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. 2015 May;44(3):471-7.
doi: 10.1093/ageing/afv010. Epub 2015 Feb 16.

Measuring frailty using self-report and test-based health measures

O Theou  1 , M D L O'Connell  2 , B L King-Kallimanis  2 , A M O'Halloran  2 , K Rockwood  1 , R A Kenny  3
Affiliations

Measuring frailty using self-report and test-based health measures

O Theou et al. Age Ageing. 2015 May.

Abstract

Background: previously, frailty indices were constructed using mostly subjective health measures. The reporting error in this type of measure can have implications on the robustness of frailty findings.

Objective: to examine whether frailty assessment differs when we construct frailty indices using solely self-reported or test-based health measures.

Design: secondary analysis of data from The Irish LongituDinal study on Ageing (TILDA).

Subjects and methods: 4,961 Irish residents (mean age: 61.9 ± 8.4; 54.2% women) over the age of 50 years who underwent a health assessment were included in this analysis. We constructed three frailty indices using 33 self-reported health measures (SRFI), 33 test-based health measures (TBFI) and all 66 measures combined (CFI). The 2-year follow-up outcomes examined were all-cause mortality, disability, hospitalisation and falls.

Results: all three indices had a right-skewed distribution, an upper limit to frailty, a non-linear increase with age, and had a dose-response relationship with adverse outcomes. Levels of frailty were lower when self-reported items were used (SRFI: 0.12 ± 0.09; TBFI: 0.17 ± 0.15; CFI: 0.14 ± 0.13). Men had slightly higher frailty index scores than women when test-based measures were used (men: 0.17 ± 0.09; women: 0.16 ± 0.10). CFI had the strongest prediction for risk of adverse outcomes (ROC: 0.64-0.81), and age was not a significant predictor when it was included in the regression model.

Conclusions: except for sex differences, characteristics of frailty are similar regardless of whether self-reported or test-based measures are used exclusively to construct a frailty index. Where available, self-reported and test-based measures should be combined when trying to identify levels of frailty.

Keywords: frailty; frailty index; older people; self-reported health measures; test-based health measures.

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Figures

Figure 1.
Figure 1.
(a) Distribution of scores on each frailty index. (b) Relationship of frailty scores with age by type of frailty index.
See this image and copyright information in PMC

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