The degree of frailty as a translational measure of health in aging

Howlett, Susan E.; Rutenberg, Andrew D.; Rockwood, Kenneth

doi:10.1038/s43587-021-00099-3

Cited by 115 publications

(65 citation statements)

References 228 publications

(334 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Frailty was associated with all-cause mortality and hospitalisation after adjustment for DAS28. This is consistent with literature on frailty in general populations as well as other long-term conditions 1 31–33. Although physical impairment and self-rated health improved after initial diagnosis, participants with moderate frailty at baseline had significantly higher HAQ-DI scores and poorer self-rated health at 2 years follow-up than robust participants or those with mild baseline frailty, despite larger reductions in DAS28 from baseline levels.…”

Section: Discussionsupporting

confidence: 89%

Frailty in rheumatoid arthritis and its relationship with disease activity, hospitalisation and mortality: a longitudinal analysis of the Scottish Early Rheumatoid Arthritis cohort and UK Biobank

et al. 2022

View full text Add to dashboard Cite

ObjectiveTo assess the prevalence of frailty in rheumatoid arthritis (RA) and its association with baseline and longitudinal disease activity, all-cause mortality and hospitalisation.ParticipantsPeople with RA identified from the Scottish Early Rheumatoid Arthritis (SERA) inception cohort (newly diagnosed, mean age 58.2 years) and UK Biobank (established disease identified using diagnostic codes, mean age 59 years). Frailty was quantified using the frailty index (both datasets) and frailty phenotype (UK Biobank only). Disease activity was assessed using Disease Activity Score in 28 joints (DAS28) in SERA. Associations between baseline frailty and all-cause mortality and hospitalisation was estimated after adjusting for age, sex, socioeconomic status, smoking and alcohol, plus DAS28 in SERA.ResultsBased on the frailty index, frailty was common in SERA (12% moderate, 0.2% severe) and UK Biobank (20% moderate, 3% severe). In UK Biobank, 23% were frail using frailty phenotype. Frailty index was associated with DAS28 in SERA, as well as age and female sex in both cohorts. In SERA, as DAS28 lessened over time with treatment, mean frailty index also decreased. The frailty index was associated with all-cause mortality (HR moderate/severe frailty vs robust 4.14 (95% CI 1.49 to 11.51) SERA, 1.68 (95% CI 1.26 to 2.13) UK Biobank) and unscheduled hospitalisation (incidence rate ratio 2.27 (95% CI 1.45 to 3.57) SERA 2.74 (95% CI 2.29 to 3.29) UK Biobank). In UK Biobank, frailty phenotype also associated with mortality and hospitalisation.ConclusionFrailty is common in early and established RA and associated with hospitalisation and mortality. Frailty in RA is dynamic and, for some, may be ameliorated through controlling disease activity in early disease.

show abstract

Section: Discussionsupporting

confidence: 89%

Frailty in rheumatoid arthritis and its relationship with disease activity, hospitalisation and mortality: a longitudinal analysis of the Scottish Early Rheumatoid Arthritis cohort and UK Biobank

et al. 2022

View full text Add to dashboard Cite

show abstract

“…For instance, cardiovascular risk and cardiovascular events and related mortality 10. Taken together, evidence implicates frailty as an indicator of generalised vulnerability to ageing-related diseases independent of known risk factors, which is hypothesised to occur, at least in part, through reduced physiological reserve causing the expression of morbidity that would otherwise not meet the threshold required for clinical detection 9 33…”

