title: A global clinical measure of fitness and frailty in elderly people.
abstract: BACKGROUND
  There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use.
  
  
  METHODS
  We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools.
  
  
  RESULTS
  The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%-30.6%) and entry into an institution (23.9%, 95% CI 8.8%-41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality).
  
  
  CONCLUSIONS
  Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.
authors.affiliation: Division of Geriatric Medicine, Dalhousie University, Halifax, NS.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Song
authors.forename: Chris
authors.initials: C
authors.lastname: MacKnight
authors.forename: Howard
authors.initials: H
authors.lastname: Bergman
authors.forename: David B
authors.initials: DB
authors.lastname: Hogan
authors.forename: Ian
authors.initials: I
authors.lastname: McDowell
authors.forename: Arnold
authors.initials: A
authors.lastname: Mitnitski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D007326:Institutionalization; D008297:Male; D009026:Mortality; D010809:Physical Fitness; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies