Background
Methods
Sampling frame
Measures
CHS Definition* | CHS Sample* (%) | WHAS Sample* (%) | FRéLE Definition | FRéLE Sample (%) |
---|---|---|---|---|
Weight loss | 7,3% | 12,7% | Weight loss | 13.3% |
Lost > 10 ponds in last year | Self-reported unintentional weight loss of 10% of normal weight or 4.5 kg or more. | |||
Exhaustion | 21.3% | 14,1% | Exhaustion | 20.1% |
Self-Report of either of: | The “vitality” subscale of the SF-36: | |||
i) Felt that everything I did was an effort in the last week, or | First quintile at 46.88 | |||
ii) could not get going in the last week | ||||
Low energy | 24,1% | 19.8% | Low energy | 20.4% |
270 on activity scale (18 items) | Physical Activity Scale for the Elderly | |||
First quintile at 32.33 for women | ||||
First quintile at 39.35 for men | ||||
Slowness | 38,0% | 31.3% | Slowness | 20.9% |
Walking 15 ft (4.57 m): | Guralnik’s mobility performance tests adjusted for a 4.572 m (15 ft) distance: | |||
Time ≥ 7 cm/s for height ≤ 159 cm or | Women: Time ≥ 5.6 cm/s (first quintile) for height ≤ 155.81 cm (average) or | |||
Time ≥ 6 cm/s for height > 159 cm | Women: Time ≥ 6.54 cm/s (first quintile) for height > 155.81 cm (average) | |||
Men: Time ≥ 6.3 cm/s (first quintile) for height ≤ 169.55 cm (average) or | ||||
Men: Time ≥ 7.0 cm/s (first quintile) for height > 169.55 cm (average) | ||||
Weakness | 26,2% | 20,8% | Weakness | 20% |
Grip strength ≤17 for BMI ≤23 kg/m2; | Martin Vigorimeter using the American Society of Hand Therapists procedure: | |||
Grip strength ≤17,3 for BMI 23,1–26 kg/m2; | Women: Grip strength ≤37.0 (first quintile) for BMI ≤23.49 kg/m2 (first quintile**) | |||
Grip strength ≤18 for BMI 26,1–29 kg/m2; | Women: Grip strength ≤35 .0 for BMI > 23.49 - ≤25.97 kg/m2 (second quintile) | |||
Grip strength ≤21 for BMI > 29 kg/m2; | Women: Grip strength ≤35.0 for BMI > 25.97 - ≤28.56 kg/m2 (third quintile) | |||
Women: Grip strength ≤35.0 for BMI > 28.56 - ≤32.11 kg/m2 (fourth quintile) | ||||
Women: Grip strength ≤ 35.0for BMI > 32.11 kg/m2 (fourth quintile) | ||||
Men: Grip strength ≤47.4 (first quintile) for BMI ≤24.17 kg/m2 (first quintile) | ||||
Men: Grip strength ≤55.0 for BMI > 24.17 - ≤26.42 kg/m2 (second quintile) | ||||
Men: Grip strength ≤55.0 for BMI > 26.42 - ≤28.59 kg/m2 (third quintile) | ||||
Men: Grip strength ≤53.6 for BMI > 28.59 - ≤31.31 kg/m2 (fourth quintile) | ||||
Men: Grip strength ≤55.0 for BMI > 31.31 kg/m2 (fourth quintile) | ||||
Overall frailty status | Overall frailty status | |||
Robust | 33.2% | 44,9% | Robust | 49,7% |
Pre-frail | 55.2% | 43,8% | Pre-frail | 38,3% |
Frail | 11.6% | 11,3% | Frail | 12,0% |
Frailty components
Factors associated with frailty
Statistical analyses
Eight analytical steps
Results
Do FRéLE and WHAS results differ on LCA with dichotomous representation of frailty components?
