Development and validation of a frailty index in the Longitudinal Aging Study Amsterdam

Abstract

BackgroundFrailty is a state of increased vulnerability to adverse outcomes. The frailty index (FI), defined by the deficit accumulation approach, is a sensitive instrument to measure levels of frailty, and therefore important for longitudinal studies of aging.AimsTo develop an FI in the Longitudinal Aging Study Amsterdam (LASA), and to examine the predictive validity of this FI for 19-year mortality.MethodsLASA is an ongoing study among Dutch older adults, based on a nationally representative sample. A 32-item FI (LASA–FI) was developed at the second LASA measurement wave (1995–1996) among 2218 people aged 57–88 years. An FI score between 0 and 1 was calculated for each individual. The LASA–FI included health deficits from the physical, mental and cognitive domain and can be constructed for most LASA measurement waves. Associations with 19-year mortality were assessed using Kaplan–Meier curves and Cox proportional hazards models.ResultsThe mean LASA–FI score was 0.19 (SD = 0.12), with a 99% upper limit of 0.53. Scores were higher in women than men (women = 0.20, SD = 0.13 vs. men = 0.17, SD = 0.11, p < 0.001). The average age-related increase in the log-transformed LASA–FI score was 3.5% per year. In a model adjusted for age and sex, the FI score was significantly associated with 19-year all-cause mortality (HR per 0.01 = 1.03, 95% CI 1.03–1.04, p < 0.001).Discussion/conclusionsThe key characteristics of the LASA–FI were in line with findings from previous FI studies in population-based samples of older people. The LASA–FI score was associated with mortality and may serve as an internal and external reference value.

Operationalization of a frailty index among older adults in the InCHIANTI study: predictive ability for all-cause and cardiovascular disease mortality

“…In line with previous studies, we only calculated an FI for participants with less than 20% missing variables [11,33]. Most older adults in the initial InCHIANTI sample had no missing variables on the FI (65.4%) or 1-3 missing variables (27.2%) out of the total of 42 variables.…”

“…As an outcome measure, the FI can be used to monitor the individual`s changes in frailty over time [7,8]. Recently, FIs have been developed in various longitudinal studies on aging, such as the English Longitudinal Study of Aging (ELSA) [9], the Longitudinal Aging Study Amsterdam (LASA) [10,11], the Health and Retirement Study (HRS) [12], the Survey of Health, Aging and Retirement in Europe (SHARE) [13,14], and the Gothenburg H70 Birth Cohort Studies (H70 Studies) [15]. This is a promising development, as this enables comparisons between different populations, countries, and settings.…”

“…Therefore, optimal FI cut-offs for predicting specific adverse health outcomes are largely unknown. Furthermore, most FIs have been validated for all-cause mortality (e.g., [11,13]. Very few studies have investigated the predictive validity for specific causes of death, such as cardiovascular disease (CVD) mortality [21].…”

Diabetes Mellitus and Gender Have a Negative Impact on the Outcome of Hip Fracture Surgery—A Pilot Study

“…Further research is required to understand this association. In addition, research has shown that increased FI is associated with increased overall mortality . Improved management of DM as a disease entity has the potential to improve both FI and post‐operative outcomes for this high‐risk group …”

Towards predicting frailty symptoms through a smart walking stick

“…Fall prediction makes sense in studies focusing on screening and early diagnosis of frailty. The frailty phenotype can be characterized by several symptoms like slow walking speed, weak grip strength, exhaustion, low physical activity level, and unintentional weight loss [6]. In this paper we focus mainly on the slow mobility and imbalance problems.…”