A frailty index based on laboratory deficits in community-dwelling men predicted their risk of adverse health outcomes

Age Ageing. 2016 Jul;45(4):463-8. doi: 10.1093/ageing/afw054. Epub 2016 Apr 13.


Background: abnormal laboratory test results accumulate with age and can be common in people with few clinically detectable health deficits. A frailty index (FI) based entirely on common physiological and laboratory tests (FI-Lab) might offer pragmatic and scientific advantages compared with a clinical FI (FI-Clin).

Objectives: to compare the FI-Lab with the FI-Clin and to assess their individual and combined relationships with mortality and other adverse health outcomes.

Design and subjects: secondary analysis of the eight-centre, longitudinal European Male Ageing Study (EMAS) of community-dwelling men aged 40-79 at baseline. Follow-up assessment occurred 4.4 ± 0.3 (mean ± SD) years later.

Methods: we constructed a 23-item FI using common laboratory tests, blood pressure and pulse (FI-Lab), compared it with a previously validated 39-item FI using self-report and performance-based measures (FI-Clin) and finally combined both FIs to create a 62-item FI-Combined. Outcomes were all-cause mortality, institutionalisation, doctor visits, medication use, self-reported health, falls and fractures.

Results: the mean FI-Lab score was 0.28 ± 0.11, the FI-Clin was 0.13 ± 0.11 and FI-Combined was 0.19 ± 0.09. Age-adjusted models demonstrated that each FI was associated with mortality [HR (CI) FI-Lab: 1.04 (1.03-1.06); FI-Clin: 1.05 (1.04-1.06); FI-Combined: 1.07 (1.06-1.09)], institutionalisation, doctor visits, medication use, self-reported health and falls. Combined in a model with FI-Clin, the FI-Lab remained independently associated with mortality, institutionalisation, doctor visits, medication use and self-reported health.

Conclusions: the FI-Lab detected an increased risk of adverse health outcomes alone and in combination with a clinical FI; further evaluation of the feasibility of the FI-Lab as a frailty screening tool within hospital care settings is needed.

Keywords: ageing; frail older people; frailty; mortality; pre-clinical frailty.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Accidental Falls
  • Adult
  • Age Factors
  • Aged
  • Aging*
  • Blood Pressure Determination
  • Cause of Death
  • Europe / epidemiology
  • Fractures, Bone / diagnosis
  • Fractures, Bone / epidemiology
  • Frail Elderly*
  • Frailty / diagnosis*
  • Frailty / epidemiology
  • Frailty / physiopathology
  • Frailty / therapy
  • Geriatric Assessment / methods*
  • Health Resources / statistics & numerical data
  • Humans
  • Independent Living*
  • Institutionalization
  • Male
  • Middle Aged
  • Office Visits
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Reproducibility of Results
  • Risk Factors
  • Self Report
  • Sex Factors
  • Time Factors