Assessing Frailty in Older Adults: Strategies and Tools for Effective Policy and Research
DOI:
https://doi.org/10.71014/sieds.v78i3.398Keywords:
Public health, Frailty Indicator, Measumerement, adverse outcomesAbstract
The progressive ageing of the population, not accompanied by a corresponding increase in healthy life expectancy, brings to the forefront the study of the health of older adults from a holistic perspective. The concept of frailty aligns with this perspective, as it considers a broader condition of vulnerability involving mainly older individuals, which is much more difficult to define and measure. This article aims to provide an overview of the concept of frailty, the various definitional approaches, and, consequently, the measurement methods, while also focussing on the relationship between frailty and the two main concepts that define health: multimorbidity and disability. Following a brief overview of the types of data and their role in the study of frailty, the article concludes with an analytical approach for defining a measure of frailty.
References
AARTS S, PATEL KV, GARCIA ME, VAN DEN AKKER M, VERHEY FR, METSEMAKERS JF, VAN BOXTEL MP, GUDNASON V, JONSDOTTIR MK, SIGGEIRSDOTTIR K, JONSSON PV, HARRIS TB, LAUNER LJ. 2015. Co-presence of multimorbidity and disability with frailty: An examination of heterogeneity in the frail older population, J Frailty Aging, Vol. 4, pp. 131-8. DOI: https://doi.org/10.14283/jfa.2015.45
ABIZANDA P., ROMERO L., SÁNCHEZ-JURADO P.M., MARTÍNEZ-REIG M., ALFONSO-SILGUERO S.A., RODRÍGUEZ-MAÑAS L. 2014. Age, frailty, disability, institutionalization, multimorbidity or comorbidity. Which are the main targets in older adults?, J Nutr Health Aging, Vol. 18, pp. 622-7. DOI: https://doi.org/10.1007/s12603-014-0033-3
BANDEEN-ROCHE K., XUE Q.-L., FERRUCCI L., WALSTON J., GURALNIK J.M., CHAVES P., ZEGER S.L., FRIED L.P. 2006. Phenotype of frailty: characterization in the women’s health and aging studies, J. Gerontol. A. Biol. Sci. Med. Sci., Vol. 61, pp. 262-266. DOI: https://doi.org/10.1093/gerona/61.3.262
BENNETT S., SONG X., MITNITSKI A., ROCKWOOD K. 2013. A limit to frailty in very old, community-dwelling people: a secondary analysis of the Chinese longitudinal health and longevity study Age Ageing, Vol. 42, pp. 372-377. DOI: https://doi.org/10.1093/ageing/afs180
BLODGETT J., THEOU O., KIRKLAND S., ANDREOU P., ROCKWOOD, K. 2015. The association between sedentary behaviour, moderate-vigorous physical activity and frailty in NHANES cohorts, Maturitas, Vol. 80, pp. 187-191. DOI: https://doi.org/10.1016/j.maturitas.2014.11.010
BOECKXSTAENS P, VAES B, LEGRAND D, DALLEUR O, DE SUTTER A, DEGRYSE JM. 2015. The relationship of multimorbidity with disability and frailty in the oldest patients: A cross-sectional analysis of three measures of multimorbidity in the BELFRAIL cohort, Eur J Gen Pract., Vol. 21, pp. 39-44. DOI: https://doi.org/10.3109/13814788.2014.914167
BÖRSCH-SUPAN A., BRANDT M., HUNKLER C., KNEIP T., KORBMACHER J., MALTER F., SCHAAN B., STUCK S., ZUBER S. 2013. Data Resource Profile: The Survey of Health, Ageing and Retirement in Europe (SHARE), International Journal of Epidemiology, Vol. 42, pp.992-1001. DOI: https://doi.org/10.1093/ije/dyt088
BROCCO R. 2020. Approfondimenti metodologici sulla costruzione di un indicatore composito di fragilità degli anziani. Applicazione e validazione nell’Azienda ULSS 6 Euganea. Università degli studi di Padova: Tesi di Laurea Magistrale. (In Italian).
