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Frailty: Emergence and Consequences in Women Aged 65 and Older in the Women's Health Initiative Observational Study

Authors

  • Nancy Fugate Woods PhD, RN, FAAN,

    1. From the *Seattle Clinical CenterClinical Coordinating Center, Fred Hutchinson Cancer Research Center, Women's Health Initiative, Seattle, WashingtonSchool of Nursing§Geriatric Pharmacy Program, School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Family and Community Medicine, School of Medicine, University of Nevada, Reno, NevadaDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii#Department of Medicine, Nephrology Analytical Services, Hennepin County Medical Center, Minneapolis, Minnesota**Department of Medicine and Epidemiology, Healthy Aging Research Program, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Andrea Z. LaCroix PhD,

    1. From the *Seattle Clinical CenterClinical Coordinating Center, Fred Hutchinson Cancer Research Center, Women's Health Initiative, Seattle, WashingtonSchool of Nursing§Geriatric Pharmacy Program, School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Family and Community Medicine, School of Medicine, University of Nevada, Reno, NevadaDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii#Department of Medicine, Nephrology Analytical Services, Hennepin County Medical Center, Minneapolis, Minnesota**Department of Medicine and Epidemiology, Healthy Aging Research Program, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Shelly L. Gray Pharm D, MS, BCPS,

    1. From the *Seattle Clinical CenterClinical Coordinating Center, Fred Hutchinson Cancer Research Center, Women's Health Initiative, Seattle, WashingtonSchool of Nursing§Geriatric Pharmacy Program, School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Family and Community Medicine, School of Medicine, University of Nevada, Reno, NevadaDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii#Department of Medicine, Nephrology Analytical Services, Hennepin County Medical Center, Minneapolis, Minnesota**Department of Medicine and Epidemiology, Healthy Aging Research Program, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Aaron Aragaki MS,

    1. From the *Seattle Clinical CenterClinical Coordinating Center, Fred Hutchinson Cancer Research Center, Women's Health Initiative, Seattle, WashingtonSchool of Nursing§Geriatric Pharmacy Program, School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Family and Community Medicine, School of Medicine, University of Nevada, Reno, NevadaDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii#Department of Medicine, Nephrology Analytical Services, Hennepin County Medical Center, Minneapolis, Minnesota**Department of Medicine and Epidemiology, Healthy Aging Research Program, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Barbara B. Cochrane PhD, RN,

    1. From the *Seattle Clinical CenterClinical Coordinating Center, Fred Hutchinson Cancer Research Center, Women's Health Initiative, Seattle, WashingtonSchool of Nursing§Geriatric Pharmacy Program, School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Family and Community Medicine, School of Medicine, University of Nevada, Reno, NevadaDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii#Department of Medicine, Nephrology Analytical Services, Hennepin County Medical Center, Minneapolis, Minnesota**Department of Medicine and Epidemiology, Healthy Aging Research Program, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Robert L. Brunner PhD,

    1. From the *Seattle Clinical CenterClinical Coordinating Center, Fred Hutchinson Cancer Research Center, Women's Health Initiative, Seattle, WashingtonSchool of Nursing§Geriatric Pharmacy Program, School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Family and Community Medicine, School of Medicine, University of Nevada, Reno, NevadaDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii#Department of Medicine, Nephrology Analytical Services, Hennepin County Medical Center, Minneapolis, Minnesota**Department of Medicine and Epidemiology, Healthy Aging Research Program, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Kamal Masaki MD,

    1. From the *Seattle Clinical CenterClinical Coordinating Center, Fred Hutchinson Cancer Research Center, Women's Health Initiative, Seattle, WashingtonSchool of Nursing§Geriatric Pharmacy Program, School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Family and Community Medicine, School of Medicine, University of Nevada, Reno, NevadaDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii#Department of Medicine, Nephrology Analytical Services, Hennepin County Medical Center, Minneapolis, Minnesota**Department of Medicine and Epidemiology, Healthy Aging Research Program, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Anne Murray MD, MSc,

    1. From the *Seattle Clinical CenterClinical Coordinating Center, Fred Hutchinson Cancer Research Center, Women's Health Initiative, Seattle, WashingtonSchool of Nursing§Geriatric Pharmacy Program, School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Family and Community Medicine, School of Medicine, University of Nevada, Reno, NevadaDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii#Department of Medicine, Nephrology Analytical Services, Hennepin County Medical Center, Minneapolis, Minnesota**Department of Medicine and Epidemiology, Healthy Aging Research Program, University of Pittsburgh, Pittsburgh, Pennsylvania.
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  • Anne B. Newman MD, MPH

    1. From the *Seattle Clinical CenterClinical Coordinating Center, Fred Hutchinson Cancer Research Center, Women's Health Initiative, Seattle, WashingtonSchool of Nursing§Geriatric Pharmacy Program, School of Pharmacy, University of Washington, Seattle, WashingtonDepartment of Family and Community Medicine, School of Medicine, University of Nevada, Reno, NevadaDepartment of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii#Department of Medicine, Nephrology Analytical Services, Hennepin County Medical Center, Minneapolis, Minnesota**Department of Medicine and Epidemiology, Healthy Aging Research Program, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Address correspondence to Nancy Fugate Woods, PhD, RN, FAAN, University of Washington School of Nursing, Box 357260, Seattle, WA 98195. E-mail: nfwoods@u.washington.edu

Abstract

Objectives: To define frailty using simple indicators; to identify risk factors for frailty as targets for prevention; and to investigate the predictive validity of this frailty classification for death, hospitalization, hip fracture, and activity of daily living (ADL) disability.

Design: Prospective study, the Women's Health Initiative Observational Study.

Setting: Forty U.S. clinical centers.

Participants: Forty thousand six hundred fifty-seven women aged 65 to 79 at baseline.

Measurements: Components of frailty included self-reported muscle weakness/impaired walking, exhaustion, low physical activity, and unintended weight loss between baseline and 3 years of follow-up. Death, hip fractures, ADL disability, and hospitalizations were ascertained during an average of 5.9 years of follow-up.

Results: Baseline frailty was classified in 16.3% of participants, and incident frailty at 3-years was 14.8%. Older age, chronic conditions, smoking, and depressive symptom score were positively associated with incident frailty, whereas income, moderate alcohol use, living alone, and self-reported health were inversely associated. Being underweight, overweight, or obese all carried significantly higher risk of frailty than normal weight. Baseline frailty independently predicted risk of death (hazard ratio (HR)=1.71, 95% confidence interval (CI)=1.48–1.97), hip fracture (HR=1.57, 95% CI=1.11–2.20), ADL disability (odds ratio (OR)=3.15, 95% CI=2.47–4.02), and hospitalizations (OR=1.95, 95% CI=1.72–2.22) after adjustment for demographic characteristics, health behaviors, disability, and comorbid conditions.

Conclusion: These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women. Underweight, obesity, smoking, and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention.

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