Comparison of Frailty Phenotypes for Prediction of Mortality, Incident Falls, and Hip Fracture in Older Women.
To compare the ability of the commonly used Women's Health Initiative (WHI) and Cardiovascular Health Study (CHS) frailty phenotypes to predict falls, hip fracture, and death in WHI Clinical Trial participants aged 65 and older.



Longitudinal cohort study.



WHI Clinical Trial.



Participants with data for WHI and CHS frailty phenotypes (N = 3,558).



Frailty was operationally defined in the CHS as the presence of three or more of weight loss, poor energy, weakness, slowness, and low physical activity. WHI operationalized frailty similarly but with the RAND-36 physical function scale substituted for slowness and weakness (RAND-36 physical function scale score <13 = 2 points, 13-78 = 1 point, >78 = 0 points). Frailty was defined as a summary score of 3 or greater, prefrailty as a score of 2 or 1, and nonfrailty as a score of 0. Outcomes were modeled using Cox regression. Harrell C-statistics were compared for models containing alternative instruments.



Approximately 5% of participants were frail based on the CHS or WHI phenotype. The WHI frailty phenotype was associated with higher rates of falls (hazard ratio (HR) = 1.48, P = .003), hip fracture (HR = 1.87, P = .04), and death (HR = 2.32, P < .001). Comparable HRs in CHS-phenotype frail women were 1.32 (P = .04), 1.08 (P = .83), and 1.91 (P < .001), respectively. Harrell C-statistics revealed marked but insignificant differences in predicting abilities between CHS and WHI phenotype models (P > .50 for all).



The WHI phenotype, which does not require direct measurements of physical performance, might offer a practical advantage for epidemiological and clinical needs.
School of Nursing, University of Washington, Seattle, Washington. ozasl@uw.edu.
Oleg
O
Zaslavsky
Faculty of Health Sciences and Social Welfare, University of Haifa, Haifa, Israel.
Shira
S
Zelber-Sagi
School of Pharmacy, University of Washington, Seattle, Washington.
Shelly L
SL
Gray
Division of Epidemiology, School of Medicine, University of California at San Diego, San Diego, California.
Andrea Z
AZ
LaCroix
Department of Nutrition, University of Nevada, Reno, Nevada.
Robert L
RL
Brunner
College of Public Health, University of Iowa, Iowa City, Iowa.
Robert B
RB
Wallace
Miller School of Medicine, University of Miami, Miami, Florida.
Mary J
MJ
O'Sullivan
School of Nursing, University of Washington, Seattle, Washington.
Barbara
B
Cochrane
School of Nursing, University of Washington, Seattle, Washington.
Nancy F
NF
Woods
D000058:Accidental Falls / Q000401:mortality*; D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D004185:Disability Evaluation; D005221:Fatigue / Q000401:mortality; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005684:Gait; D006620:Hip Fractures / Q000401:mortality*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D010641:Phenotype; D018570:Risk Assessment / Q000706:statistics & numerical data*; D057185:Sedentary Behavior; D015431:Weight Loss
SF-36; falls; frailty; function; hip fracture; mortality; predictive ability