title: Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study.
abstract: OBJECTIVE
  To define frailty using simple indicators; to identify risk factors for frailty as targets for prevention; and to investigate the predictive validity of this frailty classification for death, hospitalization, hip fracture, and activity of daily living (ADL) disability.
  
  
  METHODS
  Prospective study, the Women's Health Initiative Observational Study.
  
  
  METHODS
  Forty U.S. clinical centers.
  
  
  METHODS
  Forty thousand six hundred fifty-seven women aged 65 to 79 at baseline.
  
  
  METHODS
  Components of frailty included self-reported muscle weakness/impaired walking, exhaustion, low physical activity, and unintended weight loss between baseline and 3 years of follow-up. Death, hip fractures, ADL disability, and hospitalizations were ascertained during an average of 5.9 years of follow-up.
  
  
  RESULTS
  Baseline frailty was classified in 16.3% of participants, and incident frailty at 3-years was 14.8%. Older age, chronic conditions, smoking, and depressive symptom score were positively associated with incident frailty, whereas income, moderate alcohol use, living alone, and self-reported health were inversely associated. Being underweight, overweight, or obese all carried significantly higher risk of frailty than normal weight. Baseline frailty independently predicted risk of death (hazard ratio (HR)=1.71, 95% confidence interval (CI)=1.48-1.97), hip fracture (HR=1.57, 95% CI=1.11-2.20), ADL disability (odds ratio (OR)=3.15, 95% CI=2.47-4.02), and hospitalizations (OR=1.95, 95% CI=1.72-2.22) after adjustment for demographic characteristics, health behaviors, disability, and comorbid conditions.
  
  
  CONCLUSIONS
  These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women. Underweight, obesity, smoking, and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention.
authors.affiliation: Seattle Clinical Center, Seattle, Washington 98195, USA. nfwoods@u.washington.edu
authors.forename: Nancy Fugate
authors.initials: NF
authors.lastname: Woods
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.forename: Shelly L
authors.initials: SL
authors.lastname: Gray
authors.forename: Aaron
authors.initials: A
authors.lastname: Aragaki
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Cochrane
authors.forename: Robert L
authors.initials: RL
authors.lastname: Brunner
authors.forename: Kamal
authors.initials: K
authors.lastname: Masaki
authors.forename: Anne
authors.initials: A
authors.lastname: Murray
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002908:Chronic Disease; D003863:Depression; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006620:Hip Fractures; D006760:Hospitalization; D006801:Humans; D009765:Obesity / Q000150:complications; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D016138:Walking; D015431:Weight Loss