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Evid Based Nurs 9:57 doi:10.1136/ebn.9.2.57
  • Causation

An operational definition of frailty predicted death and other adverse outcomes in older women


 
 Q Does frailty, defined as a combination of 5 simple measures, predict death, hip fracture, activity of daily living (ADL) disability, and hospital admission in older women?

METHODS

GraphicDesign:

cohort study (Women’s Health Initiative Observational Study).

GraphicSetting:

40 clinical centres in the US.

GraphicParticipants:

40 657 postmenopausal women who were 65–79 years of age, did not have Parkinson’s disease, did not take medication for Parkinson’s disease or depression, and were expected to survive and live in the same area for ⩾3 years.

GraphicRisk factors:

frailty, defined as ⩾3 of 5 components: muscle weakness and slow walking speed (<75 out of 100 on the Rand-36 physical function scale; counts as 2 components), exhaustion (<55 out of 100 on the Rand-36 vitality scale), low physical activity (kcal of weekly energy expenditure in the lowest quartile, calculated from a detailed physical activity questionnaire), and unintentional weight loss (>5% of body weight in the previous 2 y).

GraphicOutcomes:

death, hip fracture, ADL disability, and overnight hospital admission.

MAIN RESULTS

At baseline, 16% of women were considered to be frail and 28% to have intermediate frailty (1 or 2 frailty components). At 3 years, frailty had developed in 15% of women with <3 frailty components at baseline. Frailty at baseline increased risks of ADL disability at 3 years and death, hip fracture, and hospital admission during a mean 5.9 years of follow up (table). Intermediate frailty also predicted these outcomes but to a lesser extent (table).

CONCLUSION

An operational definition of frailty was associated with increased risk of death, hip fracture, activity of daily living disability, and hospital admission in older women.

A modified version of this abstract appears in ACP Journal Club.

Commentary

  1. Karen Moore Schaefer, RN, DNSc
  1. Temple University, College of Health Professions, Nursing, Philadelphia, Pennsylvania, USA

      One of the goals of the study by Fugate Woods et al was to identify the associations between classification of frailty and future risk of death, hip fracture, ADL disability, and hospital admission. Strengths of the study include the large sample size, appropriate statistical analyses, and the similarity of findings to those of the Cardiovascular Health Study (CHS), in which indicators of frailty predicted disability in men and women.1

      When assessing baseline characteristics of participants, Fugate Woods et al found that women who were older, African-American or Hispanic, obese, or had lower income or education levels were more likely to be classified as frail. Frailty and intermediate frailty predicted an increase in hospital admissions, hip fractures, and death at 5.9 years. Although the measurements used in the CHS and the study by Fugate Woods et al were somewhat different, the components used to define frailty and the outcomes assessed to validate the definition were sufficiently alike that researchers and clinicians can begin to use this definition to refine future studies and test interventions to prevent the development of frailty.

      The indicators of frailty in the study by Fugate Woods et al and the CHS were similar, although some variation existed. Frailty predicted increased ADL disability at 3 years and increased hospital admissions and death at 5.9 years in the study by Fugate Woods et al, confirming the findings of the CHS at 3–7 years.1 The findings of Fugate Woods et al suggest that intermediate frailty can predict the same outcomes as frailty but with less certainty. This result supports the need to examine further risk factors for intermediate frailty and frailty to determine the optimal combination of predictors at each level and to make recommendations for prevention and maintenance activities.

      The results of the study by Fugate Woods et al will enable nurses who care for elderly people to use simple assessments to identify the presence or development of frailty in their patients and to incorporate interventions for fracture and injury prevention into daily care.

      References

      Association between frailty or intermediate frailty at baseline and adverse outcomes in older women*

      
 
 Q Does frailty, defined as a combination of 5 simple measures, predict death, hip fracture, activity of daily living (ADL) disability, and hospital admission in older women?

      Footnotes

      • For correspondence: Dr N Fugate Woods, University of Washington School of Nursing, Seattle, WA, USA. nfwoods{at}u.washington.edu

      • Source of funding: National Heart, Lung and Blood Institute.

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