BROCKLEHURST J.C. 1985. The geriatric service and the day hospital. In: BROCKLEHURST J.C., (ed.) Textbook of Geriatric Medicine and Gerontology, 3rd edn., Churchill, London, England, pp. 982–995.
CAMPISI J. 2013. Aging, Cellular Senescence, and Cancer, Annu. Rev. Physiol., Vol. 75, pp. 685-705. DOI: https://doi.org/10.1146/annurev-physiol-030212-183653
CANOVA C., DI DOMENICANTONIO R., CAPPAI G. DANIELI S. SIMONATO L. (Eds.). 2019. Exploiting Healthcare Administrative Databases for case-identification algorithms: a systematic review of the Italian experiences. Epidemiologia & Prevenzione, Vol. 4, Supplemento 2. Milano: Inferenze.
CESARI M., MARZETTI E., THIEM U., PÉREZ-ZEPEDA M.U., ABELLAN VAN KAN G., LANDI F., PETROVIC M., CHERUBINI A., BERNABEI R. 2016. The geriatric management of frailty as paradigm of “The end of the disease era”, Eur. J. Intern. Med., Vol. 31, pp. 11-14. DOI: https://doi.org/10.1016/j.ejim.2016.03.005
CHANG S.-F., LIN H.-C., CHENG C.-L. 2018. The Relationship of Frailty and Hospitalization Among Older People: Evidence from a Meta-Analysis, J. Nurs. Scholarsh., Vol. 50, pp. 383-391. DOI: https://doi.org/10.1111/jnu.12397
CHARLSON ME, POMPEI P, ALES KL, MACKENZIE CR. 1987. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation, J Chronic Dis, Vol. 40, pp. 373-383. DOI: https://doi.org/10.1016/0021-9681(87)90171-8
CLEGG A., YOUNG J., ILIFFE S., RIKKERT M.O., ROCKWOOD K. 2013. Frailty in elderly people, Lancet Lond. Engl., Vol. 381, pp. 752–762.
CLEGG A., YOUNG J., ILIFFE S., RIKKERT M.O., ROCKWOOD K. 2013. Frailty in elderly people, Lancet Lond. Engl., Vol. 381, pp. 752-762. DOI: https://doi.org/10.1016/S0140-6736(12)62167-9
DE LUCA V, FEMMINELLA GD, LEONARDINI L, PATUMI L, PALUMMERI E, ROBA I, ARONNI W, TOCCOLI S, SFORZIN S, DENISI F, BASSO AM, RUATTA M, OBBIA P, RIZZO A, BORGIOLI M, ECCHER C, FARINA R, CONFORTI D, MERCURIO L, SALVATORE E, GENTILE M, BOCCHINO M, SANDUZZI ZAMPARELLI A, VICECONTE G, GENTILE I, RUOSI C, FERRARA N, FABBROCINI G, COLAO A, TRIASSI M, IACCARINO G, LIOTTA G, ILLARIO M. 2023. Digital health service for identification of frailty risk factors in community-dwelling older adults: The SUNFRAIL+ Study Protocol, Int J Environ Res Public Health. Vol. 20:3861. DOI: https://doi.org/10.3390/ijerph20053861
ESPINOZA SE, QUIBEN M, HAZUDA HP. 2018. Distinguishing Comorbidity, Disability, and Frailty, Curr Geriatr Rep., Vol. 7, pp. 201-209. DOI: https://doi.org/10.1007/s13670-018-0254-0
FRIED L.P., TANGEN C.M., WALSTON J., NEWMAN A.B., HIRSCH C., GOTTDIENER J., SEEMAN T., TRACY R., KOP W.J., BURKE G., MCBURNIE M.A., Cardiovascular Health Study Collaborative Research Group. 2001. Frailty in older adults: evidence for a phenotype, J. Gerontol. A. Biol. Sci. Med. Sci., Vol. 56, pp. M146-156. DOI: https://doi.org/10.1093/gerona/56.3.M146
