Frailty in older persons: multisystem risk factors and the Frailty Risk Index (FRI)

Abstract

Importance: Currently there is no risk factor scale that identifies older persons at risk of frailty.

Objectives: In this study, we identified significant multisystem risk factors of frailty, developed a simple frailty risk index, and evaluated it for use in primary care on an external validation cohort of community-living older persons.

Design, setting, and participants: We used cross-sectional data of 1685 older adults aged 55 and older in the Singapore Longitudinal Ageing Studies (SLAS) to identify 13 salient risk factors among 40 known and putative risk factors of the frailty phenotype (weakness, slowness, low physical activity, weight loss, and exhaustion). In a validation cohort (n = 2478) followed for 2 years, we evaluated the validity of Frailty Risk Index (FRI).

Main outcomes and measures: Frailty at baseline and functional dependency, hospitalization, and SF12 physical component summary (PCS) scores at 2-year follow-up were measured among people in the validation cohort.

Results: The components (weighted scores) of the FRI are age older than 75 (2), no education (1), heart failure (1), respiratory disorders (2), stroke (2), depressive symptoms (3), hearing impairment (3), visual impairment (1), FEV1/FVC lower than 0.7 (1), eGFR lower than 60 mL/min/1.73 m(2) (1), nutritional risk score of 3 or higher (2), anemia (1), and white cell counts (× 10(9)/L) of 6.5 or more (1). In the validation cohort, the FRI (0 to 12) was significantly associated with prefrailty (OR, 1.20 per unit; 95% CI 1.19-1.27) and frailty (OR 1.80 per unit; 95% CI 1.65-1.95). The FRI predicted subsequent IADL-ADL dependency (OR1.19; 95% CI 1.11-1.27), hospitalization (OR .14; 95% CI 1.05-1.24), lowest quintile of SF12-PCS (OR 1.17; 95% CI 1.11-1.25), and combined adverse health outcomes (OR 1.16; 95% CI 1.09-1.22).

Conclusions and relevance: The FRI is a validated instrument for assessing frailty risk in community-living older persons. FRI may be a useful rapid assessment tool to identify vital body system deficits underlying the frailty syndrome.

Keywords: Physical frailty; functional dependency; hospitalization; quality of life; risk factors; scale; validation.