Frailty Index Predicts All-Cause Mortality for Middle-Aged and Older Taiwanese: Implications for Active-Aging Programs

PLoS One. 2016 Aug 18;11(8):e0161456. doi: 10.1371/journal.pone.0161456. eCollection 2016.


Background: Frailty Index, defined as an individual's accumulated proportion of listed health-related deficits, is a well-established metric used to assess the health status of old adults; however, it has not yet been developed in Taiwan, and its local related structure factors remain unclear. The objectives were to construct a Taiwan Frailty Index to predict mortality risk, and to explore the structure of its factors.

Methods: Analytic data on 1,284 participants aged 53 and older were excerpted from the Social Environment and Biomarkers of Aging Study (2006), in Taiwan. A consensus workgroup of geriatricians selected 159 items according to the standard procedure for creating a Frailty Index. Cox proportional hazard modeling was used to explore the association between the Taiwan Frailty Index and mortality. Exploratory factor analysis was used to identify structure factors and produce a shorter version-the Taiwan Frailty Index Short-Form.

Results: During an average follow-up of 4.3 ± 0.8 years, 140 (11%) subjects died. Compared to those in the lowest Taiwan Frailty Index tertile (< 0.18), those in the uppermost tertile (> 0.23) had significantly higher risk of death (Hazard ratio: 3.2; 95% CI 1.9-5.4). Thirty-five items of five structure factors identified by exploratory factor analysis, included: physical activities, life satisfaction and financial status, health status, cognitive function, and stresses. Area under the receiver operating characteristic curves (C-statistics) of the Taiwan Frailty Index and its Short-Form were 0.80 and 0.78, respectively, with no statistically significant difference between them.

Conclusion: Although both the Taiwan Frailty Index and Short-Form were associated with mortality, the Short-Form, which had similar accuracy in predicting mortality as the full Taiwan Frailty Index, would be more expedient in clinical practice and community settings to target frailty screening and intervention.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging / psychology
  • Exercise
  • Factor Analysis, Statistical
  • Female
  • Frail Elderly / statistics & numerical data*
  • Geriatric Assessment / methods*
  • Geriatric Assessment / statistics & numerical data
  • Health Promotion
  • Health Status
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Mortality*
  • Personal Satisfaction
  • Proportional Hazards Models
  • Risk Factors
  • Socioeconomic Factors
  • Taiwan / epidemiology

Grant support

This study was supported by the Aging and Health Research Center, National Yang Ming University; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, as well as the Ministry of Science and Technology of Taiwan (MOST 104-2633-B-400-001 and MOST 105-3011-B-010-001). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.