FRIED LP, FERRUCCI L, DARER J, WILLIAMSON JD, ANDERSON G. 2004. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care, J Gerontol A Biol Sci Med Sci., Vol. 59, pp. 255-63. DOI: https://doi.org/10.1093/gerona/59.3.M255
FRIES J.F., 1980. Aging, natural death, and the compression of morbidity, N. Engl. J. Med., Vol. 303, pp. 130–135. DOI: https://doi.org/10.1056/NEJM198007173030304
GALLUZZO L, SILANO M. 2023. Analisi epidemiologica della fragilità nella coorte di anziani ILSA (Italian Longitudinal Study on Aging): frequenza, caratteristiche e progressione nel tempo, Bollettino epidemiologico nazionale, 2023, Vol. 4, pp. 20-28. (in Italian)
GARMANY A., YAMADA S., TERZIC A. 2021. Longevity leap: mind the healthspan gap, NPJ Regen. Med., Vol. 6, p. 57. DOI: https://doi.org/10.1038/s41536-021-00169-5
GIRAUDO M.T., MORI F., GNAVI R., RICCERI F. 2023. Malattie croniche e multimorbidità in Piemonte (2017-2019). Epidemiologia e Prevenzione, quaderni E&P. Milano: Inferenze.
GOBBENS R.J.J., LUIJKX K.G., WIJNEN-SPONSELEE M.T., SCHOLS J.M.G.A. 2010. In search of an integral conceptual definition of frailty: opinions of experts, J. Am. Med. Dir. Assoc., Vol. 11, pp. 338-343. DOI: https://doi.org/10.1016/j.jamda.2009.09.015
HUDON C, FORTIN M, VANASSE A. 2005. Cumulative Illness Rating Scale was a reliable and valid index in a family practice context. J Clin Epidemiol., Vol. 58, pp. 603–608. DOI: https://doi.org/10.1016/j.jclinepi.2004.10.017
IRTI C. 2022. Personal Data, Non-personal Data, Anonymised Data, Pseudonymised Data, De-identified Data. In: Senigaglia R., Irti C., Bernes A. (Eds.), Privacy and Data Protection in Software Services. Singapore: Springer Nature, pp. 49-57. DOI: https://doi.org/10.1007/978-981-16-3049-1_5
JONE, D., SONG X., MITNITSKI A., ROCKWOOD K. 2005. Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians, Aging Clin. Exp. Res., Vol. 17, pp. 465-471. DOI: https://doi.org/10.1007/BF03327413
KATZ S, FORD AB, MOSKOWITZ RW, JACKSON BA, JAFFE MW. 1963. Studies of illness in the aged. The index of Adl: A standardized measure of biological and psychosocial function, JAMA, Vol.185, pp. 914-919. DOI: https://doi.org/10.1001/jama.1963.03060120024016
KENNEDY B.K., BERGER S.L., BRUNET A., CAMPISI J., CUERVO A.M., EPEL E.S., FRANCESCHI C., LITHGOW G.J., MORIMOTO R.I., PESSIN J.E., RANDO T.A., RICHARDSON A., SCHADT E.E., WYSS-CORAY T., SIERRA F. 2014. Geroscience: linking aging to chronic disease, Cell, Vol. 159, pp. 709–713. DOI: https://doi.org/10.1016/j.cell.2014.10.039
KHANNA AK, MOTAMEDI V, BOULDIN B, HARWOOD T., PAJEWSKI N.M., SAHA A.K., SEGAL S. 2023. Automated electronic frailty index–identified frailty status and associated postsurgical adverse events. JAMA Netw Open., Vol. 6: e2341915. DOI: https://doi.org/10.1001/jamanetworkopen.2023.41915
KIRKWOOD T.B.L. 2005. Understanding the odd science of aging, Cell, Vol. 120, pp. 437-447. DOI: https://doi.org/10.1016/j.cell.2005.01.027
