Frailty and health status of older individuals in three European countries: The COURAGE cross-sectional study

Exp Gerontol. 2018 Jun;106:137-144. doi: 10.1016/j.exger.2018.02.028. Epub 2018 Feb 27.


Background and aim: Frailty is characterized by several deficits in multiple health related domains. Although cognition is among the important components of frailty, there is lack of evidence on the role of specific neuro-cognitive dimensions. The primary aim of the present work was to evaluate the multidimensional definition of frailty, and to assess whether neuro-cognitive function is a constituent of the frailty syndrome among adults aged ≥50 years living in three European countries. As a secondary aim, the construct validity of the created frailty index was tested (with inpatient and outpatient hospitalization), as well as its determinants.

Methods: Data were obtained from a cross-sectional, community-based, nationally-representative survey conducted in Finland, Poland and Spain (n = 7987 individuals aged ≥50 years). Socio-demographic, clinical, lifestyle and social factors were assessed using validated procedures. Cognitive function was assessed with the following tests: learning and short-term memory, working memory and verbal fluency. A frailty index was constructed based on 31 frailty attributes. Principal component analysis was used to identify the components of the frailty index. Logistic and Poisson regression analysis was also conducted.

Results: The factor analysis on the components of the index extracted three main dimensions for frailty (disability and daily functioning, cognitive function, chronic health conditions), confirming the multiple dimensions of frailty. Various socio-demographic (e.g., financial status, education level) and lifestyle habits (alcohol consumption) were related with frailty. The presence of frailty was associated with 3.1 times higher odds for inpatient hospitalization (95%CI 2.75 to 3.51). Frailty was also related with higher frequency of outpatient visits.

Conclusions: These findings suggest that frailty is a multidimensional concept with three major dimensions. Neuro-congitive function seems to be a separate dimension of the frailty syndrome. Smoking habits and alcohol intake were positively related with frailty while inpatient and outpatient hospitalization were found to be associated to the level of frailty.

Keywords: Cognition; Europe; Frailty; Health; Older adults.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Alcohol Drinking
  • Cognition
  • Cross-Sectional Studies
  • Europe / epidemiology
  • Female
  • Frail Elderly / psychology*
  • Frailty / epidemiology*
  • Geriatric Assessment
  • Health Status*
  • Hospitalization
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Risk Factors
  • Severity of Illness Index
  • Smoking