title: Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging.
abstract: BACKGROUND
  Frailty and fitness are important attributes of older persons, but population samples of their prevalence, attributes, and outcomes are limited.
  
  
  METHODS
  The authors report data from the community-dwelling sample (n = 9008) of the Canadian Study of Health and Aging, a representative, 5-year prospective cohort study. Fitness and frailty were determined by self-reported exercise and function level and testing of cognition.
  
  
  RESULTS
  Among the community-dwelling elderly population, 171 per 1000 were very fit and 12 per 1000 were very frail. Frailty increased with age, so that by age 85 years and older, 44 per 1000 were very frail. The risk for adverse health outcomes increased markedly with frailty: Compared with older adults who exercise, those who were moderately or severely frail had a relative risk for institutionalization of 8.6 (95% confidence interval, 4.9 to 15.2) and for death of 7.3 (95% confidence interval, 4.7 to 11.4). These risks persist after adjustments for age, sex, comorbid conditions, and poor self-rated health. At all ages, men reported higher levels of exercise and less frailty compared with women. Decreased fitness and increased frailty were also associated with poor self-ratings of health (42% in the most frail vs 7% in the most fit), more comorbid illnesses (6 vs 3), and more social isolation (34% vs 29%).
  
  
  CONCLUSIONS
  Fitness and frailty form a continuum and predict survival. Exercise influences survival, even in old age. Relative fitness and frailty can be determined quickly in a clinical setting, are potentially useful markers of the risk for adverse health outcomes, and add value to traditional medical assessments that focus on diagnoses.
authors.affiliation: Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. kenneth.rockwood@dal.ca
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
authors.forename: Susan E
authors.initials: SE
authors.lastname: Howlett
authors.forename: Chris
authors.initials: C
authors.lastname: MacKnight
authors.forename: B Lynn
authors.initials: BL
authors.lastname: Beattie
authors.forename: Howard
authors.initials: H
authors.lastname: Bergman
authors.forename: Réjean
authors.initials: R
authors.lastname: Hébert
authors.forename: David B
authors.initials: DB
authors.lastname: Hogan
authors.forename: Christina
authors.initials: C
authors.lastname: Wolfson
authors.forename: Ian
authors.initials: I
authors.lastname: McDowell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010809:Physical Fitness; D015995:Prevalence; D011446:Prospective Studies