Background
Methods
Subjects
Frailty definition
Measures for cross-sectional correlations
Sociodemographic domain
-
Age (years). It was obtained by subtracting the year of birth from 2004.
-
Years of education.
Physical domain
-
Self-rated health: excellent (1), very good (2), good (3), fair (4), or poor (5).
-
Number of chronic diseases: calculated as the sum of affirmative self-reports to the following conditions (if diagnosed by a doctor): 1. Heart attack or myocardial infarction or coronary thrombosis or any other heart problem including congestive heart failure; 2. High blood pressure or hypertension; 3. High blood cholesterol; 4. Stroke or cerebral vascular disease; 5. Diabetes or high blood sugar; 6. Chronic lung disease such as chronic bronchitis or emphysema; 7. Asthma; 8. Arthritis, including osteoarthritis, or rheumatism; 9. Osteoporosis; 10. Cancer or malignant tumour, including leukaemia or lymphoma, but excluding minor skin cancers; 11. Stomach or duodenal ulcer, peptic ulcer; 12. Parkinson disease; 13. Cataracts; 14. Hip fracture or femoral fracture; 15. Other fractures; 16. Alzheimer's disease, dementia or senility; 17. Benign tumour and 18. Other conditions.
-
Number of medical symptoms present for at least the past six months.
-
Number of contacts with a medical doctor in the past 12 months.
-
Admitted to hospital in the past 12 months (yes or no).
Functional domain
-
Number of limitations with activities of daily living.
-
Number of limitations with instrumental activities of daily living.
-
Received home care for personal or nursing care in the last 12 months: yes or no.
-
Received home care for domestic tasks in the last 12 months: yes or no.
Psychological and cognitive domains
-
EURO-D depression scale [31].
-
Verbal fluency test score: maximum number of different animals that the respondent is able to name in 60 seconds.
-
Delayed word recall: maximum number of words (out of a list of 10) that the respondent is able to recall after an initial recall followed by the verbal fluency and numeracy tests.
Mortality measures (for prospective validation)
Statistical analyses
Univariate descriptives
Level of significance
Estimation of a discreet factor (DFactor) model
Correlations of the latent classes against SHARE Wave 1 variables
Prospective validation of the DFactor
Sensitivity analysis for the prospective validation
Construction of the SHARE-FI calculators
Results
Females (N= 15,578) | Males (N= 12,783) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Non-frail (N= 10,420) | Pre-frail (N= 4,025) | Frail (N= 1,133) |
Pvalue | Age-adjusted Pvalue | Non-frail (N= 10,517) | Pre-frail (N= 1,871) | Frail (N= 395) |
