title: Long-term prediction of changes in health status, frailty, nursing care and mortality in community-dwelling senior citizens—results from the Longitudinal Urban Cohort Ageing Study (LUCAS).
abstract: BACKGROUND
  The detection of incipient functional decline in elderly persons is not an easy task. Here, we propose the self-reporting Functional Ability Index (FA index) suitable to screen functional competence in senior citizens in the community setting. Its prognostic validity was investigated in the Longitudinal Urban Cohort Ageing Study (LUCAS).
  
  
  METHODS
  This index is based equally on both, resources and risks/functional restrictions which precede ADL limitations. Since 2001, the FA index was tested in the LUCAS cohort without any ADL restrictions at baseline (n = 1,679), and followed up by repeated questionnaires in Hamburg, Germany.
  
  
  RESULTS
  Applying the index, 1,022 LUCAS participants were initially classified as Robust (60.9%), 220 as postRobust (13.1%), 172 as preFrail (10.2%) and 265 as Frail (15.8%). This classification correlated with self-reported health, chronic pain and depressive mood (rank correlations 0.42, 0.26, 0.21; all p < .0001). Survival analyses showed significant differences between these classes as determined by the FA index: the initially Robust survived longest, the Frail shortest (p < .0001). Analyses of the time to need of nursing care revealed similar results. Significant differences persisted after adjustment for age, sex and self-reported health.
  
  
  CONCLUSIONS
  Disability free lifetime and its development over time are important topics in public health. In this context, the FA index presented here provides answers to two questions. First, how to screen the heterogeneous population of community-dwelling senior citizens, i.e. for their functional ability/competence, and second, how far away they are from disability/dependency. Furthermore, the index provides a tool to address the urgent question whether incipient functional decline/incipient frailty can be recognized early to be influenced positively. The FA index predicted change in functional status, future need of nursing care, and mortality in an unselected population of community-dwelling seniors. It implies an operational specification of the classification into Robust, postRobust, preFrail and Frail. Based on a self-administered questionnaire, the FA index allows easy screening of elderly persons for declining functional competence. Thereby, incipient functional decline is recognized, e.g. in GPs' practices and senior community health centers, to initiate early appropriate preventive action.
authors.affiliation: Albertinen-Haus Geriatrics Center, Scientific Department, University of Hamburg, Sellhopsweg 18-22, D-22459 Hamburg, Germany. ulrike.dapp@albertinen.de.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Dapp
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Minder
authors.forename: Jennifer
authors.initials: J
authors.lastname: Anders
authors.forename: Stefan
authors.initials: S
authors.lastname: Golgert
authors.forename: Wolfgang
authors.initials: W
authors.lastname: von Renteln-Kruse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D057187:Independent Living / Q000592:standards* / Q000639:trends; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality / Q000639:trends; D009732:Nursing Care / Q000379:methods / Q000592:standards*; D011237:Predictive Value of Tests; D057566:Self Report / Q000592:standards; D011795:Surveys and Questionnaires / Q000592:standards; D014505:Urban Population / Q000639:trends