Operationalization of a frailty index among older adults in the InCHIANTI study: predictive ability for all-cause and cardiovascular disease mortality

Aging Clin Exp Res. 2020 Jun;32(6):1025-1034. doi: 10.1007/s40520-020-01478-3. Epub 2020 Jan 31.


Background: The frailty index (FI) is a sensitive instrument to measure the degree of frailty in older adults, and is increasingly used in cohort studies on aging.

Aims: To operationalize an FI among older adults in the "Invecchiare in Chianti" (InCHIANTI) study, and to validate its predictive capacity for mortality.

Methods: Longitudinal data were used from 1129 InCHIANTI participants aged ≥ 65 years. A 42-item FI was operationalized following a standard procedure using baseline data (1998/2000). Associations of the FI with 3- and 6-year all-cause and cardiovascular disease (CVD) mortality were studied using Cox regression. Predictive accuracy was estimated by the area under the ROC curve (AUC), for a continuous FI score and for different cut-points.

Results: The median FI was 0.13 (IQR 0.08-0.21). Scores were higher in women, and at advanced age. The FI was associated with 3- and 6-year all-cause and CVD mortality (HR range per 0.01 FI increase = 1.03-1.07, all p < 0.001). The continuous FI score predicted the mortality outcomes with moderate-to-good accuracy (AUC range 0.72-0.83). When applying FI cut-offs between 0.15 and 0.35, the accuracy of this FI for predicting mortality was moderate (AUC range 0.61-0.76). Overall, the predictive accuracy of the FI was higher in women than in men.

Conclusions: The FI operationalized in the InCHIANTI study is a good instrument to grade the risk of all-cause mortality and CVD mortality. More measurement properties, such as the responsiveness of this FI when used as outcome measure, should be investigated in future research.

Keywords: Deficit accumulation; Frail elderly; Frailty index; Geriatrics; Risk prediction.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / mortality*
  • Cohort Studies
  • Female
  • Frail Elderly
  • Frailty
  • Geriatric Assessment
  • Humans
  • Longitudinal Studies
  • Male
  • Outcome Assessment, Health Care
  • Risk Factors