title: The ability of three different models of frailty to predict all-cause mortality: results from the European Male Aging Study (EMAS).
abstract: Few studies have directly compared the ability of the most commonly used models of frailty to predict mortality among community-dwelling individuals. Here, we used a frailty index (FI), frailty phenotype (FP), and FRAIL scale (FS) to predict mortality in the EMAS. Participants were aged 40-79 years (n=2929) at baseline and 6.6% (n=193) died over a median 4.3 years of follow-up. The FI was generated from 39 deficits, including self-reported health, morbidities, functional performance and psychological assessments. The FP and FS consisted of five phenotypic criteria and both categorized individuals as robust when they had 0 criteria, prefrail as 1-2 criteria and frail as 3+ criteria. The mean FI increased linearly with age (r(2)=0.21) and in Cox regression models adjusted for age, center, smoking and partner status the hazard ratio (HR) for death for each unit increase of the FI was 1.49. Men who were prefrail or frail by either the FP or FS definitions, had a significantly increased risk of death compared to their robust counterparts. Compared to robust men, those who were FP frail at baseline had a HR for death of 3.84, while those who were FS frail had a HR of 3.87. All three frailty models significantly predicted future mortality among community-dwelling, middle-aged and older European men after adjusting for potential confounders. Our data suggest that the choice of frailty model may not be of paramount importance when predicting future risk of death, enabling flexibility in the approach used.
authors.affiliation: Department of Medicine, Manchester Academic Health Science Centre, The University of Manchester, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: Rathi
authors.initials: R
authors.lastname: Ravindrarajah
authors.forename: David M
authors.initials: DM
authors.lastname: Lee
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Pye
authors.forename: Evelien
authors.initials: E
authors.lastname: Gielen
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanderschueren
authors.forename: Neil
authors.initials: N
authors.lastname: Pendleton
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Finn
authors.forename: Abdelouahid
authors.initials: A
authors.lastname: Tajar
authors.forename: Matthew D L
authors.initials: MD
authors.lastname: O'Connell
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
authors.forename: György
authors.initials: G
authors.lastname: Bartfai
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Casanueva
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.forename: Aleksander
authors.initials: A
authors.lastname: Giwercman
authors.forename: Thang S
authors.initials: TS
authors.lastname: Han
authors.forename: Ilpo T
authors.initials: IT
authors.lastname: Huhtaniemi
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kula
authors.forename: Michael E J
authors.initials: ME
authors.lastname: Lean
authors.forename: Margus
authors.initials: M
authors.lastname: Punab
authors.forename: Frederick C W
authors.initials: FC
authors.lastname: Wu
authors.forename: Terence W
authors.initials: TW
authors.lastname: O'Neill
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D005060:Europe / Q000453:epidemiology; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000401:mortality; D011795:Surveys and Questionnaires; D016019:Survival Analysis
keywords: Aging; Frailty index; Frailty phenotype; Male health; Mortality; Population-based