Early identification of frailty: Developing an international delphi consensus on pre-frailty

Sezgin, Duygu; O’Donovan, Mark; Woo, Jean; Bandeen‐Roche, Karen; Liotta, Giuseppe; Fairhall, Nicola; Rodríguez-Laso, Ángel; Apóstolo, João; Clarnette, Roger; Holland, Carol; Roller‐Wirnsberger, Regina; Illario, Maddalena; Mañas, Leocadio Rodríguez; Vollenbroek-Hutten, Miriam Marie Rosé; Yavuz, Burcu Balam; Balcı, Cafer; Pernas, Francisco Orfila; Paúl, Constança; Ahern, Emer; Romero-Ortuño, Román; Molloy, William; Cooney, Maria Therese; O’Shea, Diarmuid; Cooke, John; Lang, Deirdre; Hendry, Anne; Kennelly, Siobhán; Rockwood, Kenneth; Clegg, Andrew; Liew, Aaron; Ó’Caoimh, Rónán

doi:10.1016/j.archger.2021.104586

Cited by 32 publications

(25 citation statements)

References 56 publications

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“…1 2 It is preceded by prefrailty, a multidimensional, transitional risk state. 3 4 Fried's frailty phenotype identifies pre-frailty as the presence of one or two and frailty as three or more of the five criteria: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and low physical activity. 5 The prevalence of frailty and pre-frailty, defined using Fried's physical frailty measure, 5 among communitydwelling people aged ≥50 years across 62 countries, has been estimated to be 12% and 46%, respectively.…”

Section: Introductionmentioning

confidence: 99%

Body mass index, waist circumference and pre-frailty/frailty: the Tromsø study 1994−2016

et al. 2023

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ObjectiveThis study investigated the association between obesity, assessed using body mass index (BMI) and waist circumference (WC), and pre-frailty/frailty among older adults over 21 years of follow-up.DesignProspective cohort study.SettingPopulation-based study among community-dwelling adults in Tromsø municipality, Norway.Participants2340 women and 2169 men aged ≥45 years attending the Tromsø study in 1994–1995 (Tromsø4) and 2015–2016 (Tromsø7), with additional BMI and WC measurements in 2001 (Tromsø5) and 2007–2008 (Tromsø6).Primary outcome measurePhysical frailty was defined as the presence of three or more and pre-frailty as the presence of one to two of the five frailty components suggested by Friedet al: low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity.ResultsParticipants with baseline obesity (adjusted OR 2.41, 95% CI 1.93 to 3.02), assessed by BMI, were more likely to be pre-frail/frail than those with normal BMI. Participants with high (OR 2.14, 95% CI 1.59 to 2.87) or moderately high (OR 1.57, 95% CI 1.21 to 2.03) baseline WC were more likely to be pre-frail/frail than those with normal WC. Those at baseline with normal BMI but moderately high/high WC or overweight with normal WC had no significantly increased odds for pre-frailty/frailty. However, those with both obesity and moderately high/high WC had increased odds of pre-frailty/frailty. Higher odds of pre-frailty/frailty were observed among those in ‘overweight to obesity’ or ‘increasing obesity’ trajectories than those with stable normal BMI. Compared with participants in a stable normal WC trajectory, those with high WC throughout follow-up were more likely to be pre-frail/frail.ConclusionBoth general and abdominal obesity, especially over time during adulthood, is associated with an increased risk of pre-frailty/frailty in later years. Thus maintaining normal BMI and WC throughout adult life is important.

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Section: Introductionmentioning

confidence: 99%

Body mass index, waist circumference and pre-frailty/frailty: the Tromsø study 1994−2016

et al. 2023

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“…Our study has several limitations which warrants mention. Absolute consensus for an operational definition for prefrailty has not been achieved, however it is acknowledged in a recent publication that it lies along the frailty continuum ( 58 ). However, we utilized a well validated FRAIL score to define the cohort.…”

Section: Discussionmentioning

confidence: 99%

Gender Differences in Body Composition in Pre-Frail Older Adults With Diabetes Mellitus

