Abstract
Objectives
Design
Setting and Participants
Methods
Results
Conclusions and Implications
Keywords
Methods
Construction of Frailty Phenotype and Frailty Index
Definitions of Frailty Phenotype and Frailty Index Transitions
Mortality
Statistical Analysis
Model 1 | Model 2 | Model 3 | |||||
---|---|---|---|---|---|---|---|
HR (95% CI) | P value | HR (95% CI) | P value | HR (95% CI) | P value | ||
Total | 655/3529 (18.6) | ||||||
Frailty phenotype transition | |||||||
Maintained robustness/prefrailty | 197/1729 (11.4) | Ref | Ref | Ref | |||
Worsened frailty | 296/1065 (27.8) | 2.3 (1.9, 2.8) | <.001 | 2.1 (1.7, 2.5) | <.001 | 2.0 (1.7, 2.5) | <.001 |
Improved frailty | 124/667 (18.6) | 1.6 (1.3, 2.0) | .001 | 1.5 (1.2, 1.9) | .001 | 0.9 (0.7, 1.2) | .472 |
Maintained frailty | 38/68 (55.9) | 4.2 (3.0, 6.0) | <.001 | 3.4 (2.4, 5.0) | <.001 | 1.5 (1.0, 2.3) | .074 |
Frailty index transition defined by absolute change | |||||||
Decreased frailty index | 168/1304 (12.9) | Ref | Ref | Ref | |||
Moderately increased frailty index (increase <0.12) | 248/1664 (14.9) | 1.1 (0.9–1.3) | .537 | 1.0 (0.8–1.2) | .837 | 1.3 (1.0–1.6) | .020 |
Rapidly increased frailty index (increase ≥0.12) | 239/561 (42.6) | 2.8 (2.3–3.5) | <.001 | 2.6 (2.1–3.2) | <.001 | 3.3 (2.7–4.2) | <.001 |
Frailty index transition defined by percentage change | |||||||
Decreased frailty index | 168/1304 (12.9) | Ref | Ref | Ref | |||
Moderately increased frailty index (increase <50%) | 175/997 (17.6) | 1.2 (1.0–1.5) | .046 | 1.1 (0.9–1.3) | .515 | 1.3 (1.0–1.6) | .020 |
Rapidly increased frailty index (increase ≥50%) | 312/1228 (25.4) | 1.7 (1.4–2.1) | <.001 | 1.6 (1.3–1.9) | <.001 | 2.6 (2.1–3.3) | <.001 |
Results
Frailty Phenotype or Frailty Index Transition and Subsequent 4-Year All-Cause Mortality

Frailty Phenotype or Frailty Index Transition and Subsequent 4-Year Cause-specific Mortality


Combined Frailty Index/Frailty Phenotype Transitions and All-Cause Mortality

Discussion
Conclusions and Implications
Acknowledgments
Supplementary Data
Deficit Categories and Component Items | Answer (Corresponding Frailty Index Value) |
---|---|
I: Health status and comorbidities (17 items) | |
1. Multimorbidities (confirmed by physician diagnosis): hypertension, diabetes mellitus, heart disease, stroke, cancer, bronchitis or emphysema or asthma, arthritis or rheumatism, peptic ulcer or gastric diseases, hepatobiliary diseases, hip fracture, cataract, renal disease (including stones), gout. | ≥2 morbidities (1) |
≤1 morbidity (0) | |
2. Hypertension | 8: No (0), 0: Yes, no impact to daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
3. Diabetes mellitus | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
4. Heart disease | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
5. Stroke | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
6. Cancer | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
7. Bronchitis or emphysema or asthma | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
8. Arthritis or rheumatism | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
9. Peptic ulcer or gastric diseases | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
10. Hepatobiliary diseases | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
11. Hip fracture | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
