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. 2020 Jun;32(6):1025-1034.
doi: 10.1007/s40520-020-01478-3. Epub 2020 Jan 31.

Operationalization of a frailty index among older adults in the InCHIANTI study: predictive ability for all-cause and cardiovascular disease mortality

Emiel O Hoogendijk  1 , Sari Stenholm  2   3 , Luigi Ferrucci  4 , Stefania Bandinelli  5 , Marco Inzitari  6   7 , Matteo Cesari  8   9
Affiliations

Operationalization of a frailty index among older adults in the InCHIANTI study: predictive ability for all-cause and cardiovascular disease mortality

Emiel O Hoogendijk et al. Aging Clin Exp Res. 2020 Jun.

Abstract

Background: The frailty index (FI) is a sensitive instrument to measure the degree of frailty in older adults, and is increasingly used in cohort studies on aging.

Aims: To operationalize an FI among older adults in the "Invecchiare in Chianti" (InCHIANTI) study, and to validate its predictive capacity for mortality.

Methods: Longitudinal data were used from 1129 InCHIANTI participants aged ≥ 65 years. A 42-item FI was operationalized following a standard procedure using baseline data (1998/2000). Associations of the FI with 3- and 6-year all-cause and cardiovascular disease (CVD) mortality were studied using Cox regression. Predictive accuracy was estimated by the area under the ROC curve (AUC), for a continuous FI score and for different cut-points.

Results: The median FI was 0.13 (IQR 0.08-0.21). Scores were higher in women, and at advanced age. The FI was associated with 3- and 6-year all-cause and CVD mortality (HR range per 0.01 FI increase = 1.03-1.07, all p < 0.001). The continuous FI score predicted the mortality outcomes with moderate-to-good accuracy (AUC range 0.72-0.83). When applying FI cut-offs between 0.15 and 0.35, the accuracy of this FI for predicting mortality was moderate (AUC range 0.61-0.76). Overall, the predictive accuracy of the FI was higher in women than in men.

Conclusions: The FI operationalized in the InCHIANTI study is a good instrument to grade the risk of all-cause mortality and CVD mortality. More measurement properties, such as the responsiveness of this FI when used as outcome measure, should be investigated in future research.

Keywords: Deficit accumulation; Frail elderly; Frailty index; Geriatrics; Risk prediction.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Distribution of the frailty index at baseline
Fig. 2
Fig. 2
Association between age and baseline frailty index score for men and womena. aThe circles and squares indicate frailty index scores by age rounded to nearest whole number, and may represent more than one individual
Fig. 3
Fig. 3
Percentage of all-cause mortality at follow-up by baseline frailty index score for A men and B women
See this image and copyright information in PMC

References

    1. Cesari M, Marzetti E, Thiem U, et al. The geriatric management of frailty as paradigm of "The end of the disease era". Eur J Intern Med. 2016;31:11–14. doi: 10.1016/j.ejim.2016.03.005. - DOI - PubMed
    1. Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health. Lancet. 2019;394:1365–1375. - PubMed
    1. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet. 2013;381:752–762. doi: 10.1016/S0140-6736(12)62167-9. - DOI - PMC - PubMed
    1. Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. 2016;31:3–10. doi: 10.1016/j.ejim.2016.03.007. - DOI - PubMed
    1. Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A. 2007;62:722–727. doi: 10.1093/gerona/62.7.722. - DOI - PubMed