title: Fried phenotype of frailty: cross-sectional comparison of three frailty stages on various health domains.
abstract: BACKGROUND
  The population ageing in most Western countries leads to a larger number of frail older people. These frail people are at an increased risk of negative health outcomes, such as functional decline, falls, institutionalisation and mortality. Many approaches are available for identifying frailty among older people. Researchers most often use Fried and colleagues' description of the frailty phenotype. The authors describe five physical criteria. Other researchers prefer a combination of measurements in the social, psychological and/or physical domains. The aim of this study is to describe the levels of social, psychological and physical functioning according to Fried's frailty stages using a large cohort of Dutch community-dwelling older people.
  
  
  METHODS
  There were 8,684 community-dwelling older people (65+) who participated in this cross-sectional study. Based on the five Fried frailty criteria (weight loss, exhaustion, low physical activity, slowness, weakness), the participants were divided into three stages: non-frail (score 0), pre-frail (score 1-2) and frail (score 3-5). These stages were related to scores in the social (social network type, informal care use, loneliness), psychological (psychological distress, mastery, self-management) and physical (chronic diseases, GARS IADL-disability, OECD disability) domains.
  
  
  RESULTS
  63.2% of the participants was non-frail, 28.1% pre-frail and 8.7% frail. When comparing the three stages of frailty, frail people appeared to be older, were more likely to be female, were more often unmarried or living alone, and had a lower level of education compared to their pre-frail and non-frail counterparts. The difference between the scores in the social, psychological and physical domains were statistically significant between the three frailty stages. The most preferable scores came from the non-frail group, and least preferable scores were from the frail group. For example use of informal care: non-frail 3.9%, pre-frail 23.8%, frail 60.6%, and GARS IADL-disability mean scores: non-frail 9.2, pre-frail 13.0, frail 19.7.
  
  
  CONCLUSIONS
  When older people were categorised according to the three frailty stages, as described by Fried and colleagues, there were statistically significant differences in the level of social, psychological and physical functioning between the non-frail, pre-frail and frail persons. Non-frail participants had consistently more preferable scores compared to the frail participants. This indicated that the Fried frailty criteria could help healthcare professionals identify and treat frail older people in an efficient way, and provide indications for problems in other domains.
authors.affiliation: Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419DJ, Heerlen, The Netherlands. linda.ophetveld@zuyd.nl.|Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Duboisdomein 30, 6229GT, Maastricht, The Netherlands. linda.ophetveld@zuyd.nl.
authors.forename: Linda P M
authors.initials: LP
authors.lastname: Op het Veld
authors.affiliation: Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419DJ, Heerlen, The Netherlands. erik.vanrossum@zuyd.nl.|Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Duboisdomein 30, 6229GT, Maastricht, The Netherlands. erik.vanrossum@zuyd.nl.
authors.forename: Erik
authors.initials: E
authors.lastname: van Rossum
authors.affiliation: Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Duboisdomein 30, 6229GT, Maastricht, The Netherlands. g.kempen@maastrichtuniversity.nl.
authors.forename: Gertrudis I J M
authors.initials: GI
authors.lastname: Kempen
authors.affiliation: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. hcw.devet@vumc.nl.
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
authors.affiliation: Community Health Service South Limburg, Academic Collaborative Centres Public Health (ACC), Geleenbeeklaan 2, 6166 GR, Sittard-Geleen, The Netherlands. KlaasJan.Hajema@ggdzl.nl.
authors.forename: KlaasJan
authors.initials: K
authors.lastname: Hajema
authors.affiliation: Centre of Research Autonomy and Participation for Persons with a Chronic Illness, Faculty of Health, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419DJ, Heerlen, The Netherlands. sandra.beurskens@zuyd.nl.|Department of Family Practice, CAPHRI, School for Public Health and Primary Care, Maastricht University, Peter Debeyeplein 1, 6229 HA, Maastricht, The Netherlands. sandra.beurskens@zuyd.nl.
authors.forename: Anna J H M
authors.initials: AJ
authors.lastname: Beurskens
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods; D054624:Health Status Disparities; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010641:Phenotype; D011584:Psychology / Q000379:methods