Cross-cultural adaptation and reliability testing of the Tilburg Frailty Indicator for optimizing care of Polish patients with frailty syndrome Frailty Intervention Trial (FIT) Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews A global clinical measure of fitness and frailty in elderly people The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT. Screening for frailty among older patients with cancer that qualify for abdominal surgery. Do home-based exercise interventions improve outcomes for frail older people? Findings from a systematic review. The SHARE frailty instrument for primary care predicts incident disability in a European population-based sample. Effectiveness of a multicomponent exercise program in the attenuation of frailty in long-term nursing home residents: study protocol for a randomized clinical controlled trial A pilot trial to predict frailty syndrome: The Japanese Health Research Volunteer Study Research: The challenges of clinical trials in the exclusion zone: The case of the frail elderly Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. The predictive validity of three self-report screening instruments for identifying frail older people in the community Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes. Reduced cerebellar gray matter is a neural signature of physical frailty Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians Is grip strength a useful single marker of frailty? Operationalizing a frailty index from a standardized comprehensive geriatric assessment. Usefulness of frailty profile for targeting older heart failure patients in disease management programs: a cost-effectiveness, pilot study A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial Mesenchymal Stem Cell Therapy for Aging Frailty Transitions in cognitive status in relation to frailty in older adults: A Comparison of three frailty measures Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. Frailty as a Major Factor in the Increased Risk of Death and Disability in Older People With Diabetes. Dairy Consumption and Risk of Frailty in Older Adults: A Prospective Cohort Study.
Background Frail older people are at high risk of developing adverse outcomes , such as disability , mortality , hospitalization , and institutionalization . Previous research suggests that the Tilburg Frailty Indicator ( TFI ) is a valid and reliable instrument for measuring frailty . The aim of this study was to adapt and to test the reliability of the Polish version of the TFI . Method A st and ard guideline was used for translation and cultural adaptation of the English version of the TFI into Polish . The study included 100 Polish patients ( mean age 68.2±6.5 years ) , among them 42 men and 58 women .  Cronbach ’s alpha was used for analysis of the internal consistency of the TFI . Results The mean total TFI score was 6.7±3.1 . Forty patients scored ≥5 , which corresponded to being frail . Cronbach ’s alpha reliability coefficients of the instrument ranged from 0.68 to 0.72 and item-total correlation ranged from 0.12 to 0.52 . Conclusion The TFI is valid and reproducible for assessment of frailty syndrome among a Polish population . The Polish adaptation of the TFI proved a useful and fast tool for assessing frailty Background Frailty is a term commonly used to describe the condition of an older person who has chronic health problems , has lost functional abilities and is likely to deteriorate further . However , despite its common use , only a small number of studies have attempted to define the syndrome of frailty and measure its prevalence . The criteria Fried and colleagues used to define the frailty syndrome will be used in this study ( i.e. weight loss , fatigue , decreased grip strength , slow gait speed , and low physical activity ) . Previous studies have shown that clinical outcomes for frail older people can be improved using multi-factorial interventions such as comprehensive geriatric assessment , and single interventions such as exercise programs or nutritional supplementation , but no interventions have been developed to specifically reverse the syndrome of frailty . We have developed a multidisciplinary intervention that specifically targets frailty as defined by Fried et al. We aim to establish the effects of this intervention on frailty , mobility , hospitalisation and institutionalisation in frail older people . Methods and Design A single centre r and omised controlled trial comparing a multidisciplinary intervention with usual care . The intervention will target identified characteristics of frailty , functional limitations , nutritional status , falls risk , psychological issues and management of chronic health conditions .  Two hundred and thirty people aged 70 and over who meet the Fried definition of frailty will be recruited from clients of the aged care service of a metropolitan hospital . Participants will be followed for a 12-month period . Discussion This research is an important step in the examination of specifically targeted frailty interventions . This project will assess whether an intervention specifically targeting frailty can be implemented , and whether it is effective when compared to usual care . If successful , the study will establish a new approach to the treatment of older people at risk of further functional decline and institutionalisation . The strategies to be examined are readily transferable to routine clinical practice and are applicable broadly in the setting of aged care health services . Trial Registration Australian New Zeal and Clinical Trails Registry : ACTRN12608000250336 Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Background : There is no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information This systematic review examines the effectiveness of current exercise interventions for the management of frailty . Eight electronic data bases were search ed for r and omized controlled trials that identified their participants as “ frail ” either in the title , abstract , and /or text and included exercise as an independent component of the intervention . Three of the 47 included studies utilized a vali date d definition of frailty to categorize participants . Emerging evidence suggests that exercise  has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review . Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults . There was a paucity of evidence to characterize the most beneficial exercise program for this population . However , multicomponent training interventions , of long duration ( ≥5 months ) , performed three times per week , for 30–45 minutes per session , generally had superior outcomes than other exercise programs . In conclusion , structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty BACKGROUND Mild frailty or pre-frailty is common and yet is potentially reversible . Preventing progression to worsening frailty may benefit individuals and lower health/social care costs . However , we know little about effective approaches to preventing frailty progression . OBJECTIVES ( 1 ) To develop an evidence - and theory-based home-based health promotion intervention for older people with mild frailty . ( 2 ) To assess feasibility , costs and acceptability of ( i ) the intervention and ( ii ) a full-scale clinical effectiveness and cost-effectiveness r and omised controlled trial ( RCT ) . DESIGN Evidence review s , qualitative studies , intervention development and a feasibility RCT with process evaluation . INTERVENTION DEVELOPMENT Two systematic review s ( including systematic search es of 14 data bases and registries , 1990 - 2016 and 1980 - 2014 ) , a state-of-the-art review ( from inception to 2015 ) and policy review identified effective components for our intervention . We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people ( aged 65 - 94 years ) ( n = 44 ) , carers ( n = 12 ) and health/social care professionals ( n = 27 ) . These data , and our evidence review s , fed into development of the ' HomeHealth ' intervention in collaboration with older people and multidisciplinary stakeholders . ' HomeHealth ' comprised 3 - 6 sessions with a support worker trained in behaviour change techniques , communication skills , exercise , nutrition and mood . Participants addressed self-directed independence and well-being goals , supported through education , skills training , enabling individuals to overcome barriers , providing feedback , maximising motivation and promoting habit formation . FEASIBILITY RCT Single-blind RCT , individually r and omised to ' HomeHealth ' or treatment as usual ( TAU ) . SETTING Community setting s in London and Hertfordshire , UK . PARTICIPANTS A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty . MAIN OUTCOME MEASURES Feasibility - recruitment , retention , acceptability and intervention costs . Clinical and health economic outcome data at 6 months included functioning , frailty status , well-being , psychological distress , quality of life , capability and NHS and societal service utilisation/costs . RESULTS We successfully recruited to target , with good 6-month retention ( 94 % ) . Trial procedures were acceptable with minimal missing data . Individual r and omisation was feasible . The intervention was acceptable , with good fidelity and modest delivery costs ( £ 307 per patient ) . A total of 96 % of participants identified at least one goal , which were mostly exercise related ( 73 % ) . We found significantly better functioning ( Barthel Index + 1.68 ; p = 0.004 ) , better grip strength ( + 6.48 kg ; p = 0.02 ) , reduced psychological distress ( 12-item General Health Question naire -3.92 ; p = 0.01 ) and increased capability-adjusted life-years [ + 0.017 ; 95 % confidence interval ( CI ) 0.001 to 0.031 ] at 6 months in the intervention arm than the TAU arm , with no differences in other outcomes . NHS and carer support costs were variable but , overall , were lower in the intervention arm than the TAU arm . The main limitation was difficulty maintaining outcome assessor blinding . CONCLUSIONS Evidence is lacking to inform frailty prevention service design , with no large-scale trials of multidomain interventions . From stakeholder/public perspectives , new frailty prevention services should be personalised and encompass multiple domains , particularly socialising and mobility , and can be delivered by trained non-specialists . Our multicomponent health promotion intervention was acceptable and delivered at modest cost . Our small study shows promise for improving clinical outcomes , including functioning and independence . A full-scale individually RCT is feasible . FUTURE WORK A large , definitive RCT of the HomeHealth service is warranted . STUDY REGISTRATION This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials IS RCT N11986672 . FUNDING This project was funded by the National Institute for Health Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 21 , No. 73 . See the NIHR Journals Library website for further project information OBJECTIVE The Geriatric Assessment ( GA ) is an established method for evaluating and optimizing diagnostic and treatment plans . However , it requires experience and is time-consuming . Therefore , a variety of screening methods have been developed . The aim of this study was to compare their accuracy for predicting frailty among older patients with cancer qualified for abdominal surgery based on comparison to the GA . MATERIAL AND METHODS One hundred and thirty five consecutive patients ≥65years of age were prospect ively enrolled . The diagnostic performance of eight screening tests was evaluated : The Vulnerable Elderly Survey ( VES-13 ) , Triage Risk Screening Tool ( TRST ) , Geriatric 8 ( G8 ) , Groningen Frailty Index ( GFI ) , abbreviated Comprehensive Geriatric Assessment ( aCGA ) , Rockwood , Balducci and Fried score . RESULTS The prevalence of frailty as diagnosed by the GA was 73 % . Screening methods identified frail patients in 40 - 75.5 % of cases . The sensitivity and specificity of these tests in predicting frailty were 