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Phenotype of Frailty: Characterization in the Women's Health and Aging Studies

¹ Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
² Center on Aging and Health and ³ Division of Geriatric Medicine and Gerontology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
⁴ Clinical Research Branch, Intramural Research Program, National Institute on Aging, Baltimore, Maryland.
⁵ Division of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland.

Address correspondence to Karen Bandeen-Roche, PhD, Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205. E-mail: kbandeen{at}jhsph.edu

Background. "Frailty" is an adverse, primarily gerontologic, health condition regarded as frequent with aging and having severe consequences. Although clinicians claim that the extremes of frailty can be easily recognized, a standardized definition of frailty has proved elusive until recently. This article evaluates the cross-validity, criterion validity, and internal validity in the Women's Health and Aging Studies (WHAS) of a discrete measure of frailty recently validated in the Cardiovascular Health Study (CHS).

Methods. The frailty measure developed in CHS was delineated in the WHAS data sets. Using latent class analysis, we evaluated whether criteria composing the measure aggregate into a syndrome. We verified the criterion validity of the measure by testing whether participants defined as frail were more likely than others to develop adverse geriatric outcomes or to die.

Results. The distributions of frailty in the WHAS and CHS were comparable. In latent class analyses, the measures demonstrated strong internal validity vis à vis stated theory characterizing frailty as a medical syndrome. In proportional hazards models, frail women had a higher risk of developing activities of daily living (ADL) and/or instrumental ADL disability, institutionalization, and death, independently of multiple potentially confounding factors.

Conclusions. The findings of this study are consistent with the widely held theory that conceptualizes frailty as a syndrome. The frailty definition developed in the CHS is applicable across diverse population samples and identifies a profile of high risk of multiple adverse outcomes.

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