PHENOTYPE OF FRAILTY: Karen Bandeen-RocheMarcia D. Omondi452006-03-10T13:46:00Z2006-11-01T14:37:00Z2007-04-24T16:14:00Z110025713Johns Hopkins University4713670211.8125

PHENOTYPE OF FRAILTY:CHARACTERIZATION IN THE WOMEN’S HEALTH AND AGING STUDIESKaren Bandeen-Roche, Ph.D. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Qian-Li Xue, Ph.D.

Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Luigi Ferrucci, MD, Ph.D. Clinical Research Branch, Intramural Research Program, National Institute on Aging, Baltimore , Jeremy Walston, MD

3, Jack M. Guralnik, MD, Ph.D.5 Division of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda MD5, Paulo Chaves, MD, Ph.D.,

Scott L. Zeger, Ph.D,

1 and Linda P. Fried, MD, MPH

23ABSTRACT

BACKGROUND:

“Frailty” is a

n adverse,

primari

ly gerontologic

health

condition

regarded as frequent with aging and having severe consequences. While clinicians claim that

the extremes of

frailty can be easily recognized, a standardized definition of frailty has proved elusive until recently. Th

paper evaluates the cross-validity, criterion validity,

and

internal validity

in the Women’s Health and Aging Studies (WHAS)

discrete measure of frailty

recently

validated

in the Cardiovascular Health Study (CHS).

METHODS:

The frailty measure

developed in CHS

was

delineated in

the

HAS

datasets. Using

atent class analysis

, we

evaluate

whether criteria comprising the

measure

aggregate into a syndrome

e verified the criterion validity of the

measure

by testing whether participants defined as frail were more likely than others to develop

adverse geriatric outcomes

or die

RESULTS:

The distributions of f

railty

n the WHAS and CHS

were comparable

. In latent class analyses, the measures demonstrated

strong

internal validity

vis à vis

stated theory

characterizing

frailty

as a medical syndrome

. In proportional hazards models,

frail women had higher risk of developing I

ADL and ADL disability

, institutionalization and death,

independently of

multiple

potentially

confounding

factors

CONCLUSIONS:

The

findings of this study are

consistent with widely held theory

that conceptualizes

frailty

as a syndrome. The frailty definition developed in the CHS is appl

icab

across diverse

population

samples and identifies

a profile of high

risk

of multiple adverse outcomes.

REFERENCES

SEQ CHAPTER \h \r 1

Buchner

, Wagner, EH.

Preventing frail health.

Clin Geriat

Med

1992;

1-17.

SEQ CHAPTER \h \r 1

Hamerman D.

Toward an understanding of frailty.

Ann Int

ern

Med

1999;

130

945-950.

Fried LP, Tangen CM, Walston J,

et al.

Frailty in older adults: evidence for a phenotype.

J Gerontol

Biol Sci

Med Sc

2001;

M146-156.

SEQ CHAPTER \h \r 1

Bortz WM II. The physics of frailty.

J Am Geriatr Soc

1993;

1004-1008.

. SEQ CHAPTER \h \r 1Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol Biol Sci Med Sci. 2004;59:255-263.Lipsitz LA.

Physiological complexity, aging, and the path to frailty. Sci Aging Knowledge Environ. 2004;pe16.

Walston J. Frailty—the search for underlying causes. Sci Aging Knowledge Environ. 2004;pe4.Fried LP, Walston J. Frailty and failure to thrive. In: Hazzard WR, Blass JP, Ettinger WH Jr, Halter JB, Ouslander J, eds. Principles of Geriatric Medicine and Gerontology. 5th ed. New York: McGraw-Hill; 2003:1487-1502. SEQ CHAPTER \h \r 1Nourhashemi F, Andrieu S, Gillette-Guyonnet S, et al. Instrumental activities of daily living as a potential marker of frailty: A study of 7364 community-dwelling elderly women (the EPIDOS study). J Gerontol Biol Sci Med Sci, 2001;56:M448-M53. SEQ CHAPTER \h \r 1Gill TM, McGloin JM, Gahbauer EA, Shepard DM, Bianco LM. Two recruitment strategies for a clinical trial of physically frail community-living older persons.

Am Geriatr So

2001;49:1039-1045. SEQ CHAPTER \h \r 1 SEQ CHAPTER \h \r 1Winograd CH, Gerety MB, Chung M, Goldstein MK, Dominguez F Jr, Vallone R. Screening for frailty: criteria and predictors of outcomes.

Am Geriatr Soc

. 1991;39, 778-784. SEQ CHAPTER \h \r 1Strawbridge WJ, Shema SJ, Balfour JL, Higby HR., Kaplan GA. (1998). Antecedents of frailty over three decades in an older cohort.

J Gerontol

Psych Sci

Soc Sci. 1998;53:S9-S16. Rockwood K, Stadnyk K, MacKnight C, McDowell I, Hebert R, Hogan DB. A brief clinical instrument to classify frailty in elderly people.

Lancet

. 1999;353:205-206. SEQ CHAPTER \h \r 1Bowles J, Brooks T, Hayes-Reams P, et al. Frailty, family, and church support among urban African American elderly.

J Health Care Poor Underserved

. 2000;11:87-99. SEQ CHAPTER \h \r 1Miles TP, Palmer RF, Espino DV, Mouton CP, Lichtenstein MJ, Markides KS. New-onset incontinence and markers of frailty: data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly. J Gerontol Biol Sci Med Sci, 2001;56, M19-M24.

SEQ CHAPTER \h \r 1Villareal DT, Binder EF, Williams DB, Schechtman KB, Yarasheski KE, Kohrt WM. Bone mineral density response to estrogen replacement in frail elderly women: a randomized controlled trial.

JAMA. 2001;286:815-820.

de Jong N, Paw MJMCA, de Groot LCPGM, et al. Nutrient-dense foods and exercise in frail elderly: effects on B vitamins, homocysteine, methylmalonic acid, and neuropsychological functioning. Am J Clin Nutr. 2001;73:338-346.Merriam-Webster, Inc. (2003). Merriam-Webster Medical Dictionary. http://www2.merriam-webster.com/cgi-bin/mwmednlm, 04 Feb 2003. SEQ CHAPTER \h \r 1Goodman LA. Exploratory latent structure analysis using both identifiable and unidentifiable models. Biometrika. 1974;61:215-231. Fried LP, Kasper JD, Guralnik JM, Simonsick EM. The Women’s Health and Aging Study: An Introduction. In: Guralnik JM, Fried LP, Simonsick EM, Kasper JD, Lafferty ME, eds. The Women’s Health and Aging Study: Health and Social Characteristics of Older Women with Disability. Bethesda, MD: National Institute on Aging; NIH Pub. No. 95-4009:1-8.

Fried LP, Bandeen-Roche K, Chaves PH, Johnson BA.

Preclinical mobility disability predicts incident mobility disability in older women. J Gerontol: Biol Sci Med Sci.

2000;55:M43-M52.Akaike H. A new look at the statistical model identification. IEEE Trans Automatic Control. 1974;AC-19:716-723. Schwarz G. Estimating the dimensions of a model. Ann Stat. 1978;6:461-464.Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. The Scientific World, 2001; 1:323-336.

Studenski S, Hayes RP, Leibowitz RQ et al. Clinical global impression of change in physical frailty: Development of a measure based on clinical judgment.

J Am Geriatr Soc

2004; 52:1560-1566.

Puts MTE, Lips P,

Deeg

DJH.

Sex differences in the risk of frailty for mortality independent of disability and chronic diseases.

J Am Geriatr Soc

2005; 53:40-47. SEQ CHAPTER \h \r 1McCutcheon AL. Latent class analysis. SAGE, Newbury Park CA, 1987. PAGE PAGE 2