Comparison of Frailty Phenotypes for Prediction of Mortality, Incident Falls, and Hip Fracture in Older Women

Oleg Zaslavsky; Shira Zelber-Sagi; Shelly L Gray; Andrea Z LaCroix; Robert L Brunner; Robert B Wallace; Mary J O'Sullivan; Barbara Cochrane; Nancy F Woods

doi:10.1111/jgs.14233

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Comparison of Frailty Phenotypes for Prediction of Mortality, Incident Falls, and Hip Fracture in Older Women

Journal article

Peer reviewed

Comparison of Frailty Phenotypes for Prediction of Mortality, Incident Falls, and Hip Fracture in Older Women

Oleg Zaslavsky, Shira Zelber-Sagi, Shelly L Gray, Andrea Z LaCroix, Robert L Brunner, Robert B Wallace, Mary J O'Sullivan, Barbara Cochrane and Nancy F Woods

Journal of the American Geriatrics Society (JAGS), Vol.64(9), pp.1858-1862

09/2016

DOI: 10.1111/jgs.14233

PMCID: PMC5026871

PMID: 27310179

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Abstract

To compare the ability of the commonly used Women's Health Initiative (WHI) and Cardiovascular Health Study (CHS) frailty phenotypes to predict falls, hip fracture, and death in WHI Clinical Trial participants aged 65 and older. Longitudinal cohort study. WHI Clinical Trial. Participants with data for WHI and CHS frailty phenotypes (N = 3,558). Frailty was operationally defined in the CHS as the presence of three or more of weight loss, poor energy, weakness, slowness, and low physical activity. WHI operationalized frailty similarly but with the RAND-36 physical function scale substituted for slowness and weakness (RAND-36 physical function scale score <13 = 2 points, 13-78 = 1 point, >78 = 0 points). Frailty was defined as a summary score of 3 or greater, prefrailty as a score of 2 or 1, and nonfrailty as a score of 0. Outcomes were modeled using Cox regression. Harrell C-statistics were compared for models containing alternative instruments. Approximately 5% of participants were frail based on the CHS or WHI phenotype. The WHI frailty phenotype was associated with higher rates of falls (hazard ratio (HR) = 1.48, P = .003), hip fracture (HR = 1.87, P = .04), and death (HR = 2.32, P < .001). Comparable HRs in CHS-phenotype frail women were 1.32 (P = .04), 1.08 (P = .83), and 1.91 (P < .001), respectively. Harrell C-statistics revealed marked but insignificant differences in predicting abilities between CHS and WHI phenotype models (P > .50 for all). The WHI phenotype, which does not require direct measurements of physical performance, might offer a practical advantage for epidemiological and clinical needs.

Accidental Falls - mortality

Activities of Daily Living - classification

Aged

Aged, 80 and over

Cause of Death

Cohort Studies

Disability Evaluation

Fatigue - mortality

Female

Frail Elderly - statistics & numerical data

Gait

Hip Fractures - mortality

Humans

Longitudinal Studies

Middle Aged

Phenotype

Risk Assessment - statistics & numerical data

Sedentary Lifestyle

Weight Loss

Details

Title: Subtitle: Comparison of Frailty Phenotypes for Prediction of Mortality, Incident Falls, and Hip Fracture in Older Women
Creators: Oleg Zaslavsky - University of Washington
Shira Zelber-Sagi - University of Haifa
Shelly L Gray - University of Washington
Andrea Z LaCroix - University of California San Diego
Robert L Brunner - University of Nevada, Reno
Robert B Wallace - University of Iowa
Mary J O'Sullivan - University of Miami
Barbara Cochrane - University of Washington
Nancy F Woods - University of Washington
Resource Type: Journal article
Publication Details: Journal of the American Geriatrics Society (JAGS), Vol.64(9), pp.1858-1862
DOI: 10.1111/jgs.14233
PMID: 27310179
PMCID: PMC5026871
NLM abbreviation: J Am Geriatr Soc
ISSN: 0002-8614
eISSN: 1532-5415
Grant note: N01WH22110 / WHI NIH HHS
Language: English
Date published: 09/2016
Academic Unit: Epidemiology; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9984364411702771

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