Operationalization of Frailty Using Eight Commonly Used Scales and Comparison of Their Ability to Predict All-Cause Mortality

Authors

  • Olga Theou PhD,

    1. Geriatric Medicine Research, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Thomas D. Brothers BA,

    1. Geriatric Medicine Research, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Arnold Mitnitski PhD,

    1. Geriatric Medicine Research, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Kenneth Rockwood MD

    Corresponding author
    1. Geriatric Medicine Research, Dalhousie University, Halifax, Nova Scotia, Canada
    2. Centre for Health Care of the Elderly, QEII Health Sciences Centre, Capital District Health Authority, Halifax, Nova Scotia, Canada
    • Address correspondence to Kenneth Rockwood, Centre for Health Care of the Elderly, QEII Health Sciences Centre, Capital District Health Authority, Dalhousie University, Suite 1421, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia B3H 2E1, Canada. E-mail: kenneth.rockwood@dal.ca

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Abstract

Objectives

To operationalize frailty using eight scales and to compare their content validity, feasibility, prevalence estimates of frailty, and ability to predict all-cause mortality.

Design

Secondary analysis of the Survey of Health, Ageing and Retirement in Europe (SHARE).

Setting

Eleven European countries.

Participants

Individuals aged 50 to 104 (mean age 65.3 ± 10.5, 54.8% female, N = 27,527).

Measurements

Frailty was operationalized using SHARE data based on the Groningen Frailty Indicator, the Tilburg Frailty Indicator, a 70-item Frailty Index (FI), a 44-item FI based on a Comprehensive Geriatric Assessment (FI-CGA), the Clinical Frailty Scale, frailty phenotype (weighted and unweighted versions), the Edmonton Frail Scale, and the FRAIL scale.

Results

All scales had fewer than 6% of cases with at least one missing item, except the SHARE-frailty phenotype (11.1%) and the SHARE-Tilburg (12.2%). In the SHARE-Groningen, SHARE-Tilburg, SHARE-frailty phenotype, and SHARE-FRAIL scales, death rates were 3 to 5 times as high in excluded cases as in included ones. Frailty prevalence estimates ranged from 6% (SHARE-FRAIL) to 44% (SHARE-Groningen). All scales categorized 2.4% of participants as frail. Of unweighted scales, the SHARE-FI and SHARE-Edmonton scales most accurately predicted mortality at 2 (SHARE-FI area under the receiver operating characteristic curve (AUC) = 0.77, 95% confidence interval (CI) = 0.75–0.79); SHARE-Edmonton AUC = 0.76, 95% CI = 0.74–0.79) and 5 (both AUC = 0.75, 95% CI = 0.74–0.77) years. The continuous score of the weighted SHARE-frailty phenotype (AUC = 0.77, 95% CI = 0.75–0.78) predicted 5-year mortality better than the unweighted SHARE-frailty phenotype (AUC = 0.70, 95% CI = 0.68–0.71), but the categorical score of the weighted SHARE-frailty phenotype did not (AUC = 0.70, 95% CI = 0.68–0.72).

Conclusion

Substantive differences exist between scales in their content validity, feasibility, and ability to predict all-cause mortality. These frailty scales capture related but distinct groups. Weighting items in frailty scales can improve their predictive ability, but the trade-off between specificity, predictive power, and generalizability requires additional evaluation.

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