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The Estimation of Relative Fitness and Frailty in Community-Dwelling Older Adults Using Self-Report Data

¹ Department of Medicine
² Faculty of Computer Science
³ Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Address correspondence to Kenneth Rockwood, Division of Geriatric Medicine, Dalhousie University, Suite 1421, 5955 Veterans' Memorial Lane Rd., Halifax, NS, B3H 2E1, Canada. E-mail: kenneth.rockwood{at}dal.ca

Background. While on average health declines with age, it also becomes more variable with age. As a consequence of this marked variability, it becomes more important as people age to have a means of summarizing health status, but how precisely to do so remains controversial. We developed one measure of health status, personal biological age, from a frailty index. The index itself is a count of deficits derived, in the first instance, from a clinical database. In our earlier investigations, personal biological age demonstrated a strong relationship with 6-year survival. Here we extend this approach to self-reported data.

Methods. This is a secondary analysis of community-dwelling people aged 65 years and older (n = 9008) in the Canadian Study of Health and Aging. The frailty index was calculated from 40 self-reported variables, representing symptoms, attitudes, illnesses, and function. Personal biological age was estimated for each individual as the age corresponding to the mean chronological age for the index value. Individual frailty (and the related construct of fitness) was calculated as the difference between chronological and personal biological age.

Results. The frailty index showed, on average, an exponential increase with age at an average rate of 3% per year. Although women, on average, demonstrate more frailty than men of the same chronological age, their survival chances are greater. The frailty index strongly correlated (Pearson r =.992 for women and.955 for men) with survival.

Conclusions. A frailty index, based on self-report data, can be used as a tool for capturing heterogeneity in the health status of older adults.