2022

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Background & AimsAgeing is a risk factor for diabetes mellitus (DM) and frailty. It is associated with body composition changes including increase in fat mass (FM), central fat distribution, decrease in fat free mass (FFM) and skeletal muscle which are risk factors for DM. This study aims to evaluate gender differences in body composition in pre-frail diabetics and association with physical performance, cognitive function and perceived health. In addition, we aim to explore the association of obesity, sarcopenia, sarcopenic obesity, and body composition in pre-frail older adults to DM status.MethodsCross-sectional study of 192 pre-frail community dwelling older adults (≥ 65 years). Data was collected on demographics, physical function, cognition, frailty, sarcopenia, perceived health and body composition using the InBody S10. Univariate and multivariate logistic regression were undertaken to explore the association of sarcopenic obesity, obesity, sarcopenia and body composition measures to DM status.ResultsThere were insignificant within-gender differences for physical function, cognition and body composition, except for a higher prevalence of obesity defined by body mass index (BMI) and body fat percentage (BF%), increased fat mass index(FMI) and fat free mass index(FFMI) in females with DM. There were significant between-gender differences for those with DM where females overall had lower education levels, lower perceived health, higher prevalence of depression and low mental vitality, lower overall physical function (low short physical performance battery scores, low gait speed and hand grip strength), lower cognitive scores, lower muscle mass and muscle quality with higher FMI, FM/FFM and visceral fat area(VFA). BMI, VFA>100 cm2, FMI and FFMI were found to be independently associated with DM status after multivariable adjustment.ConclusionWithin pre-frail DM vs non-DM, there were insignificant differences in body composition, physical function, cognition and perceived health within gender except for FMI, BF% and FFMI in females. There were significant differences between gender in pre-frail DM in muscle mass, quality, functional, cognitive and mental status. Further longitudinal studies are required to understand the pathogenesis, trajectory of DM and protective role of oral hypoglycemics in pre-frail older adults.

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“…Sensitivity and specificity were well tested [29]. Since this scale served as the gold standard of frailty diagnostic tools to validate the other new frailty measurement in the literature [48][49][50][51][52], it was also used in the concurrent validation and diagnostic accuracy test in this study.…”

Section: Fried's Frailty Phenotypementioning

confidence: 99%

“…In the literature, frailty was strongly linked to the adverse outcomes of older people, including fracture, falls, hospital admission and mortality [51,[67][68][69][70]. The early detection of frailty can reduce adverse outcomes in older people, and thus, interventions for improving their health status can prevent them from becoming frail [14,35,36].…”

Section: Reliabilitymentioning

confidence: 99%

Groningen Frailty Indicator–Chinese (GFI-C) for pre-frailty and frailty assessment among older people living in communities: psychometric properties and diagnostic accuracy

et al. 2022

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Background The early identification of pre-frailty and frailty among older people is a global priority because of the increasing incidence of frailty and associated adverse health outcomes. This study aimed to validate the Groningen Frailty Indicator-Chinese (GFI-C), a widely used screening instrument, and determine the optimal cut-off value in Chinese communities to facilitate pre-frailty and frailty screening. Methods This methodological study employed a cross-sectional and correlational design to examine the psychometric properties of GFI-C, namely, internal consistency, stability, and concurrent and construct validities. The appropriate cut-off values for pre-frailty and frailty screening in the receiver-operating characteristic (ROC) curve were determined through sensitivity and specificity analysis. Results A total of 350 community older people had been assessed and interviewed by a nurse. The GFI-C showed satisfactory internal consistency (Cronbach’s α = 0.87) and two-week test-retest reliability (intra-class correlation coefficient = 0.87). Concurrent validity (r = 0.76, p < 0.001) showed a moderate correlation with Fried’s frailty phenotype. The known-groups method, hypothesis testing and confirmatory factory analysis (three-factor model; χ2/df = 2.87, TLI = 0.92, CFI = 0.93, GFI = 0.92, RMR = 0.014; RMSEA = 0.073) were suitable for the establishment of construct validity. Based on the ROC and Youden’s index, the optimal cut-off GFI-C values were 2 (sensitivity, 71.5%; specificity, 84.7%) for pre-frailty and 3 for frailty (sensitivity, 88.2%; specificity, 79.6%). Conclusions The result indicated that GFI-C is a reliable and valid instrument for pre-frailty and frailty screening among older Chinese people in communities. For optimal diagnostic accuracy, the cut-off values of 3 for frailty and 2 for pre-frailty are recommended.

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Early identification of frailty: Developing an international delphi consensus on pre-frailty

Cited by 32 publications

References 56 publications

Body mass index, waist circumference and pre-frailty/frailty: the Tromsø study 1994−2016

Body mass index, waist circumference and pre-frailty/frailty: the Tromsø study 1994−2016

Gender Differences in Body Composition in Pre-Frail Older Adults With Diabetes Mellitus

Groningen Frailty Indicator–Chinese (GFI-C) for pre-frailty and frailty assessment among older people living in communities: psychometric properties and diagnostic accuracy

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