A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men.
OBJECTIVE
To compare the validity of a parsimonious frailty index (components: weight loss, inability to rise from a chair, and poor energy (Study of Osteoporotic Fractures (SOF) index)) with that of the more complex Cardiovascular Health Study (CHS) index (components: unintentional weight loss, low grip strength, poor energy, slowness, and low physical activity) for prediction of adverse outcomes in older men.


METHODS
Prospective cohort study.


METHODS
Six U.S. centers.


METHODS
Three thousand one hundred thirty-two men aged 67 and older.


METHODS
Frailty status categorized as robust, intermediate stage, or frail using the SOF index and criteria similar to those used in CHS index. Falls were reported three times for 1 year. Disability (>or=1 new impairments in performing instrumental activities of daily living) ascertained at 1 year. Fractures and deaths ascertained during 3 years of follow-up. Analysis of area under the receiver operating characteristic curve (AUC) statistics compared for models containing the SOF index versus those containing the CHS index.


RESULTS
Greater evidence of frailty as defined by either index was associated with greater risk of adverse outcomes. Frail men had a higher age-adjusted risk of recurrent falls (odds ratio (OR)=3.0-3.6), disability (OR=5.3-7.5), nonspine fracture (hazard ratio (HR)=2.2-2.3), and death (HR=2.5-3.5) (P<.001 for all models). AUC comparisons revealed no differences between models with the SOF index and models with the CHS index in discriminating falls (AUC=0.63, P=.97), disability (AUC=0.68, P=.86), nonspine fracture (AUC=0.63, P=.90), or death (AUC=0.71 for model with SOF index and 0.72 for model with CHS index, P=.19).


CONCLUSIONS
The simple SOF index predicts risk of falls, disability, fracture, and mortality in men as well as the more-complex CHS index.
Ensrud
Kristine E
KE
Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA. ensru001@umn.edu
Ewing
Susan K
SK
Cawthon
Peggy M
PM
Fink
Howard A
HA
Taylor
Brent C
BC
Cauley
Jane A
JA
Dam
Thuy-Tien
TT
Marshall
Lynn M
LM
Orwoll
Eric S
ES
Cummings
Steven R
SR
D000058:Accidental Falls / Q000401:mortality*; D000203:Activities of Daily Living / Q000145:classification; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000401:mortality*; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D018737:Hand Strength; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D016019:Survival Analysis; D015431:Weight Loss