Elsevier

Archives of Gerontology and Geriatrics

Volume 41, Issue 2, September–October 2005, Pages 141-149
Archives of Gerontology and Geriatrics

Frailty, morbidity and survival

https://doi.org/10.1016/j.archger.2005.01.002Get rights and content

Abstract

Frailty, as a reflection of decreased physical reserve rather than disability, is assessed by various functional tests rather than by specific disease burden. We investigated association of measures of frailty to disease outcomes and survival in a population-based study of Midwestern adults. The markers of frailty we evaluated were: time to walk a measured course (gait-time), handgrip strength, peak respiratory flow rate, ability to stand from a sitting position without using arms, and best corrected visual acuity. A history of cardiovascular disease, cancer, and hypertension were obtained. Data were collected at the third examination (1998–2000) of the Beaver Dam Eye Study cohort (n = 2962). Follow-up for mortality occurred up to 412 years after the 1998–2000 examinations. Markers of frailty were significantly associated with age. Values in the highest quartile (slowest) of gait-time, lowest quartile of peak expiratory flow rate, lowest quartile of handgrip strength, inability to stand from sitting in one try (those not in a wheelchair), and visual impairment were combined in an index to denote a general description of frailty. The range of the index was 0 (no frailty) to 5 (maximum frailty). Greater frailty was significantly associated with cardiovascular disease and hypertension. Frailty was associated with poorer survival over an interval of 412 years after adjusting for age, sex, hypertension, diabetes, and cardiovascular disease. Greater frailty was associated with greater likelihood of concurrent medical conditions and with decreased survival.

Introduction

Frailty results from declines in multiple systems (Lipsitz and Goldberger, 1992, Bortz, 1993, Campbell and Buchner, 1997, Hamerman, 1999). It differs from disability or morbidity in that it is meant to describe a general decrease in functional status (Chin et al., 1999, Fried et al., 2001). Markers of frailty include low lung function (Sharp et al., 1997), decreased mobility, slower gait-time, age-related decreases in balance and muscle strength, and poorer visual function (Kahn et al., 1977, Dana et al., 1990, Tielsch et al., 1990, Klein et al., 1999, Klein et al., 2003, Hyman et al., 2001, Wang et al., 2001). These signs may be accompanied by a reduced ability to rebound from challenges, leading to increased mortality (Klein et al., 1995, Sharp et al., 1997, Anstey et al., 2001, Fried et al., 2001, Hennis et al., 2001, Wang et al., 2001) and morbidity (Tinetti et al., 1986, Tinetti et al., 1995, Nevitt et al., 1989, Klein et al., 1998). In addition, it has been postulated that this apparently multifaceted syndrome may be characterized as a phenotype which leads to the possibility of exploring environmental and genetic antecedents to it (Fried et al., 2001).

It is the purpose of this report to describe the associations of morbidity and survival to an index of frailty in the Beaver Dam Eye Study cohort.

Section snippets

Methods

All persons of 43–86 years of age living in Beaver Dam Wisconsin were invited to participate in a study evaluation from 1988 to 1990 (Campbell and Palit, 1988, Klein et al., 1991). Tenets of the Declaration of Helsinki were followed. Signed consent was obtained from each participant at each examination. Institutional review board approval was obtained yearly. All subjects who were eligible for participation in the baseline examination (Klein et al., 1991) were invited for a second examination 5

Results

There were 2515 of the 2962 participants for whom we had data for all frailty markers. Those without all measurements tended to be older, female, had poor peak expiratory flow rate, had poor grip strength, were less able to do the chair stand, had poor visual acuity, and resided in a nursing home.

Values for gait-time, grip strength in the dominant hand, and peak expiratory flow rate differed by age and gender (Fig. 1). For the chair stand, there was decreased ability to rise in one attempt with

Discussion

Men were more likely to be frail than women in our population. The reverse has been found in the Cardiovascular Health Study (CHS) (Fried et al., 2001). This may have resulted from different sex-specific cutoffs for defining characteristics of frailty. Our definition of frailty, which allows for differences in values for the markers between the sexes, results in a similar relationship of the index to death for the sexes. This is in keeping with the notion of frailty being a measure of

Acknowledgement

This research is supported by National Institutes of Health grants EY06594 and EY13438.

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