The frailty phenotype and the frailty index: different instruments for different purposes

Abstract

The integration of frailty measures in clinical practice is crucial for the development of interventions against disabling conditions in older persons. The frailty phenotype (proposed and validated by Fried and colleagues in the Cardiovascular Health Study) and the Frailty Index (proposed and validated by Rockwood and colleagues in the Canadian Study of Health and Aging) represent the most known operational definitions of frailty in older persons. Unfortunately, they are often wrongly considered as alternatives and/or substitutables. These two instruments are indeed very different and should rather be considered as complementary. In the present paper, we discuss about the designs and rationals of the two instruments, proposing the correct ways for having them implemented in the clinical setting.

Frailty Index and Frailty Phenotype in elderly patients with cancer

“…The FI prevalence estimate in our population was more than 2.0 times higher than the prevalence estimated by the FP, which is in concordance with results found in the general population [4,13,14]. Studies with large study samples of community dwelling adults proposed that these two frailty models capture different, but overlapping, groups of older adults and that they cover different sides of the spectrum of frailty [15,16]. In the community dwelling population it seems that the FI could define risk of adverse outcomes, including mortality, more precisely than the FP does [13,14].…”

A Frailty Index predicts 10-year fracture risk in adults age 25 years and older: results from the Canadian Multicentre Osteoporosis Study (CaMos)

“…A cumulative deficits Frailty Index correlates well with the frailty phenotype [5,24]; although unique instruments, they may serve as complementary measures [27]. A shorter measure is an advantage of the frailty phenotype; however, flexibility and generalizability may be reduced due to the highly specified items [28].…”

“…A shorter measure is an advantage of the frailty phenotype; however, flexibility and generalizability may be reduced due to the highly specified items [28]. It may also be difficult to measure performance measures in patients with illness or severe physical limitations [29,30], without special equipment (i.e., dynamometers; [27]), and these items are often not be available in population-based databases. The Frailty Index is highly generalizable, being derivable in any clinical or population-based dataset with a critical mass of relevant variables.…”

Fragilidade de idosos em vulnerabilidade social

“…(8) Another study, with 363 elderly people in a context of high social vulnerability in São Paulo, Brazil, showed that 27.3% of the elderly evaluated were frail, according to Fried's phenotype. (9) Although there is no gold standard for assessing frailty, Cesari et al (10) argue that the EFS is a scale composed of clinical and social issues adequate for the Brazilian population, because it is objective and consistent with the context being studied. (10) Multidimensional and multisectoral interventions related to frailty in vulnerable elderly, is of paramount importance for primary care services, to improve monitoring and enable the conducting of long term care approaches, both of health care and basic social protection within the public system.…”

“…(9) Although there is no gold standard for assessing frailty, Cesari et al (10) argue that the EFS is a scale composed of clinical and social issues adequate for the Brazilian population, because it is objective and consistent with the context being studied. (10) Multidimensional and multisectoral interventions related to frailty in vulnerable elderly, is of paramount importance for primary care services, to improve monitoring and enable the conducting of long term care approaches, both of health care and basic social protection within the public system. The development of research in the area of aging is a priority, and is included in the Research Agenda on Aging for the Twenty-First Century, which focuses on the social aspects associated to aging.…”