Bootstrap | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Loglikehood | Chi-Square Fit | BIC | Differences in BIC | loglikehood | ||||||
P Values | ratio test | |||||||||
# of Classes | FRéLE | WASP | d.f. | FRéLE | WASP | FRéLE | WASP | FRéLE | WASP | FRéLE |
3 (vs. 2) | − 3665,2 | N.Av.** | 14 | 0,48 | 0,52 | 7456 | 3467 | 26 | 27 | 0,030 |
2 (vs. 1) | − 3674,1 | N.A. | 20 | 0,05 | 0,22 | 7430 | 3440 | − 445 | − 143 | < 0.001 |
1 class | − 3919,0 | N.A. | 26 | < 0.001 | < 0.001 | 7875 | 3583 | N.Ap.*** | N.Ap.*** | N.Ap. |
* Woman Health and Aging Study | ||||||||||
** N.Av. Not Available | ||||||||||
*** N.Ap. Not Applicable |
How many factors from the components?
Is the null hypothesis of the 1-class model rejected in FRéLE with LCA and FMM models?
Bootstrap | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
k-class | Differences | 1000 draws | Observed | Coefficients | S.E | Coverage | Power | |||
Models | Entropy | BIC | in BIC | LL | p = 0,05 | −2*(LL [H1]-LL [H0]) | Bias | Bias | ||
A: Latent classes: no factor loadings and no factor variance | ||||||||||
1. classes differ on intercepts [LCA-ev models] | ||||||||||
4 classes*** | N.A.** | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. |
3 classes | 2 classes | 0,681 | 65,379 | −187 | −32,611,7 | 17,5 | 231,4* | 0,22% | 1,58% | 95,1% | 99,9% |
2 classes | 1 class | 0,670 | 65,566 | − 952 | − 32,727,4 | 16,7 | 988,8* | 0,18% | 1,63% | 95,0% | 100,0% |
1 class | N/A | 66,518 | N.A. | −33,221,8 | N/A | N.A. | 0,10% | 1,58% | 94,9% | 99,1% |
***Search process stopped. One class with case count equal to 14 only. | ||||||||||
2. classes differ on intercepts and residual errors [LCA-uv models] | ||||||||||
5 classes*** | 0,557 | 65,251 | N.A. | −32,444,4 | N.A. | N.A. | 1,16% | 17,2% | 93,5% | 96,7% |
4 classes |3 classes | 0,628 | 65,264 | −62 | −32,476,5 | 28,2 | 135,8* | 0,55% | 3,70% | 94,3% | 99,2% |
3 classes | 2 classes | 0,601 | 65,326 | −156 | −32,544,4 | 27,7 | 245,6* | 0,39% | 1,56% | 94,4% | 96,6% |
2 classes | 1 class | 0,696 | 65,482 | − 1036 | −32,667,2 | 31,5 | 1109,2* | 0,15% | 1,40% | 95,1% | 95,2% |
1 class | N.A. | 66,518 | N.A. | −33,221,8 | N.A. | N.A. | 0,10% | 1,58% | 94,9% | 99,1% |
***S.E. bias greater than 10% | ||||||||||
B: Factor mixture model - Classes do not differ on residual errors and factor variance | ||||||||||
1. Strict measurement invariance [SiMI-ev models] | ||||||||||
3 classes*** | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. |
2 classes | 1 class | 0,219 | 65,359 | 10 | −32,612,7 | 6,7 | 12,8* | 2,98% | 3,07% | 94,9% | 97,1% |
1 class | N/A | 65,349 | N.A. | −32,619,1 | N.A. | N.A. | 0,89% | 1,30% | 95,1% | 99,8% |
***Search process stopped. One class with case count equal to one. | ||||||||||
2. Weak measurement invariance [WMI-ev models] | ||||||||||
4 classes**** | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. |