KOJIMA G., ILIFFE S., JIVRAJ S., WALTERS K. 2016. Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis, J. Epidemiol. Community Health, Vol. 70, pp. 716-721. DOI: https://doi.org/10.1136/jech-2015-206717
KYU H.H. et al., 2018. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet 392, 1859–1922. https://doi.org/10.1016/S0140-6736(18)32335-3 DOI: https://doi.org/10.1016/S0140-6736(18)32335-3
LAWTON MP, BRODY EM. 1969. Assessment of older people: self-maintaining and instrumental activities of daily living, Gerontologist, Vol. 9, pp. 179-86. DOI: https://doi.org/10.1093/geront/9.3_Part_1.179
LEME D.E.D.C., THOMAZ R.P., BORIM F.S.A., BRENELLI S.L., OLIVEIRA D.V., FATTORI A. 2019. Survival of elderly outpatients: effects of frailty, multimorbidity and disability, Cien Saude Colet., Vol. 24, pp. 137-146. DOI: https://doi.org/10.1590/1413-81232018241.04952017
LÓPEZ-OTÍN C., BLASCO M.A., PARTRIDGE L., SERRANO M., KROEMER G. 2013. The Hallmarks of Aging, Cell, Vol. 153, pp. 1194–1217. DOI: https://doi.org/10.1016/j.cell.2013.05.039
LUO J, LIAO X, ZOU C, ZHAO Q, YAO Y, FANG X, SPICER J. 2022. Identifying frail patients by using Electronic Health Records in primary care: Current status and future directions, Front Public Health, Vol. 22: 901068 DOI: https://doi.org/10.3389/fpubh.2022.901068
MINISTERO DELLA SALUTE – DIREZIONE GENERALE DELLA PROGRAMMAZIONE SANITARIA. 2016. Piano Nazionale della Cronicità. www.salute.gov.it/imgs/C_17_pubblicazioni_2584_allegato.pdf
MINISTERO DELLA SALUTE. 2022. DECRETO 23 maggio 2022, n. 77 , Regolamento recante la definizione di modelli e standard per lo sviluppo dell'assistenza territoriale nel Servizio sanitario nazionale. (GU Serie Generale n.144 del 22-06-2022)
MITNITSKI A.B., MOGILNER A.J., ROCKWOOD K. 2001. Accumulation of deficits as a proxy measure of aging, Scientific World Journal, Vol. 1, pp. 323-336. DOI: https://doi.org/10.1100/tsw.2001.58
MOGUILNER S., KNIGHT S.P., DAVIS J.R.C., O’HALLORAN A.M., KENNY R.A., ROMERO-ORTUNO R. 2021. The Importance of Age in the Prediction of Mortality by a Frailty Index: A Machine Learning Approach in the Irish Longitudinal Study on Ageing, Geriatrics, Vol. 6, 84. DOI: https://doi.org/10.3390/geriatrics6030084
MORLEY J.E., VELLAS B., VAN KAN G.A., ANKER S.D., BAUER J.M., BERNABEI R., CESARI M., CHUMLEA W.C., DOEHNER W., EVANS J., FRIED L.P., GURALNIK J.M., KATZ P.R., MALMSTROM T.K., MCCARTER R.J., GUTIERREZ ROBLEDO L.M., ROCKWOOD K., VON HAEHLING S., VANDEWOUDE M.F., WALSTON J. 2013. Frailty consensus: a call to action. J Am Med Dir Assoc., Vol. 14(6), pp. 392-7. DOI: https://doi.org/10.1016/j.jamda.2013.03.022
PIVETTA N.R.S., MARINCOLO J.C.S., NERI A.L., APRAHAMIAN I., YASSUDA M.S., BORIM F.S.A. 2020. Multimorbidity, frailty and functional disability in octogenarians: A structural equation analysis of relationship, Arch. Gerontol. Geriatr., Vol. 86:103931. DOI: https://doi.org/10.1016/j.archger.2019.103931
