Frail

Participants were born between and and were 49 to 65 years of age at the Wave 1 baseline assessment. Interviewers completed 26 hours of training on study-specific interviewing and physical performance measurements. In-home assessments were repeated 9 years later after baseline during Wave Of the original participants, were successfully re-evaluated during Wave Fatigue, Resistance, Ambulation, Illness, and Loss of weight Frail scale scores range from 0—5 i. Illness was scored 1 for respondents who reported 5 or more illnesses out of 11 total illnesses. The associations of FRAIL scale scores categorized as frail or pre-frail versus healthy were examined with poor outcomes on the following measures: ADL difficulties, instrumental activities of daily living IADL difficulties, short physical performance battery SPPB , gait speed, one-leg stand test, grip strength, injurious falls, laboratory tests, and mortality.

Disability was assessed using activities of daily living scales. ADL difficulties represent the number of these tasks for which respondents reported difficulty performing the task. ADL dependency was defined as positive when respondents reported difficulty on an ADL item and, also, reported a being unable to do the task or b receiving help from another person to do the task.

IADLs included eight items preparing meals, shopping for groceries, managing money, making phone calls, doing light housework, doing heavy housework, getting to places outside walking distance, and managing medications from LSOA-II 18 and Lawton and Brody 19 and was scored as the number of tasks for which the respondent reported difficulty performing that task.

The SPPB is a summary measure of lower body performance based on three component tasks: Isometric grip strength was assessed using a handgrip dynamometer Fabrication Enterprises, Inc.

The mean of the last two of three maximal effort trials with the self-reported stronger hand was used in these analyses. Injurious falls were classified as the total number of falls in the past year which resulted in any of the following events: For the one-leg stand test individuals chose their preferred leg to balance on and were required to raise the other foot at least 2 inches above the ground and hold the position for as long as possible up to 30 seconds. The response for each FES item ranges from 0 no confidence to 10 complete confidence and the FES total score ranges from 0— Vital status was determined by proxy report as part of the annual AAH follow-up Waves 1—5 plus Waves 8 and 10 and tracing via local databases e.

Blood was drawn for laboratory analyses shortly after the baseline, in-home assessment, or at the time of further clinical examinations required for special substudies during Wave 1. Serum was stored until analysis for cytokines in Blood tests were available on participants, and the characteristics of the subsample have been previously reported Adiponectin was determined using a commercially available radioimmuno-assay kit Linco Research, St.

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Charles, MO with intra-assay and interassay coefficients of variation CVs of 5. The intra-assay and interassay CVs were 4. The intra-assay and interassay CVs were 5. Intra-assay and interassay CVs were 4. The intra-assay and interassay coefficient of variation were 6. ANOVA for continuous variables with Tukey posthoc tests and chi-square for categorical variables were used to compare population characteristics across FRAIL scale status healthy, pre-frail, frail. Linear regression continuous outcomes and binary logistic regression dichotomous outcomes were used to investigate cross-sectional and longitudinal associations for FRAIL status groups and for each of the five individual components of the FRAIL scale.

Cross-sectional regression analyses were adjusted for age and gender.

Analyses were performed excluding participants with 1 or more ADLs difficulties at baseline Wave 1 and then repeated excluding participants with 1 or more ADL dependencies at baseline. In the group without ADL difficulties at baseline, 2.

At baseline, when participants with any ADL dependencies were excluded, 7. By Wave 10, 8. Baseline characteristics of the population comparing healthy, frail, and prefrail are given in Table 1 for participants with no ADL difficulty and also those with no ADL dependence. Cross-sectional and longitudinal descriptive statistics for outcome measures for each ADL disability definition and categories by FRAIL scale classifications healthy, pre-frail, and frail are provided in Table 2.

Cross-sectionally Wave 1 among those without ADL disability difficulty or dependence definition at baseline, both being frail and prefrail were associated with more IADL difficulties, lower SPPB scores, lower grip strength, and shorter time for one-leg stand Table 3. Cross-sectional and longitudinal associations for baseline prefrail and frail status with outcome measures among AAH participants.

Notably, both being frail and being prefrail were associated with mortality over the 9 year period Table 3 , with estimated ORs about 4 for frailty and 1. Persons with no ADL difficulty, or no ADL dependence, who were frail or prefrail at baseline Wave 1 were more likely to have deficits in ADLs after 9 years than those who were healthy at baseline.

As can be seen, mortality and SPPB were predicted by resistance and ambulation, while ADL decline was predicted by fatigue, resistance, ambulation, and by illnesses in the dependence-excluded group. IADL difficulties, gait speed, one-leg stand, and grip strength were predicted by resistance in Models 1a and 1b, while only IADL difficulties showed a statistically significant relationship with resistance in Models 2a and 2b.

