0010

[22]

Frailty in Older Adults: Evidence for a Phenotype

L. P. Fried, C. M. Tangen, J. Walston et al.

The Journals of Gerontology Series A: Biological S... 2001 10.1093/gerona/56.3.m146

[23]

An Introduction to the Bootstrap

Bradley Efron, Robert J. Tibshirani

1993 10.1007/978-1-4899-4541-9

[24]

Rockwood K, Mitnitski A: Limits to deficit accumulation in elderly people. Mech Ageing Dev. 2006, 127 (5): 494-6. 10.1016/j.mad.2006.01.002

[25]

Rockwood K, Mitnitski A: frailty, fitness and the mathematics of deficit accumulation. Rev Clin Gerontol. 2007, 17: 1-12. 10.1017/S0959259807002353. 10.1017/s0959259807002353

[26]

Lee SJ, Lindquist K, Segal MR, Covinsky KE: Development and validation of a prognostic index for 4-year mortality in older adults. JAMA. 2006, 295 (7): 801-8. 10.1001/jama.295.7.801. Erratum in: JAMA 2006, 295(16):1900 10.1001/jama.295.7.801

[27]

Gompertz B: On the nature of the function expressive of the law of human mortality and on a new mode of determining life contingencies. Philosophical Transaction of the Royal Society of London. 1825, San Diego: Academic Press

[28]

Yashin AI, Arbeev KG, Akushevich I, Kulminski A, Akushevich L, Ukraintseva SV: Stochastic model for analysis of longitudinal data on aging and mortality. Math Biosci. 2007, 208: 538-551. 10.1016/j.mbs.2006.11.006. 10.1016/j.mbs.2006.11.006

[29]

Kulminski AM, Ukraintseva SV, Kulminskaya IV, Arbeev KG, Land K, Yashin AI: Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc. 2008, 56: 898-903. 10.1111/j.1532-5415.2008.01656.x. 10.1111/j.1532-5415.2008.01656.x

[30]

Martin FC, Brighton P: Frailty: different tools for different purposes?. Age Ageing. 2008, 37 (2): 129-31. 10.1093/ageing/afn011. 10.1093/ageing/afn011

[31]

Rockwood K, Abeysundera MJ, Mitnitski A: How should we grade frailty in nursing home patients?. J Am Med Dir Assoc. 2007, 8 (9): 595-603. 10.1016/j.jamda.2007.07.012. 10.1016/j.jamda.2007.07.012

[32]

Mitnitski A, Bao L, Rockwood K: Going from bad to worse: a stochastic model of transitions in deficit accumulation, in relation to mortality. Mech Ageing Dev. 2006, 127: 490-493. 10.1016/j.mad.2005.09.007. 10.1016/j.mad.2006.01.007

[33]

Mitnitski A, Song X, Rockwood K: Improvement and decline in health status from late middle age: modeling age-related changes in deficit accumulation. Exp Gerontol. 2007, 42 (11): 1109-15. 10.1016/j.exger.2007.08.002

[34]

Flegal KM, Graubard BI, Williamson DF, Gail MH: Cause-specific excess deaths associated with underweight, overweight and obesity. JAMA. 2007, 298 (17): 2028-2037. 10.1001/jama.298.17.2028. 10.1001/jama.298.17.2028

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Published: Sep 30, 2008
Vol/Issue: 8(1)
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Authors

Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

Cite This Article

Samuel D Searle, Arnold Mitnitski, Evelyne A Gahbauer, et al. (2008). A standard procedure for creating a frailty index. BMC Geriatrics, 8(1). https://doi.org/10.1186/1471-2318-8-24

A standard procedure for creating a frailty index

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