3 classes! 1 classes | 0,657 | 65,250 | −99 | −32,528,5 | 30,0 | 181,2* | 1,08% | 1,82% | 94,9% | 99,3% |
2 classes*** | 0,743 | 65,281 | N.A. | −32,566,5 | N.A. | N.A. | 0,32% | 10,6% | 94,6% | 99,8% |
1 class | N/A | 65,349 | N.A. | −32,619,1 | N/A | N.A. | 0,89% | 1,30% | 95,1% | 99,8% |
**** Search process stopped. One class with count equal to 18 only. | ||||||||||
***S.E. bias greater than 10% | ||||||||||
3. No measurement invariance [NMI-ev models] | ||||||||||
3 classes*** | 2 classes | 0,484 | 65,264 | −29 | −32,506,2 | 24,8 | 103,2 | 1,75% | 9,98% | 95,1% | 99,1% |
2 classes | 1 class | 0,709 | 65,293 | −56 | −32,557,8 | 26,0 | 122,6* | 0,42% | 1,82% | 95,0% | 96,6% |
1 class | N.A. | 65,349 | N/A | −32,619,1 | N.A. | N.A. | 0,89% | 1,30% | 95,1% | 99,8% |
*** 3 classes model not significant | ||||||||||
C: Factor mixture model - Classes differ on residual errors and factor variance | ||||||||||
1. Strong measurement invariance [SoMI-uv models] | ||||||||||
5 classes*** | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. |
4 classes | 2 classes | 0,585 | 65,232 | −32 | −32,482,7 | 30,9 | 136,0* | 0,96% | 7,45% | 93,6% | 94,6% |
3 classes*** | 0,437 | 65,234 | N.A. | −32,506,1 | N.A. | N.A. | 0,71% | 13,0% | 94,4% | 99,3% |
2 classes | 1 class | 0,420 | 65,264 | −85 | −32,550,7 | 18,1 | 136,8* | 0,68% | 2,03% | 93,9% | 92,9% |
1 class | N.A. | 65,349 | N.A. | −32,619,1 | N.A. | N.A. | 0,89% | 1,30% | 95,1% | 99,8% |
***S.E. bias greater than 10% | ||||||||||
**** | ||||||||||
2. Week measurement invariance [WMI-uv models] | ||||||||||
4 classes | 3 classes*** | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. |
3 classes | 2 classes | 0,393 | 65,202 | −55 | −32,456,9 | 27,1 | 143,0* | 1,10% | 6,43% | 94,6% | 99,0% |
2 classes | 1 class | 0,399 | 65,257 | −92 | −32,528,4 | 33,7 | 181,4* | 0,88% | 8,11% | 94,6% | 99,3% |
1 class | N.A. | 65,349 | N/A | −32,619,1 | N.A. | N.A. | 0,89% | 1,30% | 95,1% | 99,8% |
*** The loglikelihood ratio for the (k-1) = 3-class model could not be computed. None of the coefficients on the factor part and of its variance were statistically significant. This model degenerated into the LPA 4-class model with equal variances | ||||||||||
3. No measurement invariance [NMI-uv models] | ||||||||||
4 classes** | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. | N.A. |
3 classes | 1 classes | 0,408 | 65,211 | − 138 | −32,438,8 | 58,4 | 360,6* | 3,04% | 9,8% | 92,9% | 94,1% |
2 classes*** | 0,375 | 65,250 | N.A. | −32,510,1 | N.A. | N.A. | 1,64% | 10,7% | 93,3% | 99,1% |
1 class | N.A. | 65,349 | N.A. | −32,619,1 | N.A. | N.A. | 0,89% | 1,30% | 95,1% | 99,8% |
** Search for a reduced model degenerated into the LPA model with 4 classes with unequal variances. | ||||||||||
***S.E. bias greater than 10% | ||||||||||
Note: * Null hypothesis rejected at p ≤ 0,05 | ||||||||||
**N.A.: Not Applicable or Non Available |
How many classes?
Are residuals equal over classes?