12. Cataract | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
13. Renal disease (including stones) | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66), | |
2: Yes, much impact on daily life (1) | |
14. Gout | 8: No (0), 0: Yes, no impact on daily life (0.33), |
1: Yes, some impact on daily life (0.66) | |
2: Yes, much impact on daily life (1) | |
15. Self-rated health | 1: Very poor (1), 2: Poor (0.75), 3: Fair (0.5), |
4: Good (0.25), 5: Very good (0) | |
16. Pain | 0: None (0), 1: Mild (0.25), 2: Moderate (0.5), |
3: Severe (tolerable) (0.75), 4: Very severe (intolerable) (1) | |
17. Health status evaluated by spouse | 1: Very good (0), 2: Good (0.25), 3: Fair (0.5), |
4: Poor (0.75), 5: Very poor (1) | |
II: Physical activity, ADL and IADL (22 items) | |
1. Fall or accidental injury in past year | 0: No (0), 1: Yes (1) |
2. Stand for 15 minutes | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
3. Stand for 2 hours | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
4. Squatting | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
5. Raising both hands over head | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
6. Grasping objects with fingers | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
7. Lifting 11–12 kilograms | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
8. Run for 20–30 minutes | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
9. Walking 200–300 m | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
10. Climb 2–3 flights of stairs | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
11. Taking Bath | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
12. Dressing | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
13. Eating | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
14. Get up from bed; stand; sit on the chair | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
15. Moving around the house | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
16. Toileting | 0: No difficulty (0), 1: Some difficulty, (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
17. Buying personal item | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
18. Managing money | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
19. Riding bus/train on one’s own | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
20. Doing light tasks at home | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
21. Doing physical work at home | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
22. Making phone calls | 0: No difficulty (0), 1: Some difficulty (0.33), |
2: Much difficulty (0.66), 3: Can’t do it at all (1) | |
III: Cognitive domain (10 items) | |
1. Orientation to time (year) | 0: Wrong (1), 1: Right (0) |
2. Orientation to time (month) | 0: Wrong (1), 1: Right (0) |
3. Orientation to time (day) | 0: Wrong (1), 1: Right (0) |
4. Orientation to time (day of the week) | 0: Wrong (1), 1: Right (0) |
5. Recall home address | 0: Wrong (1), 1: Right (0) |
6. Recall mother’s family name | 0: Wrong (1), 1: Right (0) |
7. Recall current president’s name | 0: Wrong (1), 1: Right (0) |
8. Recall former president’s name | 0: Wrong (1), 1: Right (0) |
9. Know his/her own age | 0: Wrong (1), 1: Right (0) |
10. Immediate recall (10 items) | Participants answering X items, score = (1- (X/10)) |
IV: Psychological (10 items) | |
