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Ability of Self-Reported Frailty Components to Predict Incident Disability, Falls, and All-Cause Mortality: Results From a Population-Based Study of Older British Men

Papachristou, E; Wannamethee, SG; Lennon, LT; Papacosta, O; Whincup, PH; Iliffe, S; Ramsay, SE; (2017) Ability of Self-Reported Frailty Components to Predict Incident Disability, Falls, and All-Cause Mortality: Results From a Population-Based Study of Older British Men. Journal of the American Medical Directors Association , 18 (2) pp. 152-157. 10.1016/j.jamda.2016.08.020. Green open access

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Abstract

BACKGROUND: Frailty is a state of increased vulnerability to disability, falls, and mortality. The Fried frailty phenotype includes assessments of grip strength and gait speed, which are complex or require objective measurements and are challenging in routine primary care practice. In this study, we aimed to develop a simple assessment tool based on self-reported information on the 5 Fried frailty components to identify older people at risk of incident disability, falls, and mortality. METHODS: Analyses are based on a prospective cohort comprising older British men aged 71-92 years in 2010-2012. A follow-up questionnaire was completed in 2014. The discriminatory power for incident disability and falls was compared with the Fried frailty phenotype using receiver operating characteristic-area under the curve (ROC-AUC); for incident falls it was additionally compared with the FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight). Predictive ability for mortality was assessed using age-adjusted Cox proportional hazard models. RESULTS: A model including self-reported measures of slow walking speed, low physical activity, and exhaustion had a significantly increased ROC-AUC [0.68, 95% confidence interval (CI) 0.63-0.72] for incident disability compared with the Fried frailty phenotype (0.63, 95% CI 0.59-0.68; P value of ΔAUC = .003). A second model including self-reported measures of slow walking speed, low physical activity, and weight loss had a higher ROC-AUC (0.64, 95% CI 0.59-0.68) for incident falls compared with the Fried frailty phenotype (0.57, 95% CI 0.53-0.61; P value of ΔAUC < .001) and the FRAIL scale (0.56, 95% CI 0.52-0.61; P value of ΔAUC = .001). This model was also associated with an increased risk of mortality (Harrell's C = 0.73, Somer's D = 0.45; linear trend P < .001) compared with the Fried phenotype (Harrell's C = 0.71; Somer's D = 0.42; linear trend P < .001) and the FRAIL scale (Harrell's C = 0.71, Somer's D = 0.42; linear trend P < .001). CONCLUSIONS: Self-reported information on the Fried frailty components had superior discriminatory and predictive ability compared with the Fried frailty phenotype for all the adverse outcomes considered and with the FRAIL scale for incident falls and mortality. These findings have important implications for developing interventions and health care policies as they offer a simple way to identify older people at risk of adverse outcomes associated with frailty.

Type: Article
Title: Ability of Self-Reported Frailty Components to Predict Incident Disability, Falls, and All-Cause Mortality: Results From a Population-Based Study of Older British Men
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jamda.2016.08.020
Publisher version: http://dx.doi.org/10.1016/j.jamda.2016.08.020
Language: English
Additional information: Copyright © 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: Frailty, disability, falls, mortality
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Education
UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education
UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education > IOE - Psychology and Human Development
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1522090
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