Pvalue | Age-adjusted Pvalue | |
Frailty phenotype: DFactor model
| ||||||||||
Exhaustion: yes (cp) | 0.21 | 0.51 | 0.81 |
<0.001
Ω
|
<0.001
Ω
| 0.17 | 0.47 | 0.80 |
<0.001
Ω
|
<0.001
Ω
|
Weight loss: yes (cp) | 0.03 | 0.12 | 0.39 |
<0.001
Ω
|
<0.001
Ω
| 0.03 | 0.12 | 0.42 |
<0.001
Ω
|
<0.001
Ω
|
Handgrip strength: mean (Kg) | 29.4 | 23.7 | 17.9 |
<0.001
Ω
|
<0.001
Ω
| 45.8 | 36.2 | 26.5 |
<0.001
Ω
|
<0.001
Ω
|
Slowness: yes (cp) | 0.02 | 0.22 | 0.84 |
<0.001
Ω
|
<0.001
Ω
| 0.01 | 0.29 | 0.92 |
<0.001
Ω
|
<0.001
Ω
|
Low activity: hardly ever, or never (cp) | 0.03 | 0.17 | 0.54 |
<0.001
Ω
|
<0.001
Ω
| 0.03 | 0.21 | 0.62 |
<0.001
Ω
|
<0.001
Ω
|
Sociodemographic
| ||||||||||
Age: mean (SD) | 60.5 (9.4) | 66.7 (10.9) | 73.3 (11.0) |
<0.001
#
| - | 62.6 (9.0) | 69.1 (10.4) | 74.0 (10.2) |
<0.001
#
| - |
Years of education: mean (SD) | 10.3 (4.2) | 8.2 (4.4) | 6.5 (4.4) |
<0.001
#
|
<0.001
§
| 10.9 (4.3) | 8.6 (4.7) | 7.8 (5.0) |
<0.001
#
|
<0.001
§
|
Physical
| ||||||||||
Self-rated health (best:1; worst:5): mean (SD) | 2.7 (1.0) | 3.5 (0.9) | 4.2 (0.8) |
<0.001
#
|
<0.001
§
| 2.7 (1.0) | 3.7 (1.0) | 4.4 (0.7) |
<0.001
#
|
<0.001
§
|
No. chronic diseases: mean (SD) | 1.2 (1.2) | 2.1 (1.5) | 3.1 (1.8) |
<0.001
#
|
<0.001
§
| 1.2 (1.2) | 2.1 (1.5) | 2.9 (1.7) |
<0.001
#
|
<0.001
§
|
No. symptoms: mean (SD) | 1.2 (1.3) | 2.3 (1.8) | 3.9 (2.3) |
<0.001
#
|
<0.001
§
| 0.9 (1.1) | 2.0 (1.7) | 3.4 (2.1) |
<0.001
#
|
<0.001
§
|
No. contacts with doctor in last year: mean (SD) | 5.0 (7.1) | 9.4 (11.4) | 15.5 (17.0) |
<0.001
#
|
<0.001
§
| 4.9 (7.6) | 10.1 (12.4) | 17.5 (20.2) |
<0.001
#
|
<0.001
§
|
Admitted to hospital in last year (%) | 7.9 | 16.5 | 30.0 |
<0.001
χ
|
<0.001
Δ
| 10.4 | 23.5 | 36.7 |
<0.001
χ
|
<0.001
Δ
|
Functional
| ||||||||||
No. limitations with ADLs: mean (SD) | 0.0 (0.2) | 0.2 (0.7) | 1.1 (1.5) |
<0.001
#
|
<0.001
§
| 0.0 (0.3) | 0.3 (0.9) | 1.3 (1.7) |
<0.001
#
|
<0.001
§
|
No. limitations with IADLs: mean (SD) | 0.1 (0.3) | 0.5 (1.0) | 1.8 (1.8) |
<0.001
#
|
<0.001
§
| 0.1 (0.3) | 0.5 (1.1) | 1.9 (2.0) |
<0.001
#
|
<0.001
§
|
Received home care: personal/nursing (%) | 1.9 | 5.9 | 18.6 |
<0.001
χ
|
<0.001
Δ
| 1.6 | 6.8 | 17.2 |
<0.001
χ
|
<0.001
Δ
|
Received home care: domestic tasks (%) | 1.9 | 10.3 | 28.7 |
<0.001
χ
|
<0.001
Δ
| 1.0 | 6.9 | 19.2 |
<0.001
χ
|
<0.001
Δ
|
Psychological and cognitive
| ||||||||||
EURO-D score (min: 0; max: 12) (SD) | 1.9 (1.8) | 3.7 (2.4) | 5.5 (2.6) |
<0.001
#
|
<0.001
§
| 1.4 (1.6) | 3.1 (2.3) | 5.2 (2.7) |
<0.001
#
|
<0.001
§
|
Verbal fluency test score: mean (SD) | 20.2 (7.1) | 16.5 (6.7) | 13.1 (6.0) |
<0.001
#
|
<0.001
§
| 20.1 (7.1) | 15.9 (6.4) | 13.2 (5.7) |