1. Poor appetite | 0: No (0), 1: Seldom (1 day/week) (0.33), |
2: Sometimes (2–3 days/week) (0.66), | |
3: Usually or often (more than 4 days/week) (1) | |
2. Everything was an effort | 0: No (0), 1: Seldom (1 day/week) (0.33), |
2: Sometimes (2–3 days/week) (0.66), | |
3: Usually or often (more than 4 days/week) (1) | |
3. Could not get going | 0: No (0), 1: Seldom (1 day/week) (0.33), |
2: Sometimes (2–3 days/week) (0.66), | |
3: Usually or often (more than 4 days/week) (1) | |
4. Insomnia | 0: No (0), 1: Seldom (1 day/week) (0.33), |
2: Sometimes (2–3 days/week) (0.66), | |
3: Usually or often (more than 4 days/week) (1) | |
5. Feels lonely | 0: No (0), 1: Seldom (1 day/week) (0.33), |
2: Sometimes (2–3 days/week) (0.66), | |
3: Usually or often (more than 4 days/week) (1) | |
6. Low mood | 0: No (0), 1: Seldom (1 day/week) (0.33), |
2: Sometimes (2–3 days/week) (0.66), | |
3: Usually or often (more than 4 days/week) (1) | |
7. Feel others are unfriendly | 0: No (0), 1: Seldom (1 day/week) (0.33), |
2: Sometimes (2–3 days/week) (0.66), | |
3: Usually or often (more than 4 days/week) (1) | |
8. Feels happy | 0: Usually or often (more than 4 days/week) (0), |
1: Sometimes (2–3 days/week) (0.33), | |
2: Seldom (1 day/week) (0.66), 3: Never (1) | |
9. Life goes well | 0: Usually or often (more than 4 days/week) (0), |
1: Sometimes (2–3 days/week) (0.33), | |
2: Seldom (1 day/week) (0.66), 3: Never (1) | |
10. Feels sad | 0: No (0), 1: Seldom (1 day/week) (0.33), |
2: Sometimes (2–3 days/week) (0.66), | |
3: Usually or often (more than 4 days/week) (1) | |
V: Life satisfaction, stress, and financial status (10 items) | |
1. Satisfaction with life | 0: No (1), 1: Yes (0) |
2. Satisfaction with what you’re doing | 0: No (1), 1: Yes (0) |
3. Living in a safe and secure environment | 0: No (1), 1: Yes (0) |
4. Satisfaction with current financial status | 1: Very good (0), 2: Good (0.25), 3: Fair (0.5), |
4: Poor (0.75), 5: Very poor (1) | |
5. Meeting living expenses | 1: No difficulty (0), 2: Fair (0.33), |
3: Some difficulty (0.66), 4: Much difficulty (1) | |
6. Stress on one’s own finances | 0: None (0), 1: Sometimes (0.5), 2: Often (1) |
7. Stress on one’s job | 0: None (0), 1: Sometimes (0.5), 2: Often (1) |
8. Stress on family member’s health, finances, or job | 0: None (0), 1: Sometimes (0.5), 2: Often (1) |
9. Stress on family’s relationship | 0: None (0), 1: Sometimes (0.5), 2: Often (1) |
10: Concerns from family and friends | 1: Very good (0), 2: Good (0.25), 3: Fair (0.5), |
4: Poor (0.75), 5: Very poor (1) | |
VI: Sensory (3 items) | |
1. Visual impairment | 0: Can see without glasses (0), |
1: Can see with glasses (0.5), | |
2: Visual impairment (1) | |
2. Hearing impairment | 0: Can hear without hearing aids (0), |
1: Can hear with hearing aids (0.5), | |
2: Hearing impairment (1) | |
3. Oral intake difficulty | 0: Can eat without denture (0), |
1: Can eat with denture (0.5), | |
2: Poor oral intake (1) |
Cause of Death Category | ICD-9 Codes |
---|---|
Infectious diseases | 001–139, 460–466, 473, 480–488, 597, 599 |
Malignancy | 140–239 |
Cardiometabolic and cerebrovascular diseases | 250, 390–417, 430–459 |
Organ failure (heart, lung, digestive system, kidney) | 420–429, 490–496, 500–508, 511–519, 530–579, 580–588 |
Others | 240–246, 251–259, 260–269, 270–279, 280–289, 290–389, 680–709, 710—739, 780–799, 800–999 |