# of | Differences | Bootstrap | Observed | |||||
---|---|---|---|---|---|---|---|---|
# of Classes | Test | parameters | BIC | in BIC | LL | p = 0,05 | −2*(LL [H1]-LL [H0]) | |
A. Within LCA Models | ||||||||
1. H [a.1]:LCA-uv1 | 4 classes | H [a.1]|H [a.0] | 42 | 65,264 | 115 | −32,476,9 | 43,6 | 269,6* |
2. H [a.0]:LCA-ev2 | 3 classes | 21 | 65,379 | −32,611,7 | ||||
B. Within Strong Measurement Invariance (SMI) models | ||||||||
3. H [b.1]:SoMI-uv3 | 4 classes | H [b.1]|H [b.0] | 36 | 65,232 | 120 | −32,482,7 | 36,3 | 260,8* |
4. H [b.0]:SiMI-ev4 | 2 classes | 17 | 65,352 | −32,613,1 | ||||
C. Within Weak measurement invariance (WMI) models | ||||||||
5. H [c.1]:WMI-uv5 | 3 classes | H [c.1]|H [c.0] | 38 | 65,189 | 61 | −32,453,8 | 19,6 | 149,4* |
6. H [b.0]:WMI-ev6 | 3 classes | 26 | 65,250 | −32,528,5 | ||||
D. Within Null Measurement Invariance (NMI) models | ||||||||
7. H [d.1]:NMI-uv7 | 3 classes | H [d.1]|H [c.0] | 45 | 65,211 | 82 | −32,438,8 | 38,4 | 238,0* |
8. H [d.0]:NMI-ev8 | 2 classes | 25 | 65,293 | −32,557,8 | ||||
E. Testing the LPA-uv, WMI-uv and NMI-uv models against the null model (SMI-uv) | ||||||||
9. H [d.1]:NMI-uv7 | 3 classes | H [d.1]|H [b.1] | 45 | 65,211 | 21 | −32,438,8 | 282,3 | 87,8 |
10. H [c.1]:WMI-uv5 | 3 classes | H [c.1]|H [b.1] | 38 | 65,189 | 43 | −32,453,8 | 267,5 | 57,8 |
11. H [a.1]:LPA-uv1 | 4 classes | H [a.1]|H [b.1] | 42 | 65,264 | −32 | −32,476,9 | 306,1 | 11,6 |
The null model: | ||||||||
12. H [b.1]:SMI-uv4 | 4 classes | 36 | 65,232 | N.A.** | −32,482,7 | N.A. | N.A. | |
Notes: | ||||||||
* Null rejected | ||||||||
** N.A. Not Applicable | ||||||||
1. LPA-uv: LPA with unequal variances | ||||||||
2. LPA-ev: LPA with equal variances | ||||||||
3. SoMI-uv: FMM with Strong Measurement invariance - unequal variances | ||||||||
4. SiMI-ev: FMM with Strict Measurement invariance - equal variances | ||||||||
5. WMI-uv: FMM with Weak Measurement invariance - unequal variances | ||||||||
6. WMI-ev: FMM with Weak Measurement invariance - equal variances | ||||||||
7. NMI-uv: FMM with No Measurement invariance - unequal variances | ||||||||
8. NMI-ev: FMM with No Measurement invariance - equal variances |
Do frailty components increase in the same direction across the selected LCA, WMI and NMI classes?
Fried 3-Class model | SiMI 4-Class model | WMI 3-Class model | Total | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Frail | Pre-frail | Robust | Class 1 | Class 2 | Class 3 | Class 4 | Class 1 | Class 2 | Class 3 | sample | |
Part A. Coefficients for the Fried LCA 3-class, FRéLE SiMI-uv 4-classes and FRéLE WMI-uv models | |||||||||||
Factor loadings | |||||||||||
Exhaustion | N.A.* | N.A. | N.A. | 1,00 | 1,00 | 1,00 | 1,00 | 1,00 | 1,00 | 1,00 | N.A. |
Physical Activities | N.A. | N.A. | N.A. | 4,10 | 4,10 | 4,10 | 4,10 | 4,61 | 4,61 | 4,61 | N.A. |
Grip strength | N.A. | N.A. | N.A. | 1,21 | 1,21 | 1,21 | 1,21 | 1,13 | 1,13 | 1,13 | N.A. |
Gait speed | N.A. | N.A. | N.A. | 2,17 | 2,17 | 2,17 | 2,17 | 3,38 | 3,38 | 3,38 | N.A. |
