Abstract
BackgroundAmong the many definitions of frailty, the frailty phenotype defined by Fried et al. is one of few constructs that has been repeatedly validated: first in the Cardiovascular Health Study (CHS) and subsequently in other large cohorts in the North America. In Europe, the Survey of Health, Aging and Retirement in Europe (SHARE) is a gold mine of individual, economic and health information that can provide insight into better understanding of frailty across diverse population settings. A recent adaptation of the original five CHS-frailty criteria was proposed to make use of SHARE data and measure frailty in the European population. To test the validity of the SHARE operationalized frailty phenotype, this study aims to evaluate its prospective association with adverse health outcomes.MethodsData are from 11,015 community-dwelling men and women aged 60+ participating in wave 1 and 2 of the Survey of Health, Aging and Retirement in Europe, a population-based survey. Multivariate logistic regression analyses were used to assess the 2-year follow up effect of SHARE-operationalized frailty phenotype on the incidence of disability (disability-free at baseline) and on worsening disability and morbidity, adjusting for age, sex, income and baseline morbidity and disability.ResultsAt 2-year follow up, frail individuals were at increased risk for: developing mobility (OR 3.07, 95% CI, 1.02-9.36), IADL (OR 5.52, 95% CI, 3.76-8.10) and BADL (OR 5.13, 95% CI, 3.53-7.44) disability; worsening mobility (OR 2.94, 95% CI, 2.19- 3.93) IADL (OR 4.43, 95% CI, 3.19-6.15) and BADL disability (OR 4.53, 95% CI, 3.14-6.54); and worsening morbidity (OR 1.77, 95% CI, 1.35-2.32). These associations were significant even among the prefrail, but with a lower magnitude of effect.ConclusionsThe SHARE-operationalized frailty phenotype is significantly associated with all tested health outcomes independent of baseline morbidity and disability in community-dwelling men and women aged 60 and older living in Europe. The robustness of results validate the use of this phenotype in the SHARE survey for future research on frailty in Europe.
Highlights
Among the many definitions of frailty, the frailty phenotype defined by Fried et al is one of few constructs that has been repeatedly validated: first in the Cardiovascular Health Study (CHS) and subsequently in other large cohorts in the North America
The SHAREoperationalized frailty phenotype was assessed in 10,237 participants and classified 46.0% as non-frail, 41.1% as pre-frail, and 12.9% as frail
Frail individuals had more than 7-fold risk of developing Basic activities of daily living (BADL) disability; more than a 5-fold risk of developing Instrumental activities of daily living (IADL) disability, and only a 2.5 fold risk of developing mobility disability compared to non-frail individuals
Summary
Among the many definitions of frailty, the frailty phenotype defined by Fried et al is one of few constructs that has been repeatedly validated: first in the Cardiovascular Health Study (CHS) and subsequently in other large cohorts in the North America. Physiological, social and psychosocial models on the possible causes and pathways of frailty [1,11,12,13,14,15,16,17,18], the one that has attracted considerable attention is the “phenotype of frailty” [1] This concept embodies a set of signs and symptoms that is well aligned with geriatric syndromes, underscoring a biological origin, and reflecting a syndromic character in which an aggregate of multiple-system impairments that are inter-related cause a loss of function [19,20,21]. As one of most widely-referenced constructs, the frailty phenotype is defined by the presence of three or more of the five specific measurable attributes: weight loss, muscle weakness, poor endurance, slow motor performance and reduced physical activity [1]
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