Characteristics | 1999 Wave | 2003 Wave |
---|---|---|
Baseline characteristics | ||
Age, y | 67.6 ± 8.6 | 71.6 ± 8.6 |
Male sex | 1817 (51.5) | 1817 (51.5) |
Education, y | 5.1 ± 4.6 | 5.1 ± 4.6 |
Marital status | ||
Married/cohabiting | 2503 (70.9) | 2277 (64.5) |
Alcohol consumption | 400 (11.4) | 338 (9.6) |
Current smoker | 852 (24.2) | 675 (19.1) |
Medical history | ||
Number of comorbidities | 1.6 ± 1.6 | 2.1 ± 1.8 |
Hypertension | 1148 (32.5) | 1423 (40.3) |
Diabetes | 452 (12.8) | 613 (17.4) |
Heart disease | 597 (16.9) | 790 (22.4) |
Stroke | 149 (4.2) | 280 (7.9) |
Cancer | 86 (2.4) | 121 (3.4) |
Chronic lung disease | 388 (11.0) | 501 (14.2) |
Peptic ulcer disease | 672 (19.0) | 747 (21.2) |
Hepatobiliary disease | 256 (7.3) | 326 (9.2) |
Chronic kidney disease | 262 (7.4) | 351 (9.9) |
Frailty assessment | ||
Frailty phenotype | ||
Slowness | 582 (16.5) | 939 (26.6) |
Weakness | 212 (6.0) | 378 (10.7) |
Low physical activity | 696 (20.3) | 851 (24.1) |
Exhaustion | 687 (20.3) | 700 (21.6) |
Weight loss | 178 (5.2) | 194 (5.9) |
Robustness | 2041 (57.8) | 1791 (50.8) |
Prefrailty | 1263 (35.8) | 1349 (38.2) |
Frailty | 225 (6.4) | 389 (11.0) |
Summed frailty phenotype score (0–5) | 0.7 ± 0.9 | 0.9 ± 1.1 |
Frailty index | 0.15 ± 0.11 | 0.19 ± 0.15 |
Cause of Death | Number of Deaths (%) | Model 1 | Model 2 | ||
---|---|---|---|---|---|
Infection | |||||
Total | 72/3529 (2.0) | ||||
Decreased frailty index | 10/1304 (0.8) | Ref | |||
Moderately increased frailty index (<50%) | 27/997 (2.7) | 4.1 (1.8–9.4) | <.001 | ||
Rapidly increased frailty index (≥50%) | 35/1228 (2.9) | 5.4 (2.4–12.6) | <.001 | ||
Malignancy | |||||
Total | 168/3529 (4.8) | ||||
Decreased frailty index | 44/1304 (3.4) | Ref | Ref | ||
Moderately increased frailty index (<50%) | 40/997 (4.0) | 1.0 (0.6–1.6) | .972 | 1.0 (0.7–1.6) | 0.846 |
Rapidly increased frailty index (≥50%) | 84/1228 (6.8) | 1.8 (1.2–2.7) | .009 | 1.9 (1.2–2.9) | .006 |
Cardiometabolic/cerebrovascular | |||||
Total | 189/3529 (5.4) | ||||
Decreased frailty index | 51/1304 (3.9) | Ref | Ref | ||
Moderately increased frailty index (<50%) | 53/997 (5.3) | 1.2 (0.8–1.8) | .474 | 1.1 (0.7–1.7) | .633 |
Rapidly increased frailty index (≥50%) | 85/1228 (6.9) | 2.7 (1.8–4.1) | <.001 | 2.2 (1.5–3.4) | <.001 |
Organ failure | |||||
Total | 130/3529 (3.7) | ||||
Decreased frailty index | 36/1304 (2.8) | Ref | Ref | ||
Moderately increased frailty index (<50%) | 32/997 (3.2) | 1.0 (0.6–1.6) | .914 | 1.0 (0.6–1.6) | .930 |
Rapidly increased frailty index (≥50%) | 62/1228 (5.0) | 1.4 (0.8–2.4) | .198 | 1.5 (0.8–2.5) | .176 |
Others | |||||
Total | 96/3529 (2.7) | ||||
Decreased frailty index | 27/1304 (2.1) | Ref | |||
Moderately increased frailty index (<50%) | 23/997 (2.3) | 1.1 (0.6–2.0) | .744 | ||
Rapidly increased frailty index (≥50%) | 46/1228 (3.7) | 2.0 (1.2–3.6) | .012 |
Decreased Frailty Index (n = 168/1304) | Moderately Increased Frailty Index (<50%) (n = 175/997) | Rapidly Increased Frailty Index (≥50%) (n = 312/1228) | |||||||
---|---|---|---|---|---|---|---|---|---|
n (%) | OR (95% CI) | P Value | n | OR (95% CI) | P Value | n | OR (95% CI) | P Value | |
Maintained robustness or prefrailty | 68/704 (9.7) | 1 | 56/492 (11.4) | 1 | 73/533 (13.7) | 1 | |||