Similar associations were seen in cross-sectional comparisons Table 4. Individual components associations with cross-sectional outcomes among AAH participants with no ADL disability difficulty or dependence criterion at baseline. Table 6 compares the cytokine receptor, C-reactive protein, adiponectin and leptin levels in healthy, prefrail and frail groups. Table 7 provides the age- and sex-adjusted associations of cytokine receptors, leptin, and adiponectin with frailty and prefrailty at baseline Wave 1.

Most notably, we showed that being frail or prefrail significantly predicts mortality and increased ADL and IADL disability levels over 9 years of follow-up. One strength of this study is that the FRAIL scale was predictive of these changes in outcomes even when persons who had ADL disability difficulty or dependence criterion at baseline were excluded. A useful frailty scale should be able to predict future disability before the person becomes disabled 9.

The two most commonly used frailty scales, viz, the CHS and the Study of Osteoporotic Fractures SOF , require physical examination techniques not commonly performed by practicing physicians 7 , 8. The FRAIL scale is a simple questionnaire that can be rapidly administered by the physician, healthcare professional or even by the patient or a relative. It is also easy to perform by telephone or self-administered questionnaires and can be performed at frequent intervals quite economically, as opposed to the CHS and SOF scales. Another study found that the components of the FRAIL scale predicted both mortality and disability after four to eight years of follow-up in males aged 65 years and older Another frail scale which has been validated is the scale of Rockwood et al This scale depends on the addition of the number of deficits resulting in an accumulated deficit score.

The inclusion of the illness category in the FRAIL scale allows this component to be captured, but not at the expense of the other potentially predictive factors. A simple FRAIL score that can be repeated frequently allows the physician to identify frailty at an early stage. In theory, this should allow early intervention in an attempt to slow the rate of the development of disabilities. There is evidence that exercise therapy aerobic, resistance and balance can slow the progression of the frailty syndrome 4 , In addition, replacement of 25 OH vitamin D and testosterone may reverse some of the sarcopenic features of frailty 5.

There is also evidence that a leucine enriched essential amino acid supplement may improve mobility 5. Testosterone may also decrease frailty 6 , Chronic inflammation has been shown to be associated with frailty In this population, we have previously demonstrated that inflammatory markers are associated with functional limitations and disability Here we extended that finding to show that soluble cytokine receptors as well as CRP are related to frailty. These findings are in concert with the fact that elevated cytokines are associated with poorer physical performance, muscle strength and weight loss 31 — A surprising finding was the failure to find an association of 25 OH vitamin D levels with frailty.

Some studies have previously suggested an association of 25 OH vitamin D with frailty 35 , The very low levels of 25 OH vitamin D in this African American population both healthy and frail may explain the lack of association in this study. A limitation of this study is that there is low power for the longitudinal analyses that involve participants classified as frail on the FRAIL scale due to significant excess mortality for people with frailty and with ADL difficulties. Another limitation is that the AAH cohort includes late middle-aged adults at baseline, so it is expected that the prevalence of frailty among African Americans would be higher in an older cohort.

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Finally, these results in an African American population may not generalize to other populations. We suggest that this questionnaire would be an excellent screening test for clinicians to identify persons at risk of developing disability.

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This would allow the institution of an aggressive management program to prevent disability. In addition, we have confirmed the association between frailty and chronic inflammation. Studies examining the cross-sectional and longitudinal validity of the FRAIL scale in other populations are needed. This research was supported by a grant from the National Institute on Aging to Dr.

The authors declare there are no conflicts with regards to this manuscript. National Center for Biotechnology Information , U. Research has shown that individuals who smoke, persons with depression or long-term medical problems, and those who are underweight are more likely to become frail. Frail older adults are more likely to develop infections because their immune systems do not work as well as in healthy older adults.

Simple infections may cause more harm, even death, for a frail elderly person, than for for an individual of the same age who is healthy. Malnutrition is also common among frail older adults. Loss of muscle mass more than with healthy aging may result from a diet low in protein. Because of inability to plan and prepare their own meals, frail elderly individuals may not consume enough protein and calories to maintain their body weight and health. Get some physical activity into each day, structuring the exercise according to the person's abilities. Walking is useful to improve heart fitness, balance, and muscle mass.

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Exercises using resistance such as weights or bands build muscle and help to reduce joint stiffness and pain. Even small increases in fitness can improve symptoms of frailty. Keeping the mind active is important for older adults. Crossword or number puzzles, reading, playing games, and socializing are all good ways to maintain mental sharpness. Recognize and treat depression, other psychiatric illnesses, and medical problems to prevent progression of frailty.

How to select a frail elderly population? A comparison of three working definitions.

Maintain good nutrition with a balanced diet including enough protein to maintain muscle mass , fruits and vegetables, fiber, and fluids especially in warmer climates. National Institute on Aging http: National Council on Aging http: Many are available in English and Spanish.



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A Patient Page on fitness for older adults was published in the July 12, , issue; and one on psychiatric illness in older adults was published in the June 7, , issue. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients.

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