Objectives: To determine the independent prognostic effect of seven potential frailty criteria, including five from the Fried phenotype, on several adverse outcomes.
Design: Prospective cohort study.
Setting: Greater New Haven, Connecticut.
Participants: Seven hundred fifty-four initially nondisabled, community-living persons aged 70 and older.
Measurements: An assessment of seven potential frailty criteria (slow gait speed, low physical activity, weight loss, exhaustion, weakness, cognitive impairment, and depressive symptoms) was completed at baseline and every 18 months for 72 months. Participants were followed with monthly telephone interviews for up to 96 months to determine the occurrence of chronic disability, long-term nursing home (NH) stays, injurious falls, and death.
Results: In analyses adjusted for age, sex, race, education, number of chronic conditions, and the presence of the other potential frailty criteria, three of the five Fried criteria (slow gait speed, low physical activity, and weight loss) were independently associated with chronic disability, long-term NH stays, and death. Slow gait speed was the strongest predictor of chronic disability (hazard ratio (HR)=2.97, 95% confidence interval (CI)=2.32-3.80) and long-term NH stay (HR=3.86, 95% CI=2.23-6.67) and was the only significant predictor of injurious falls (HR=2.19, 95% CI=1.33-3.60). Cognitive impairment was also associated with chronic disability (HR=1.82, 95% CI=1.40-2.38), long-term NH stay (HR=2.64, 95% CI=1.75-3.99), and death (HR=1.54, 95% CI=1.13-2.10), and the magnitude of these associations was comparable with that of weight loss.
Conclusion: The results of this study provide strong evidence to support the use of slow gait speed, low physical activity, weight loss, and cognitive impairment as key indicators of frailty while raising concerns about the value of self-reported exhaustion and muscle weakness.