Worsened frailty | 28/194 (14.4) | 1.1 (0.7–1.7) | .797 | 59/296 (19.9) | 1.4 (1.0–2.1) | .076 | 209/575 (36.3) | 2.7 (2.0–3.6) | <.001 |
Improved frailty | 60/383 (15.7) | 0.7 (0.4–1.2) | .212 | 43/180 (23.9) | 1.1 (0.7–1.8) | .734 | 21/104 (20.2) | 0.8 (0.5–1.5) | .497 |
Maintained frailty | 12/23 (52.2) | 1.1 (0.5–2.5) | .885 | 17/29 (58.6) | 1.8 (0.9–3.8) | .110 | 9/16 (56.3) | 1.3 (0.5–3.1) | .560 |
Maintained Robustness or Prefrailty (n = 197/1729) | Worsened Frailty (n = 296/1065) | Improved Frailty (n = 124/667) | Maintained Frailty (n = 38/68) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n (%) | OR (95% CI) | P Value | n (%) | OR (95% CI) | P Value | n (%) | OR (95% CI) | P Value | n (%) | OR (95% CI) | P Value | |
Decreased frailty index | 68/704 (9.7) | 1 | 28/194 (14.4) | 1 | 60/383 (15.7) | 1 | 12/23 (52.2) | 1 | ||||
Moderately increased frailty index | 56/492 (11.4) | 1.0 (0.7–1.5) | .825 | 59/296 (19.9) | 1.5 (0.9–2.3) | .093 | 43/180 (23.9) | 1.8 (1.2–2.7) | .007 | 17/29 (58.6) | 1.8 (0.8–4.1) | .139 |
Rapidly increased frailty index | 73/533 (13.7) | 1.3 (0.9–1.9) | .160 | 209/575 (36.3) | 4.3 (2.8–6.7) | <.001 | 21/104 (20.2) | 2.0 (1.1–3.4) | .017 | 9/16 (56.3) | 1.7 (0.5–5.1) | .366 |
HR (95% CI) | P Value | |
---|---|---|
Frailty phenotype transition | ||
Maintained robustness or prefrailty | Ref | |
Worsened frailty | 1.9 (1.4–2.4) | <.001 |
Improved frailty | 0.9 (0.7–1.3) | .774 |
Maintained frailty | 1.4 (0.8–2.4) | .282 |
Baseline frailty phenotype | ||
Robust | Ref | |
Prefrail | 1.5 (1.1–2.0) | .021 |
Frail | 3.0 (1.8–5.0) | <.001 |
Baseline frailty phenotype∗ frailty phenotype transition | ||
Baseline frailty phenotype∗ frailty phenotype transition | Ref | |
Baseline frailty phenotype (1)∗ frailty phenotype transition | 1.2 (0.8–1.8) | .285 |
Baseline frailty phenotype (2)∗ frailty phenotype transition | 0.7 (0.3–1.8) | .455 |
References
- Frailty in elderly people.Lancet. 2013; 381: 752-762
- 13. Older Adults: Standards of Medical Care in Diabetes-2022.Diabetes Care. 2022; 45: S195-S207
- 2018 ESC/ESH Guidelines for the management of arterial hypertension.Eur Heart J. 2018; 39: 3021-3104
- Frailty as a predictor of future falls among community-dwelling older people: a systematic review and meta-analysis.J Am Med Dir Assoc. 2015; 16: 1027-1033
- Frailty predicts trajectories of quality of life over time among British community-dwelling older people.Qual Life Res. 2016; 25: 1743-1750
- Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70.J Am Geriatr Soc. 2006; 54: 975-979
- Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- Frail phenotype and mortality prediction: a systematic review and meta-analysis of prospective cohort studies.Int J Nurs Stud. 2015; 52: 1362-1374
- Frailty index as a predictor of mortality: a systematic review and meta-analysis.Age Ageing. 2018; 47: 193-200
- Recurrent measurement of frailty is important for mortality prediction: findings from the North West Adelaide Health Study.J Am Geriatr Soc. 2019; 67: 2311-2317
- Frailty as a predictor of all-cause mortality in older men and women.Geriatr Gerontol Int. 2014; 14: 899-905
- Frailty, transition in frailty status and all-cause mortality in older adults of a Taichung community-based population.BMC Geriatr. 2019; 19: 26
- Frailty changes predict mortality in four longitudinal studies of aging.J Gerontol A Biol Sci Med Sci. 2021; 76: 1619-1626