REBORA P, SCIRÈ CA, OCCHINO G, BORTOLAN F, LEONI O, CIDENI F, ZUCCHELLI A, FOCÀ E, MARENGONI A, BELLELLI G AND VALSECCHI MG. 2023. Development and validation of an electronic database-based frailty index to predict mortality and hospitalization in a population-based study of adults with SARS-CoV-2, Front. Med., Vol. 10:1134377. DOI: https://doi.org/10.3389/fmed.2023.1134377
RITT M, JÄGER J, RITT JI, SIEBER CC, GAßMANN KG. 2017. Operationalizing a frailty index using routine blood and urine tests, Clin Interv Aging., Vol. 28, pp. 1029-1040. DOI: https://doi.org/10.2147/CIA.S131987
ROCKWOOD K., MITNITSKI A. 2007. Frailty in relation to the accumulation of deficits, J. Gerontol. A. Biol. Sci. Med. Sci., Vol. 62, pp. 722–727. DOI: https://doi.org/10.1093/gerona/62.7.722
ROCKWOOD K., SONG X., MACKNIGHT C., BERGMAN H., HOGAN D.B., MCDOWELL I., MITNITSKI A. 2005. A global clinical measure of fitness and frailty in elderly people, CMAJ Can. Med. Assoc. J., Vol. 173, pp. 489-495. DOI: https://doi.org/10.1037/t19726-000
ROCKWOOD, K., FOX R.A., STOLEE P., ROBERTSON D., BEATTIE B.L., 1994, Frailty in elderly people: an evolving concept. CMAJ Can. Med. Assoc. J., Vol. 150, pp. 489-495.
RODRÍGUEZ-MAÑAS L., FÉART C., MANN G., VIÑA J., CHATTERJI S., CHODZKO-ZAJKO W., GONZALEZ-COLAÇO HARMAND M., BERGMAN H., CARCAILLON L., NICHOLSON C., SCUTERI A., SINCLAIR A., PELAEZ M., VAN DER CAMMEN T., BELAND F., BICKENBACH J., DELAMARCHE P., FERRUCCI L., FRIED L.P., GUTIÉRREZ-ROBLEDO L.M., ROCKWOOD K., RODRÍGUEZ ARTALEJO F., SERVIDDIO G., VEGA E., FOD-CC group. 2013. Searching for an operational definition of frailty: A Delphi method based consensus statement: the frailty operative definition-consensus conference project, J. Gerontol. A. Biol. Sci. Med. Sci., Vol. 68, pp. 62-67. DOI: https://doi.org/10.1093/gerona/gls119
ROLFSON D.B., MAJUMDAR S.R., TSUYUKI R.T., TAHIR A., ROCKWOOD K. 2006. Validity and reliability of the Edmonton Frail Scale, Age Ageing, Vol. 35, pp. 526-529. DOI: https://doi.org/10.1093/ageing/afl041
ROMERO-ORTUNO R. 2013. An alternative method for Frailty Index cut-off points to define frailty categories, Eur. Geriatr. Med., Vol. 4, 10.1016/j.eurger.2013.06.005. DOI: https://doi.org/10.1016/j.eurger.2013.06.005
SANTONI G., ANGLEMAN S., WELMER A.-K., MANGIALASCHE F., MARENGONI A., FRATIGLIONI L. 2015. Age-Related Variation in Health Status after Age 60, PLOS ONE, Vol. 10, e0120077. DOI: https://doi.org/10.1371/journal.pone.0120077
SEARLE S.D., MITNITSKI A., GAHBAUER E.A., GILL T.M., ROCKWOOD K.. 2008. A standard procedure for creating a frailty index, BMC Geriatr., Vol.8, 24. DOI: https://doi.org/10.1186/1471-2318-8-24
SEBASTIANI G., DI FILIPPO P., DEMARIA M., CARANCI N., DI MINCO L., TAMBURINI C., D’ERRICO A., GRIPPO F., COSTA G. 2019. Lo studio longitudinale italiano: integrazione delle indagini sulla salute con dati di mortalità e ospedalizzazione. Metodologia e potenzialità di utilizzo. Istat Working Papers N. 14/2019. Roma: Istituto nazionale di statistica.
