A major obstacle to the success of such interventions has been the absence of a standardized and valid method for screening of those who are truly frail so as to effectively target care (1)(3). Oxford University Press is a department of the University of Oxford.
Three-year incidence of frailty was 7% for years 0–3 and was 7%, as well, for 4-year incidence of frailty from years 3–7, for the first cohort. A standardized phenotype provides a basis for future comparison with other populations. Cycle of frailty hypothesized as consistent with demonstrated pairwise associations and clinical signs and symptoms of frailty. Methods: BMC Geriatr. Ettinger WH, Jr Burns R, Bessier SP, et al. There is a growing consensus that markers of frailty include age-associated declines in lean body mass, strength, endurance, balance, walking performance, and low activity (9)(10)(14)(15)(16)(17), and that multiple components must be present clinically to constitute frailty (9)(14). Covariates selected were based on analyses performed on the first cohort; external validation using the second cohort showed good agreement. This end stage has been reported to be irreversible and presage death (19)(24)(52)(53).
This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29–2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Covariate-adjusted Cox models were also fit, utilizing baseline covariates shown to be predictive of mortality in this cohort (42): age, gender, income, smoking status, diuretic use without a history of hypertension or congestive heart failure, fasting glucose, albumin, creatinine; objective measures of subclinical disease, including: brachial and tibial systolic blood pressure, abnormal left ventricular ejection fraction (LVEF; by echocardiography), major ECG abnormality, forced vital capacity (FVC), and maximal stenosis of the internal carotid artery (by ultrasound), congestive heart failure (validated history), digit symbol substitution score, depressive symptoms (CES–D score excluding the two questions utilized in the frailty definition), and difficulty in ≥1 IADL. In this same issue, we separately examine the association of frailty with cardiovascular diseases (51). In meta-analyses, the prevalence of multimorbidity in frail individual was 72% (95% confidence interval = 63%-81%; I2 = 91.3%), and the prevalence of frailty among multimorbid individuals was 16% (95% confidence interval = 12%-21%; I2 = 96.5%).
Deaths were identified at semi-annual contacts and confirmed through intensive surveillance (37)(42). A version of the Minnesota Leisure Time Activities Questionnaire (34) ascertained physical activities in the prior 2 weeks, plus frequency and duration. 1), and, in a population-based study of older adults, evaluated its prevalence and incidence, cross-sectional correlates, and its validity in terms of predicting the adverse outcomes geriatricians associate with frail older adults. Address correspondence to Dr. Richard Kronmal, CHS Coordinating Center, Century Square Building, 1501 4th Avenue, Suite 2105, Seattle, WA 98101.
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