- Changes in a frailty index and association with mortality.J Am Geriatr Soc. 2021; 69: 1057-1062
- A comparison of two approaches to measuring frailty in elderly people.J Gerontol A Biol Sci Med Sci. 2007; 62: 738-743
- Frailty phenotype and cause-specific mortality in the United States.J Gerontol A Biol Sci Med Sci. 2020; 75: 1935-1942
- Frailty status predicts all-cause and cause-specific mortality in community dwelling older adults.J Am Med Dir Assoc. 2019; 20: 1230-1235.e1232
- Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study.Lancet Public Health. 2020; 5: e650-e660
- Health Promotion Administration, Ministry of Health and Welfare, Taiwan, Taiwan Longitudinal Study on Aging (TLSA).2015https://www.hpa.gov.tw/EngPages/Detail.aspx?nodeid=1077&pid=6197Date accessed: June 24, 2022
- Longitudinal changes of frailty in 8 years: comparisons between physical frailty and frailty index.BMC Geriatr. 2021; 21: 726
- The prevalence of subjective frailty and factors associated with frailty in Taiwan.Arch Gerontol Geriatr. 2010; 50: S43-S47
- A standard procedure for creating a frailty index.BMC Geriatr. 2008; 8: 24
- Evaluation of clinically meaningful changes in measures of frailty.J Gerontol A Biol Sci Med Sci. 2020; 75: 1143-1147
- Early frailty transition predicts 15-year mortality among nondisabled older Mexican Americans.Ann Epidemiol. 2018; 28: 362-367.e363
- Progression of physical frailty and the risk of all-cause mortality: is there a point of no return?.J Am Geriatr Soc. 2021; 69: 908-915
- The frailty index is a predictor of cause-specific mortality independent of familial effects from midlife onwards: a large cohort study.BMC Med. 2019; 17: 94
- Association of prediagnostic frailty, change in frailty status, and mortality after cancer diagnosis in the Women's Health Initiative.JAMA Netw Open. 2020; 3: e2016747
- Perspectives on care at the close of life. Serving patients who may die soon and their families: the role of hospice and other services.JAMA. 2001; 285: 925-932
- Impact of frailty on mortality and hospitalization in chronic heart failure: a systematic review and meta-analysis.J Am Heart Assoc. 2018; 7: e008251
- Simple functional performance tests and mortality in COPD.Eur Respir J. 2013; 42: 956-963
- Frailty, dialysis initiation, and mortality in end-stage renal disease.Arch Intern Med. 2012; 172: 1071-1077
- The physical frailty syndrome as a transition from homeostatic symphony to cacophony.Nat Aging. 2021; 1: 36-46
- The frailty phenotype and the frailty index: different instruments for different purposes.Age Ageing. 2014; 43: 10-12
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
- Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality.J Am Geriatr Soc. 2013; 61: 1537-1551
- Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation.J Am Geriatr Soc. 2012; 60: 1478-1486
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Y.J.C. and L.K.C. contributed equally to the study.
This work was supported by the Ministry of Science and Technology, Taiwan (MOST 109–2314-B-010 -047 -MY2 and MOST 111-2314-B-A49-018-MY3), National Health Research Insitute, Taiwan (NHRI-11A1-CG-CO-01-2225-1) and Taipei Veterans General Hospital. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no conflicts of interest.