Section: Discussionmentioning

confidence: 99%

Frailty, lifestyle, genetics and dementia risk

Ward

Ranson

Wallace

et al. 2021

J Neurol Neurosurg Psychiatry

Self Cite

View full text Add to dashboard Cite

ObjectiveTo optimise dementia prevention strategies, we must understand the complex relationships between lifestyle behaviours, frailty and genetics.MethodsWe explored relationships between frailty index, healthy lifestyle and polygenic risk scores (all assessed at study entry) and incident all-cause dementia as recorded on hospital admission records and death register data.ResultsThe analytical sample had a mean age of 64.1 years at baseline (SD=2.9) and 53% were women. Incident dementia was detected in 1762 participants (median follow-up time=8.0 years). High frailty was associated with increased dementia risk independently of genetic risk (HR 3.68, 95% CI 3.11 to 4.35). Frailty mediated 44% of the relationship between healthy lifestyle behaviours and dementia risk (indirect effect HR 0.95, 95% CI 0.95 to 0.96). Participants at high genetic risk and with high frailty had 5.8 times greater risk of incident dementia compared with those at low genetic risk and with low frailty (HR 5.81, 95% CI 4.01 to 8.42). Higher genetic risk was most influential in those with low frailty (HR 1.31, 95% CI 1.22 to 1.40) but not influential in those with high frailty (HR 1.09, 95% CI 0.92 to 1.28).ConclusionFrailty is strongly associated with dementia risk and affects the risk attributable to genetic factors. Frailty should be considered an important modifiable risk factor for dementia and a target for dementia prevention strategies, even among people at high genetic risk.

show abstract

“…Although a data-driven or machine learning approach can be used in claims-based frailty indices (31), we applied the conventional deficit accumulation model (8) – a generalizable approach to frailty, in which a wide range of deficits e.g., signs, symptoms, diseases, functional limitations, laboratory measures, can be included as long as it includes at least 30 age-related deficits (8,34). We noticed, however, some differences in the characteristics of our eFI compared to a survey-based Rockwood FI.…”

Section: Discussionmentioning

confidence: 99%

Development of an electronic frailty index for hospitalized geriatric patients in Sweden

Mak

Hägg

Eriksdotter

et al. 2021

Preprint

View full text Add to dashboard Cite

BackgroundFrailty assessment in the Swedish health system relies on the Clinical Frailty Scale (CFS), but it requires training, in-person evaluation, and is often missing in medical records. We aimed to develop an electronic frailty index (eFI) from routinely collected electronic health records (EHRs) and assess its predictive ability for adverse outcomes in geriatric patients.MethodsEHRs were extracted for 18,225 geriatric patients with unplanned admissions between 1/3/2020 and 17/6/2021 from nine geriatric clinics in Stockholm, Sweden. A 48-item eFI was constructed using diagnostic codes, functioning and other health indicators, and laboratory data. The CFS, Hospital Frailty Risk Score, and Charlson Comorbidity Index were used for comparative assessment of the eFI. We modelled in-hospital mortality and 30-day readmission using logistic regression; 30-day and 6-month mortality using Cox regression; and length of stay using linear regression.Results13,188 patients were included in analyses (mean age 83.1 years). A 10% increment in the eFI was associated with higher risks of in-hospital (odds ratio: 5.34; 95% confidence interval: 4.20-6.82), 30-day (hazard ratio [HR]: 3.28; 2.91-3.69), and 6-month mortality (HR: 2.70; 2.52-2.90) adjusted for age and sex. Of the frailty and comorbidity measures, the eFI had the best predictive accuracy for in-hospital mortality, yielding an area under receiver operating characteristic curve of 0.813. Higher eFI also predicted a longer length of stay, but had a rather poor discrimination for 30-day readmission.ConclusionsAn EHR-based eFI has good predictive accuracy for adverse outcomes, suggesting that it can be used in risk stratification in geriatric patients.

show abstract

The degree of frailty as a translational measure of health in aging

Cited by 115 publications

References 228 publications

Frailty in rheumatoid arthritis and its relationship with disease activity, hospitalisation and mortality: a longitudinal analysis of the Scottish Early Rheumatoid Arthritis cohort and UK Biobank

Frailty in rheumatoid arthritis and its relationship with disease activity, hospitalisation and mortality: a longitudinal analysis of the Scottish Early Rheumatoid Arthritis cohort and UK Biobank

Frailty, lifestyle, genetics and dementia risk

Development of an electronic frailty index for hospitalized geriatric patients in Sweden

Contact Info

Product

Resources

About