SHOCK N.W., OTHERS A. 1984. Normal Human Aging: The Baltimore Longitudinal Study of Aging. Superintendent of Documents, U.S. Government Printing Office, Washington, DC.
SILAN M., CAPERNA G., BOCCUZZO, G. 2019. Quantifying frailty in older people at an Italian local health unit: A proposal based on Partially Ordered Sets, Soc Indic Res, Vol. 146, pp. 757–782. DOI: https://doi.org/10.1007/s11205-019-02142-8
SILAN M., SIGNORIN G., FERRACIN E., LISTORTI E., SPADEA T., COSTA G., BOCCUZZO G. 2022. Construction of a Frailty Indicator with Partially Ordered Sets: A multiple-outcome proposal based on administrative healthcare data, Soc Indic Res, Vol. 160, pp. 989–1017. DOI: https://doi.org/10.1007/s11205-020-02512-7
STERNBERG S., SCHWARTZ A.W., KARUNANANTHAN S., BERGMAN H. 2011. The identification of Frailty: A systematic literature review, Journal of The American Geriatrics Society, Vol. 59, pp. 2129-38. DOI: https://doi.org/10.1111/j.1532-5415.2011.03597.x
TENCHOV R., SASSO J.M., WANG X., ZHOU Q.A. 2023. Aging Hallmarks and Progression and Age-Related Diseases: A Landscape View of Research Advancement, ACS Chem. Neurosci., Vol. 15, pp. 1-30. DOI: https://doi.org/10.1021/acschemneuro.3c00531
THANDI M., WONG S.T., PRICE M., BAUMBUSCH J., 2024. Perspectives on the representation of frailty in the electronic frailty index, BMC Prim. Care, Vol. 25, 4. DOI: https://doi.org/10.1186/s12875-023-02225-z
UNITED NATIONS DEPARTMENT OF ECONOMIC AND SOCIAL AFFAIRS, POPULATION DIVISION. 2020. World Population Ageing 2020 Highlights: Living arrangements of older persons (ST/ESA/SER.A/451).
VAUPEL J.W., MANTON K.G., STALLARD E. 1979. The impact of heterogeneity in individual frailty on the dynamics of mortality, Demography, Vol. 16, pp. 439-454. DOI: https://doi.org/10.2307/2061224
VERMEIREN S., VELLA-AZZOPARDI R., BECKWÉE D., HABBIG A.-K., SCAFOGLIERI A., JANSEN B., BAUTMANS I., GERONTOPOLE BRUSSELS STUDY GROUP. 2016. Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis, J. Am. Med. Dir. Assoc., Vol. 17, pp. 1163.e1-1163.e17. DOI: https://doi.org/10.1016/j.jamda.2016.09.010
VILLACAMPA-FERNÁNDEZ P, NAVARRO-PARDO E, TARÍN JJ, CANO A. 2016. Frailty and multimorbidity: Two related yet different concepts, Maturitas. Vol. 95, pp. 31-35. DOI: https://doi.org/10.1016/j.maturitas.2016.10.008
VOLLSET S.E., et al. 2024. Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021, The Lancet, No. 403, pp. 2204–2256. DOI: https://doi.org/10.1016/S0140-6736(24)00685-8
VOS T., et al. 2016. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016, The Lancet, Vol. 390, pp. 1211–1259.
WALLACE E., STUART E., VAUGHAN N., BENNETT K., FAHEY T., SMITH S.M. 2014. Risk prediction models to predict emergency hospital admission in community-dwelling adults: A systematic review, Medical care, Vol. 52, pp. 751–765. DOI: https://doi.org/10.1097/MLR.0000000000000171
WARD Z.J., GOLDIE S.J. 2024. Global Burden of Disease Study 2021 estimates: implications for health policy and research, The Lancet, Vol. 403, pp. 1958–1959. DOI: https://doi.org/10.1016/S0140-6736(24)00812-2
WORLD HEALTH ORGANIZATION. 2001. International classification of functioning, disability and health: ICF. World Health Organization. https://iris.who.int/handle/10665/42407
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