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Prevalence, Attributes, and Outcomes of Fitness and Frailty in Community-Dwelling Older Adults: Report From the Canadian Study of Health and Aging

¹ Division of Geriatric Medicine
² Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.
³ Division of Geriatric Medicine, University of British Columbia, Canada.
⁴ Division of Geriatric Medicine, McGill University, Montréal, Québec, Canada.
⁵ Université Sherbrooke, Québec, Canada.
⁶ Division of Geriatric Medicine, University of Calgary, Alberta, Canada.
⁷ Department of Epidemiology and Biostatistics, McGill University, Montréal, Québec, Canada.
⁸ Department of Epidemiology and Community Medicine, University of Ottawa, Ontario, Canada.

Address correspondence to Kenneth Rockwood, MD, Centre for Health Care of the Elderly, 5955 Veterans' Memorial Lane, Suite 1421, Halifax, Nova Scotia, Canada B3H 2E1. E-mail: kenneth.rockwood{at}dal.ca

 Background. Frailty and fitness are important attributes of older persons, but population samples of their prevalence, attributes, and outcomes are limited.

 Methods. The authors report data from the community-dwelling sample (n = 9008) of the Canadian Study of Health and Aging, a representative, 5-year prospective cohort study. Fitness and frailty were determined by self-reported exercise and function level and testing of cognition.

 Results. Among the community-dwelling elderly population, 171 per 1000 were very fit and 12 per 1000 were very frail. Frailty increased with age, so that by age 85 years and older, 44 per 1000 were very frail. The risk for adverse health outcomes increased markedly with frailty: Compared with older adults who exercise, those who were moderately or severely frail had a relative risk for institutionalization of 8.6 (95% confidence interval, 4.9 to 15.2) and for death of 7.3 (95% confidence interval, 4.7 to 11.4). These risks persist after adjustments for age, sex, comorbid conditions, and poor self-rated health. At all ages, men reported higher levels of exercise and less frailty compared with women. Decreased fitness and increased frailty were also associated with poor self-ratings of health (42% in the most frail vs 7% in the most fit), more comorbid illnesses (6 vs 3), and more social isolation (34% vs 29%).

 Conclusions. Fitness and frailty form a continuum and predict survival. Exercise influences survival, even in old age. Relative fitness and frailty can be determined quickly in a clinical setting, are potentially useful markers of the risk for adverse health outcomes, and add value to traditional medical assessments that focus on diagnoses.

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				K. Rockwood, X. Song, C. MacKnight, H. Bergman, D. B. Hogan, I. McDowell, and A. Mitnitski A global clinical measure of fitness and frailty in elderly people Can. Med. Assoc. J., August 30, 2005; 173(5): 489 - 495. [Abstract] [Full Text] [PDF]