<0.001
#
|
<0.001
§
|
Delayed word recall score: mean (SD) | 3.9 (2.0) | 3.0 (2.0) | 1.9 (1.8) |
<0.001
#
|
<0.001
§
| 3.4 (1.9) | 2.5 (1.8) | 1.7 (1.6) |
<0.001
#
|
<0.001
§
|
Mortality at Wave 2
| ||||||||||
% dead | 0.7 | 2.6 | 9.2 |
<0.001
χ
|
<0.001
Δ
| 2.0 | 8.8 | 22.6 |
<0.001
χ
|
<0.001
Δ
|
OR for mortality (95% CI) | 1.0 | 3.7 (2.5-5.3) | 14.2 (9.7-20.8) | - | - | 1.0 | 4.8 (3.7-6.2) | 14.6 (10.3-20.7) | - | - |
Age-adjusted OR for mortality (95% CI) | 1.0 | 2.1 (1.4- 3.0) | 4.8 (3.1- 7.4) | - | - | 1.0 | 3.0 (2.3-4.0) | 6.9 (4.7-10.2) | - | - |
Estimation of the DFactor models
DFactor for females
-
Fatigue = 0.4088 (R 2 = 0.1671)
-
Loss of appetite = 0.3325 (R 2 = 0.1246)
-
Grip strength = -0.4910 (R 2 = 0.2411)
-
Functional difficulties = 0.6012 (R 2 = 0.4109)
-
Physical activity = 0.4818 (R 2 = 0.2445)
DFactor for males
-
Fatigue = 0.3762 (R 2 = 0.1415)
-
Loss of appetite = 0.3130 (R 2 = 0.1133)
-
Grip strength = -0.4653 (R 2 = 0.2165)
-
Functional difficulties = 0.6146 (R 2 = 0.4075)
-
Physical activity = 0.4680 (R 2 = 0.2244)
Bivariate correlations
Predictive validity of SHARE-FI
Mortality data available (N= 11,384) | Mortality data not available (N= 5,920) | Significance of the difference (P) | |
---|---|---|---|
Frailty variables | |||
Exhaustion: yes (%) | 36.1 | 37.0 | 0.244χ
|
Weight loss: yes (%) | 9.1 | 11.5 |
< 0.001
χ
|
Handgrip strength, Kg: mean (SD) | 26.9 (7.4) | 26.1 (7.8) |
< 0.001
μ
|
Slowness: yes (%) | 16.7 | 19.3 |
< 0.001
χ
|
Low activity: hardly ever, or never (%) | 12.3 | 18.1 |
< 0.001
χ
|
Frailty classes
| |||
Non-frail (%) | 68.5 | 63.6 |
< 0.001
χ
|
Pre-frail (%) | 25.0 | 27.6 |
0.001
χ
|
Frail (%) | 6.5 | 8.9 |
< 0.001
χ
|
Sociodemographic
| |||
Age: mean (SD) | 63.6 (10.9) | 63.8 (11.4) | 0.627μ
|
Years of education: mean (SD) | 9.4 (4.5) | 9.3 (4.4) | 0.499μ
|
Physical
| |||
Self-rated health (best:1; worst:5): mean (SD) | 3.0 (1.1) | 3.1 (1.1) |
< 0.001
μ
|
No. chronic diseases: mean (SD) | 1.6 (1.5) | 1.6 (1.5) | 0.057μ
|
No. symptoms: mean (SD) | 1.7 (1.7) | 1.7 (1.8) | 0.057μ
|
No. contacts with doctor in last year: mean (SD) | 6.8 (9.7) | 8.3 (11.9) |
< 0.001
μ
|
Admitted to hospital in last year (%) | 12.4 | 12.9 | 0.287χ
|
Functional
| |||
No. limitations with ADLs: mean (SD) | 0.22 (0.80) | 0.27 (0.93) | 0.054μ
|
No. limitations with IADLs: mean (SD) | 0.39 (1.08) | 0.50 (1.22) |
< 0.001
μ
|
Received home care: personal/nursing (%) | 5.1 | 4.4 | 0.046χ
|
Received home care: domestic tasks (%) | 6.5 | 7.5 | 0.023χ
|
Psychological and cognitive
| |||
EURO-D score (min: 0; max: 12) (SD) | 2.7 (2.3) | 2.8 (2.5) | 0.057μ
|
Verbal fluency test score: mean (SD) | 18.8 (7.3) | 17.9 (7.6) |
