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1 Division of Geriatric Medicine,2 Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax, Nova Scotia, Canada.
Address correspondence to Kenneth Rockwood, MD, Centre for Health Care of the Elderly, 1421-5955 Veterans' Memorial Lane, Halifax, Nova Scotia, Canada, B3H 2E1. E-mail: kenneth.rockwood{at}dal.ca
Background. Many definitions of frailty exist, but few have been directly compared. We compared the relationship between a definition of frailty based on a specific phenotype with one based on an index of deficit accumulation.
Methods. The data come from all 2305 people 70 years old and older who composed the clinical examination cohort of the second wave of the Canadian Study of Health and Aging. We tested convergent validity by correlating the measures with each other and with other health status measures, and analyzed cumulative index distributions in relation to phenotype. To test criterion validity, we evaluated survival (institutionalization and all-cause mortality) by frailty index (FI) score, stratified by the phenotypic definitions as "robust," "pre-frail," and "frail."
Results. The measures correlated moderately well with each other (R = 0.65) and with measures of function (phenotypic definition R = 0.66; FI R = 0.73) but less well with cognition (phenotypic definition R = –0.35; FI R = –0.58). The median FI scores increased from 0.12 for the robust to 0.30 for the pre-frail and 0.44 for the frail. Survival was also lower with increasing frailty, and institutionalization was more common, but within each phenotypic class, there were marked differences in outcomes based on the FI values—e.g., among robust people, the median 5-year survival for those with lower FI values was 85%, compared with 55% for those with higher FI values.
Conclusion. The phenotypic definition of frailty, which offers ready clinical operationalization, discriminates broad levels of risk. The FI requires additional clinical translation, but allows the risk of adverse outcomes to be defined more precisely.
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