title: Frailty, hospitalization, and progression of disability in a cohort of disabled older women.
abstract: OBJECTIVE
  To determine the association between a previously validated frailty phenotype and the development of new-onset dependence in activities of daily living, independent of hospitalizations and other established predictors of disability.
  
  
  METHODS
  Seven hundred and forty-nine women enrolled in the Women's Health and Aging Study-I who were independent in all activities in daily living when enrolled in the cohort.
  
  
  METHODS
  Assessments and interviews were conducted through home visits at 6-month intervals for 3 years. Frailty was classified using a validated phenotype (> or =3 of the following: weight loss, exhaustion, slow walking, sedentariness, and weak grip), and hospitalizations were identified by self-report. Grouped-time proportional hazard models assessed associations among frailty, hospitalization, and the development of dependence in activities in daily living, adjusting for other factors.
  
  
  RESULTS
  Twenty-five percent of the cohort (186/749) were frail at baseline; 56% (104/186) of frail versus 20% (23/117) of nonfrail women developed dependence in activities in daily living (P <.001). In multivariate analysis, frailty was independently associated with the development of dependence in activities in daily living (hazard ratio [HR] = 2.2; 95% confidence interval [CI]: 1.4 to 3.6), adjusting for hospitalization status, age, race, education, baseline functional status, cognition, depressive symptoms, number of chronic diseases, and self-reported health status. Additionally, a dose-response relationship existed between the number of frailty criteria that a woman had and the hazard of subsequent dependence in activities in daily living.
  
  
  CONCLUSIONS
  Frailty, conceptualized as an underlying vulnerability, and hospitalization, which marks an acute deterioration in health, were strongly and independently associated with new-onset dependence in activities in daily living. Additional research is needed to determine if dependence can be minimized by targeting resources and programs to frail older persons.
authors.affiliation: Division of Geriatric Medicine and Gerontology, Center on Aging and Health, National Institute on Aging, Baltimore, Md, USA. cboyd1@jhmi.edu
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
authors.forename: Qian-Li
authors.initials: QL
authors.lastname: Xue
authors.forename: Crystal F
authors.initials: CF
authors.lastname: Simpson
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: Linda P
authors.initials: LP
authors.lastname: Fried
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015142:Baltimore / Q000453:epidemiology; D003072:Cognition Disorders / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D018450:Disease Progression; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D018737:Hand Strength; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D009043:Motor Activity; D018908:Muscle Weakness / Q000453:epidemiology; D010641:Phenotype; D016016:Proportional Hazards Models; D015431:Weight Loss