Prevalence and Outcomes of Frailty in Korean Elderly Population: Comparisons of a Multidimensional Frailty Index with Two Phenotype Models

Abstract

BackgroundFrailty is related to adverse outcomes in the elderly. However, current status and clinical significance of frailty have not been evaluated for the Korean elderly population. We aimed to investigate the usefulness of established frailty criteria for community-dwelling Korean elderly. We also tried to develop and validate a new frailty index based on a multidimensional model.MethodsWe studied 693 participants of the Korean Longitudinal Study on Health and Aging (KLoSHA). We developed a new frailty index (KLoSHA Frailty Index, KFI) and compared predictability of it with the established frailty indexes from the Cardiovascular Health Study (CHS) and Study of Osteoporotic Fracture (SOF). Mortality, hospitalization, and functional decline were evaluated.ResultsThe prevalence of frailty was 9.2% (SOF index), 13.2% (CHS index), and 15.6% (KFI). The criteria from CHS and KFI correlated with each other, but SOF did not correlate with KFI. During the follow-up period (5.6±0.9 years), 97 participants (14.0%) died. Frailty defined by KFI predicted mortality better than CHS index (c-index: 0.713 and 0.596, respectively; p<0.001, better for KFI). In contrast, frailty by SOF index was not related to mortality. The KFI showed better predictability for following functional decline than CHS index (area under the receiver-operating characteristic curve was 0.937 for KFI and 0.704 for CHS index, p = 0.001). However, the SOF index could not predict subsequent functional decline. Frailty by the KFI (OR = 2.13, 95% CI 1.04–4.35) and CHS index (OR = 2.24, 95% CI 1.05–4.76) were associated with hospitalization. In contrast, frailty by the SOF index was not correlated with hospitalization (OR = 1.43, 95% CI 0.68–3.01).ConclusionPrevalence of frailty was higher in Korea compared to previous studies in other countries. A novel frailty index (KFI), which includes domains of comprehensive geriatric assessment, is a valid criterion for the evaluation and prediction of frailty in the Korean elderly population.

Frailty and depressive symptoms in older adults: data from the FIBRA study - UNICAMP

“…Regarding the frailty profiles of the present sample, the prevalence of frailty and pre-frailty was 6.9 % and 50.2 %, respectively, similar to rates reported by other national and international studies (Fried et al 2001;Chen et al 2010;Duarte et al 2010;Moreira and Lourenço 2013;Jung et al 2014).…”

Risk of death in elderly persons based on the frailty phenotype and the frailty index: a review study

“…The FRAIL, SOF, frailty phenotype and frailty index models were more effective in predicting the incidence of disability at 3 and 9 years; while the FRAIL models and the frailty index were better predictors of mortality at 9 years. In the Korean Longitudinal Study of Aging (KLoSHA) 19 three measures of frailty were compared: the KLoSHA model developed for the study, the SOF 18 and the frailty phenotype. The SOF model estimated the prevalence of frailty at 9.2%, the phenotype at 13.2%, and the KLoSHA model at 15.6%.…”

Comparison Between Korean Version of Physical Activity Scale for the Elderly and International Physical Activity Questionnaire-Short Form in Evaluation of Frailty Phenotype

“…In this scale, frailty was defined as the presence of at least 3 of the following components: (1) exhaustion: an answer of "moderate or most of the time during the last week" to either of the following: "I felt that everything I did was an effort" or "I could not get going"; (2) low activity: physical activity level in the lowest quintile according to the K-PASE (below the 20th percentile cutoff point in the ASPRA cohort), IPAQ (below the 20th percentile cutoff point in a representative sample of older Koreans in the KNHANES), or using a cutoff point derived from the regression analysis (described in the statistical analysis section below); (3) slowness: usual gait speed <0.8 m/sec; (4) weakness: dominant handgrip strength <26 kg for men and <17 kg for women; and (5) weight loss: unintentional weight loss of >3 kg during the previous 6 months 5,18,19) .…”

“…In other words, frailty can reflect the physiologic age of a person 3) . Since frailty status can predict adverse health events in older people more effectively than do age and comorbidities 4) , accounting for frailty in therapeutic decision making is essential 5) . Therefore, evaluating frailty in older people has become a critical component of geriatric medicine and aging research.…”

“…Many clinical and preclinical studies used the Cardiovascular Health Study (CHS) frailty phenotype as a reference standard method [7][8][9][10] . As the construct validity and predictive validity of the CHS frailty phenotype have also been demonstrated in older Koreans 5) , the CHS frailty phenotype is widely used for varying purposes in Korea 8,11) . Regarding the frailty phenotype, measuring physical activity level is necessary to define a low activity status.…”