Comparing models of frailty: the Health and Retirement Study.
OBJECTIVE
To operationalize and compare three models of frailty, each representing a distinct theoretical view of frailty: as deficiencies in function (Functional Domains model), as an index of health burden (Burden model), and as a biological syndrome (Biologic Syndrome model).


METHODS
Cross-sectional analysis.


METHODS
2004 wave of the Health and Retirement Study, a nationally representative, longitudinal health interview survey.


METHODS
Adults aged 65 and older (N=11,113) living in the community and in nursing homes in the United States.


METHODS
The outcome measure was the presence of frailty, as defined according to each frailty model. Covariates included chronic diseases and sociodemographic characteristics.


RESULTS
Almost one-third (30.2%) of respondents were frail according to at least one model; 3.1% were frail according to all three models. The Functional Domains model showed the least overlap with the other models. In contrast, 76.1% of those classified as frail according to the Biologic Syndrome model and 72.1% of those according to the Burden model were also frail according to at least one other model. Older adults identified as frail according to the different models differed in sociodemographic and chronic disease characteristics. For example, the Biologic Syndrome model demonstrated substantial associations with older age (adjusted odds ratio (OR)=10.6, 95% confidence interval (CI)=6.1-18.5), female sex (OR=1.7, 95% CI=1.2-2.5), and African-American ethnicity (OR=2.1, % CI=1.0-4.4).


CONCLUSIONS
Different models of frailty, based on different theoretical constructs, capture different groups of older adults. The different models may represent different frailty pathways or trajectories to adverse outcomes such as disability and death.
Cigolle
Christine T
CT
Department of Family Medicine, University of Michigan, 300 N. Ingalls, Room 919, Ann Arbor, MI 48109, USA. ccigolle@umich.edu
Ofstedal
Mary Beth
MB
Tian
Zhiyi
Z
Blaum
Caroline S
CS
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003710:Demography; D004185:Disability Evaluation; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008962:Models, Theoretical; D014481:United States