title: Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70.
abstract: OBJECTIVE
  To measure relative fitness and frailty in older people without specific frailty instruments and to relate that measurement to long-term health outcomes.
  
  
  METHODS
  Retrospective cohort studies.
  
  
  METHODS
  Two population-based studies of people aged approximately 70 at baseline and followed up to 10 years (in the Canadian Study of Health and Aging (CSHA)) or 26 years in the Gothenburg H-70 cohort study.
  
  
  METHODS
  Nine hundred sixty-two men and 1,178 women.
  
  
  METHODS
  Deficit accumulation (the exposure) was counted using self-reported (CSHA) or clinically designated (H-70) symptoms, signs, diseases, and disabilities. Relative fitness and frailty were measured in relation to the degree of deficit accumulation evaluated in four quartiles, representing those most fit to those most frail. The items that made up the frailty index were selected randomly without replacement in 1,000 iterations. The outcomes were risks of death or residential long-term care.
  
  
  RESULTS
  Worse frailty, however measured, was associated with worse survival; the Kaplan-Meier curves of random iterations of the frailty definition showed virtually no interquartile overlap for mortality. For any given level of frailty, men died younger than women. Worse frailty was also associated with a higher risk of institutionalization.
  
  
  CONCLUSIONS
  Frailty appears to be a robust concept that is readily operationalized, with the risk of adverse outcomes being largely established by age 70.
authors.affiliation: Geriatric Medicine Research Unit, Dalhousie University, 1431-5955 Veterans Memorial Lane, Halifax, Nova Scotia B3H 2E1, Canada. Kenneth.Rockwood@Dal.Ca
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
authors.forename: Arnold
authors.initials: A
authors.lastname: Mitnitski
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Song
authors.forename: Bertil
authors.initials: B
authors.lastname: Steen
authors.forename: Ingmar
authors.initials: I
authors.lastname: Skoog
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D007326:Institutionalization / Q000639:trends*; D008134:Long-Term Care; D008297:Male; D009026:Mortality / Q000639:trends*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors