Abstract
Objectives
To examine the ability of each item of the Fried phenotype of frailty to predict physical
limitation and physical performance measures after 4 years, walking speed and hospitalization
after 7 years, and mortality after 12 years.
Design
Prospective cohort study.
Setting
Community-living older people in Hong Kong SAR, China.
Participants
4000 community-living Chinese men and women aged 65 and older were recruited using
stratified sampling so that approximately 33% each would be aged 65-69, 70-74, and
75 and older. Those who were unable to walk independently, had had bilateral hip replacement,
or were not competent to give informed consent were excluded.
Measurements
Information was collected from questionnaire to include sociodemographic and lifestyle
data, medical history, cognition, mood, and ability to carry out daily functional
tasks. Frailty was assessed using the 5-item Fried phenotype, or Cardiovascular Health
Study (CHS) scale. Measurements include grip strength, 6-m walking speed, and chair
stand. Length of hospital stay was obtained from the hospital records. Death was ascertained
from the Death Registry.
Statistical analysis
Logistic regression was used to analyze the association between individual items and
health outcomes, adjusting for age, education, chronic obstructive pulmonary disease,
diabetes mellitus, hypertension, heart disease, current smoker, Mini–Mental State
Examination score, and depression. The predictive ability of each item was examined
using the area under the curve (AUC), and stepwise models were applied to assess the
incremental predictive validity.
Results
In men, all items of the CHS scale predicted increased risk of physical limitation
after 4 years with similar AUC values. The lowest quintile of walking speed and grip
strength predicted increased risk of walking speed <0.8 m/s at 4 and 7 years. The
other items had variable predictive ability for outcomes. For women, low walking speed
and grip strength were the only 2 items that predicted all the adverse outcomes except
mortality. When each item was entered into a stepwise model to predict adverse outcomes,
low walking speed predicted nearly as well as the combined 5-item CHS.
Conclusion
The 5-item Fried phenotype in frailty screening in clinical management may be replaced
by a single physical performance measure such as walking speed or grip strength, but
cut-off values derived from individual populations need to be applied.
Keywords
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References
- Multidimensional geriatric assessment.in: Fillet H. Rockwood K. Woodhouse K. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 7th ed. Saunders, Philadelphia, PA2009: 211-217
- Frailty: An emerging public health priority.J Am Med Dir Assoc. 2016; 17: 188-192
- Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments.Ageing Res Rev. 2016; 26: 53-61
- Predicting risk and outcomes for frail older adults: An umbrella review of frailty screening tools.JBI Database System Rev Implement Rep. 2017; 15: 1154-1208
- Frailty screening in low- and middle-income countries: A systematic review.J Am Geriatr Soc. 2016; 64: 806-823
- Frailty in older adults: Evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans.J Nutr Health Aging. 2012; 16: 601-608
- Screening for frailty with the FRAIL Scale: A comparison with the phenotype criteria.J Am Med Dir Assoc. 2017; 18: 592-596
- The selection of a screening test for frailty identification in community-dwelling older adults.J Nutr Health Aging. 2014; 18: 199-203
- Bone mineral density and the risk of peripheral arterial disease in men and women: Results from Mr. and Ms Os, Hong Kong.Osteoporos Int. 2005; 16: 1933-1938
- Mini-Mental State: A practical method for grading cognitive state of patients for clinician.J Psychiatr Res. 1975; 12: 189-198
- A Chinese version of the Mini-Mental State Examination—Impact of Illiteracy in a Shanghai dementia survey.J Clin Epidemiol. 1988; 41: 971-978
- Development and validation of a geriatric depression screening scale: A preliminary report.J Psychiatr Res. 1982; 17: 37-49
- Chinese elderly and the GDS short form: A preliminary study.Clin Gerontol. 1993; 14: 37-39
- Comparing effect sizes in follow-up studies: ROC area, Cohen's d, and r.Law Hum Behav. 2005; 29: 615-620
- Walking speed: A summary indicator of frailty?.J Am Med Dir Assoc. 2015; 16: 635-637
- Hand grip strength as a screening tool for frailty in older patients with haematological malignancies.Acta Clin Belg. 2016; 71: 227-230
- A conventional and novel screening tool for frailty predicting a poor prognosis in patients with heart failure.J Card Fail. 2016; 22: S163
- Ethnic and geographic variations in muscle mass, muscle strength and physical performance measures.Eur Geriatr Med. 2014; 5: 155-164
- Reference values of grip strength, prevalence of low grip strength, and factors affecting grip strength values in Chinese adults.J Am Med Dir Assoc. 2017; 18: 551.e9-551.e16
- Global variation in grip strength: A systematic review and meta-analysis of normative data.Age Ageing. 2016; 45: 209-216
Article info
Publication history
Published online: December 16, 2017
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