< 0.001
μ
|
Delayed word recall score: mean (SD) | 3.6 (2.1) | 3.2 (2.0) |
< 0.001
μ
|
Mortality data available (N= 9,163) | Mortality data not available (N= 4,648) | Significance of the difference (P) | |
---|---|---|---|
Frailty variables | |||
Exhaustion: yes (%) | 25.3 | 27.4 |
0.007
χ
|
Weight loss: yes (%) | 5.9 | 7.8 |
< 0.001
χ
|
Handgrip strength, Kg: mean (SD) | 43.6 (10.5) | 42.4 (11.5) |
< 0.001
μ
|
Slowness: yes (%) | 10.9 | 13.6 |
< 0.001
χ
|
Low activity: hardly ever, or never (%) | 8.5 | 14.6 |
< 0.001
χ
|
Frailty classes
| |||
Non-frail (%) | 83.9 | 79.0 |
< 0.001
χ
|
Pre-frail (%) | 13.5 | 17.0 |
< 0.001
χ
|
Frail (%) | 2.7 | 4.0 |
< 0.001
χ
|
Sociodemographic
| |||
Age: mean (SD) | 64.2 (9.7) | 64.0 (10.1) | 0.071μ
|
Years of education: mean (SD) | 10.4 (4.5) | 10.5 (4.5) | 0.018μ
|
Physical
| |||
Self-rated health (best:1; worst:5): mean (SD) | 2.9 (1.1) | 3.0 (1.2) |
< 0.001
μ
|
No. chronic diseases: mean (SD) | 1.4 (1.3) | 1.5 (1.4) | 0.046μ
|
No. symptoms: mean (SD) | 1.2 (1.4) | 1.3 (1.5) | 0.080μ
|
No. contacts with doctor in last year: mean (SD) | 5.7 (9.0) | 7.4 (11.9) |
< 0.001
μ
|
Admitted to hospital in last year (%) | 13.1 | 14.9 |
0.003
χ
|
Functional
| |||
No. limitations with ADLs: mean (SD) | 0.16 (0.66) | 0.22 (0.90) |
0.004
μ
|
No. limitations with IADLs: mean (SD) | 0.23 (0.89) | 0.34 (1.07) |
< 0.001
μ
|
Received home care: personal/nursing (%) | 3.3 | 3.4 | 0.974χ
|
Received home care: domestic tasks (%) | 2.7 | 3.4 | 0.058χ
|
Psychological and cognitive
| |||
EURO-D score (min: 0; max: 12) (SD) | 1.8 (1.9) | 2.0 (2.2) |
< 0.001
μ
|
Verbal fluency test score: mean (SD) | 19.3 (7.3) | 18.6 (7.5) |
< 0.001
μ
|
Delayed word recall score: mean (SD) | 3.2 (1.9) | 3.0 (1.9) |
< 0.001
μ
|
Sensitivity analysis
Females | Males | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Frailty class |
N(class) |
N
(mortality available) |
N
(died) | Unadj. mortality rate (%) |
N(mortality missing) |
Nmissing expected as dead |
N(class) |
N
(mortality available) |
N
(died) | Unadj. mortality rate (%) |
N(mortality missing) |
Nmissing expected as dead |
Non-frail | 10,420 | 7,179 | 51 | 0.7 | 3,241 | 23 | 10,517 | 7,231 | 142 | 2.0 | 3,286 | 66 |
Pre-frail | 4,025 | 2,621 | 67 | 2.6 | 1,404 | 37 | 1,871 | 1,162 | 102 | 8.8 | 709 | 62 |
Frail | 1,133 | 682 | 63 | 9.2 | 451 | 41 | 395 | 230 | 52 | 22.6 | 165 | 37 |
Frailty calculators
Females
-
If predicted DFS < 0.3151361243, NON-FRAIL
-
If predicted DFS < 2.1301121973, PRE-FRAIL
-
If predicted DFS < 6, FRAIL
Males
-
If predicted DFS < 1.211878526, NON-FRAIL
-
If predicted DFS < 3.0052612772, PRE-FRAIL
-
If predicted DFS < 7, FRAIL