Abstract
Objectives
To develop short versions of the Frailty Trait Scale (FTS) for use in clinical settings.
Design
Prospective population-based cohort study.
Setting and Participants
Data from 1634 participants from the Toledo Study for Healthy Aging.
Methods
The 12-item Frailty Trait Scale (FTS) reduction was performed based on an area under
the curve (AUC) analysis adjusted by age, sex, and comorbidity. Items that maximized
prognostic information for adverse events were selected. Each item score was done
at the same time as the reduction, identifying the score that maximized the predictive
ability for adverse events. For each short version of the FTS, cutoffs that optimized
the prognostic information (sensitivity and specificity) were chosen, and their predictive
value was later compared with a surrogate gold standard for frailty (the Fried Phenotype).
Results
Two short forms, the 5-item (FTS5) (range 0-50) and 3-item (FTS3) (range 0-30), were identified, both with AUCs for health adverse events similar
to the 12-item FTS. The identified cutoffs were >25 for the FTS5 scale and >15 for the FTS3. The frailty prevalence with these cutoffs was 24% and 20% for the FTS5 and FTS3, respectively, whereas frailty according to Fried Phenotype (FP) reached 8% and prefrailty
reached 41%. In general, the FTS5 showed better prognostic performance than the FP, especially with prefrail individuals,
in whom the FTS5 form identified 65% of participants with an almost basal risk and 35% with a very
high risk for mortality (OR: 4) and frailty (OR: 6.6-8.7), a high risk for hospitalization
(OR: 1.9-2.1), and a moderate risk for disability (OR: 1.7) who could be considered
frail. The FTS3 form had worse performance than the FTS5, showing 31% of false negatives between frail participants identified by FP with
a high risk of adverse events.
Conclusions and Implications
The FTS5 is a short scale that is easy to administer and has a similar performance to the
FTS, and it can be used in clinical settings for frailty diagnosis and evolution.
Keywords
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References
- Frailty in the clinical scenario.Lancet. 2015; 385: e7-e9
- New IDF guideline for managing type 2 diabetes in older people.Diabetes Res Clin Pract. 2014; 103: 538-540
- The frailty syndrome in the public health agenda.J Epidemiol Community Health. 2014; 68: 703-704
- Agreement between 35 published frailty scores in the general population.Am J Epidemiol. 2017; 186: 420-434
- A new operational definition of frailty: The Frailty Trait Scale.J Am Med Dir Assoc. 2014; 15 (371.e7-371.e13)
- Frailty as a major factor in the increased risk of death and disability in older people with diabetes.J Am Med Dir Assoc. 2016; 17: 949-955
- Global performance of executive function is predictor of risk of frailty and disability in older adults.J Nutr Health Aging. 2017; 21: 980-987
- Cognitive performance across 3 frailty phenotypes: Toledo Study for Healthy Aging.J Appl Physiol (1985). 2017; 18: 785-790
- Frailty is associated with objectively assessed sedentary behaviour patterns in older adults: Evidence from the Toledo Study for Healthy Aging (TSHA).PLoS One. 2017; 12: e0183911
- Reallocating accelerometer-assessed sedentary time to light or moderate- to vigorous-intensity physical activity reduces frailty levels in older adults: An isotemporal substitution approach in the TSHA study.J Am Med Dir Assoc. 2018; 19: 185.e1-185.e6
- The prevalence of frailty syndrome in an older population from Spain. The Toledo Study for Healthy Aging.J Nutr Health Aging. 2011; 15: 852-856
- Frailty in older adults: Evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- A standard procedure for creating a frailty index.BMC Geriatr. 2008; 8: 24
- Can comorbidity be measured by questionnaire rather than medical record review?.Med Care. 1996; 34: 73-84
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.J Chronic Dis. 1987; 40: 373-383
- R: A Language and Environment for Statistical Computing.R Foundation for Statistical Computing, Vienna, Austria2014
- Frailty in older adults: A nationally representative profile in the United States.J Gerontol A Biol Sci Med Sci. 2015; 70: 1427-1434
- Cross-national differences in grip strength among 50+ year-old Europeans: Results from the SHARE study.Eur J Ageing. 2009; 6: 227-236
- Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: A systematic review and meta-analysis.BMJ Open. 2018; 8: e018195
- The standardization of frailty phenotype criteria improves its predictive ability: The Toledo Study for Healthy Aging.J Am Med Dir Assoc. 2017; 18: 402-408
- Global variation in grip strength: A systematic review and meta-analysis of normative data.Age Ageing. 2016; 45: 209-216
- Strong or weak handgrip? Normative reference values for the German population across the life course stratified by sex, age, and body height.PLoS One. 2016; 11: e0163917
Article info
Publication history
Published online: January 29, 2020
Footnotes
The authors were supported by grants PI15/01305, CB16/10/00456 and CB16/10/00464 from the Instituto de Salud Carlos III (FEDER funds, Ministerio de Ciencia e Innovación, Spain), RD12/0043 from the Instituto de Salud Carlos III (Ministerio de Economía y Competitividad, Spain), PI2010/020 from FISCAM (Junta de Comunidades de Castilla La Mancha, Spain), FP7-305483-2 (“Frailomic Iniciative”) from FP7-Health-2012-Innovation (European Union).
The authors declare no conflicts of interest.
Identification
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© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
