title: A Frailty Instrument for primary care for those aged 75 years or more: findings from the Survey of Health, Ageing and Retirement in Europe, a longitudinal population-based cohort study (SHARE-FI75+).
abstract: OBJECTIVE
  To create and validate a frailty assessment tool for community-dwelling adults aged ≥75 years.
  
  
  METHODS
  Longitudinal, population-based study.
  
  
  METHODS
  The Survey of Health, Ageing and Retirement in Europe (SHARE).
  
  
  METHODS
  4001 women and 3057 men aged ≥75 years from the second wave of SHARE. 3325 women and 2587 men had complete information for the frailty indicators: fatigue, low appetite, weakness, observed gait (walking without help, walking with help, chairbound/bedbound, unobserved) and low physical activity.
  
  
  METHODS
  The internal validity of the frailty indicators was tested with latent class analysis, by modelling an underlying variable with three ordered categories. The predictive validity of the frailty classification was tested against 2-year mortality and 4-year disability. The mortality prediction of SHARE-FI75+ was compared with that of previously operationalised frailty scales in SHARE (SHARE-FI, 70-item index, phenotype, FRAIL).
  
  
  RESULTS
  In both genders, all frailty indicators significantly aggregated into a three-category ordinal latent variable. After adjusting for baseline age, comorbidity and basic activities of daily living (BADL) disability, the frail had an OR for 2-year mortality of 2.2 (95% CI 1.2 to 3.8) in women and 4.2 (2.6 to 6.8) in men. The mortality prediction of SHARE-FI75+ was similar to that of the other SHARE frailty scales. By wave 4, 49% of frail women (78 of 159) had at least one more limitation with BADL (compared with 18% of non-frail, 125 of 684; p<0.001); in men, these proportions were 39% (26 of 66) and 18% (110 of 621), respectively (p<0.001). A calculator is supplied for point-of-care use, which automatically replicates the frailty classification for any given measurements.
  
  
  CONCLUSIONS
  SHARE-FI75+ could help frailty case finding in primary care and provide a focus for personalised community interventions. Further validation in trials and clinical programmes is needed.
authors.affiliation: Department of Medicine for the Elderly (DME), Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Roman
authors.initials: R
authors.lastname: Romero-Ortuno
authors.affiliation: Department of Medical Physics and Bioengineering, St. James's Hospital, Dublin, Ireland Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland.
authors.forename: Christopher
authors.initials: C
authors.lastname: Soraghan
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015897:Comorbidity; D006233:Persons with Disabilities; D005060:Europe; D005221:Fatigue; D005260:Female; D016330:Frail Elderly; D005684:Gait; D015577:Geriatric Assessment / Q000379:methods*; D006262:Health; D006304:Health Status; D006305:Health Status Indicators; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality; D016017:Odds Ratio; D011320:Primary Health Care; D012111:Residence Characteristics; D012179:Retirement; D016138:Walking
keywords: Frail Elderly; Geriatric Assessment; Longitudinal Survey; Primary Health Care; Screening; Validation Studies