Weight lost (in Kg) | N.A. | N.A. | N.A. | −0,35 | −0,35 | −0,35 | −0,35 | −0,13 | −0,13 | −0,13 | N.A. |
Class thresholds or Intercepts | |||||||||||
Exhaustion | 0,16 | −0,82 | − 2954 | 43,15 | 43,15 | 43,15 | 43,15 | 53,23 | 62,42 | 73,76 | N.A. |
Physical Activities | 1,26 | −0,92 | − 7706 | 0,00 | 0,00 | 0,00 | 0,00 | 57,96 | 69,88 | 121,53 | N.A. |
Grip strength | 0,38 | −0,81 | − 3293 | 34,77 | 34,77 | 34,77 | 34,77 | 56,44 | 47,73 | 73,53 | N.A. |
Gait speed | 3,32 | −1,05 | − 3275 | 44,28 | 44,28 | 44,28 | 44,28 | 83,54 | 79,10 | 100,00 | N.A. |
Weight lost (in Kg if > 0) | N.A. | N.A. | N.A. | 7,05 | 7,05 | 7,05 | 7,05 | 0,00 | 3,47 | 0,00 | N.A. |
Weight lost (1 if Kg > 4,5; else = 0) | 1,05 | 1,27 | 3366 | 0,45 | 0,45 | 0,45 | 0,45 | 0,00 | 1,03 | 1,47 | N.A. |
Means | N.A. | N.A. | N.A. | 32.232 | 21,72 | 8,53 | 0,00 | N.A. | N.A. | N.A. | N.A. |
Part B. Associations of FRéLE and Fried classes with frailty components | |||||||||||
Means on components | |||||||||||
Exhaustion | 42,72 | 57,77 | 72,13 | 43,20 | 50,00 | 65,40 | 77,30 | 46,70 | 62,80 | 75,30 | 63,10 |
Physical Activities | 11,07 | 67,92 | 111,92 | −16,00 | 28,66 | 91,50 | 146,14 | 47,00 | 65,80 | 127,50 | 82,98 |
Grip strength | 40,72 | 53,16 | 68,40 | 40,20 | 43,12 | 60,00 | 81,20 | 56,00 | 45,60 | 76,00 | 59,22 |
Gait speed | 49,49 | 79,16 | 103,20 | 33,76 | 59,70 | 91,79 | 120,83 | 86,10 | 77,70 | 101,90 | 87,72 |
Weight lost (in Kg if > 0) | 8,42 | 7,15 | 0,00 | 12,11 | 4,35 | 3,88 | 4,25 | 7,65 | 3,58 | 4,21 | 7,37 |
Weight lost (1 if Kg > 0; else = 0) | 43,7% | 21,0% | 0,00% | 38,6% | 21,8% | 9,5% | 3,2% | 23,7% | 12,6% | 3,6% | 13,2% |
Part C. Associations of FRéLE classes and Fried classes with frailty risk factors | |||||||||||
Means on risk factors | |||||||||||
Age | 84,6 | 80,4 | 75,9 | 83,3 | 83,9 | 78,0 | 73,0 | 79,60 | 81,40 | 75,20 | 78,10 |
Males | 46,8% | 48,9% | 51,2% | 61,4% | 32,5% | 50,4% | 69,5% | 50,7% | 29,6% | 70,7% | 50,0% |
Education | 4,41 | 5,22 | 5,72 | 4,18 | 4,55 | 5,48 | 6,30 | 5,14 | 4,93 | 5,99 | 5,37 |
Self rated health | 3,44 | 2,93 | 2,34 | 3,43 | 3,23 | 2,64 | 2,06 | 3,16 | 2,82 | 2,25 | 2,71 |
Chronic Diseases | 4,60 | 3,80 | 2,50 | 4,70 | 4,30 | 3,10 | 2,20 | 4,07 | 3,50 | 2,38 | 3,25 |
Cognitive Impairment | 21,5 | 23,4 | 24,8 | 20,5 | 22,3 | 24,2 | 25,5 | 23,2 | 23,4 | 24,8 | 23,90 |
Depressive symptoms | 62,9% | 27,7% | 7,4% | 65,1% | 45,3% | 15,0% | 5,2% | 46,2% | 21,9% | 5,1% | 22,1% |
Disability in IADL | 93,2% | 55,4% | 23,4% | 100,0% | 85,4% | 34,8% | 8,8% | 62,8% | 58,0% | 1,6% | 44,4% |
Disability in ADL | 66,8% | 30,3% | 11,3% | 84,1% | 49,5% | 17,7% | 7,1% | 39,6% | 30,5% | 10,0% | 25,6% |
Deceased | 34,8% | 14,5% | 5,9% | 40,9% | 22,9% | 9,5% | 4,9% | 20,7% | 13,7% | 6,3% | 13,0% |
Number of cases | 207 | 627 | 807 | 47 | 411 | 874 | 309 | 422 | 628 | 591 | 1641 |
% in each class or class | 12,5% | 38,3% | 49,2% | 2,7% | 25,1% | 53,4% | 18,8% | 25,7% | 38,3% | 36,0% |