52%-97 % ( Fried score-G8 ) and 44 - 100 % ( G8-Rockwood score ) , respectively . The positive and negative predictive values were 82 - 100 % ( Balducci-Rockwood ) and 43 - 84 % ( TRST-G8 ) , respectively . Age significantly influenced the predictive value of the screening tests whereas gender and type of cancer did not . CONCLUSION At present , there is no universal screening test that adequately identifies frailty in at risk older patients . The results of this study showed that the aCGA and G8 were the best screens for older patients with cancer that qualified for elective abdominal surgery ; the G8 had the highest sensitivity and negative predictive value and the aCGA was a good overall assessment tool BACKGROUND Frailty is common in older age , and is associated with important adverse health outcomes including increased risk of disability and long-term care admission . OBJECTIVES To evaluate whether home-based exercise interventions improve outcomes for frail older people . DATA SOURCES We search ed systematic ally for r and omised controlled trials ( RCTs ) and cluster RCTs , with literature search ing to February 2010 . STUDY SELECTION All trials that evaluated home-based exercise interventions for frail older people were eligible . Primary outcomes were mobility , quality of life and daily living activities . Secondary outcomes included long-term care admission and hospitalisation . RESULTS Six RCTs involving 987 participants met the inclusion criteria . Four trials were considered of high quality . One high quality trial reported improved disability in those with moderate but not severe frailty . Meta- analysis of long-term care admission rates identified a trend towards reduced risk . Inconsistent effects on other primary and secondary outcomes were reported in the other studies . CONCLUSIONS There is preliminary evidence that home-based exercise interventions may improve disability in older people with moderate , but not severe , frailty . There is considerable uncertainty regarding effects on important outcomes including quality of life and long-term care admission .  Home-based exercises are a potentially simple , safe and widely applicable intervention to prevent dependency decline for frail older people BACKGROUND The adoption of a frailty paradigm in primary care would be helpful to identify adults who need priority access to specialised re sources . The frailty phenotype by Fried et al is a popular operationalisation of frailty , but it is not easily applicable in routine primary care practice . We recently created and vali date d a frailty instrument based on the Survey of Health , Ageing and Retirement in Europe ( SHARE-FI ) , in order to provide primary care practitioners with an easy , reliable and freely accessible tool for the assessment and monitoring of frailty in community dwelling adults over the age of 50 years ( www.biomed central .com/1471 - 2318/10/57 ) . AIM To provide further prospect i ve validation of SHARE-FI , with a focus on disability . METHODS DESIGN longitudinal study ( wave 1 : 2004 - 2006 ; mean follow-up : 2.4 years ) . SETTING European population -based survey ( 12 countries ) . SUBJECTS 17 567 community dwelling participants ( mean age 63.3 years ) , of whom 13 378 ( 76.2 % ) were non-frail , 3438 ( 19.6 % ) pre-frail and 751 ( 4.3 % ) frail . MAIN OUTCOME MEASURES number of difficulties with basic ( ADL ) and instrumental ( IADL ) activities of daily living . STATISTICAL ANALYSES repeated measures ANOVA with adjustment for baseline age . RESULTS By wave 2 , 3.6 % of the non-frail , 12.2 % of the pre-frail and 30.4 % of the frail had increased their number of ADL difficulties by at least one . Likewise , 6.6 % of the non-frail , 20.4 % of the prefrail and 36.6 % of the frail had , by wave 2 , increased their number of IADL difficulties by at least one . Table 1 shows the repeated measures ANOVA suggested . CONCLUSION SHARE-FI may contribute to quality in primary care by offering a quick and reliable way to assess and monitor frailty in community dwelling individuals over the age of 50 and prioritize their access to re sources , and it serves as a novel tool for audit and research Background There is increasing evidence suggesting that cognition and physical frailty interact within a cycle of decline associated with aging which has been called cognitive frailty . Exercise programs have demonstrated to be an effective tool to prevent functional and cognitive decline during aging , but little is known about their potential to restore or maintain functionality in individuals that require long-term nursing care . Besides , WHO has recently highlighted the importance of introducing systematic musculoskeletal health programs for older people living in residential care , as they represent a particularly vulnerable group for the development of noncommunicable diseases . Methods This is a multicentre r and omized controlled trial . 114 participants will be r and omly allocated to a  usual care group or to an  intervention group .  Inclusion criteria are as follows : ≥ 70 years , ≥ 50 on the Barthel Index , ≥ 20 on MEC-35 who are capable to st and up and walk independently for 10 m. Subjects in the intervention group will add to the activities scheduled for the control group the participation in a 6 months long multicomponent exercise program design ed to improve strength , balance and walking retraining . Study assessment s will be conducted at baseline and at 3 and 6 months . The primary outcome is change in function assessed by Short Physical Performance Battery and secondary outcomes include other measurements to assess all together the condition of frailty , which includes functionality , sedentary behaviors , cognitive and emotional status and biological markers . The present study has been approved by the Committee on Ethics in Research of the University of the Basque Country ( Humans Committee Code M10/2016/105 ; Biological Sample s Committee Code M30/2016/106 ) . Discussion Results from this research will show if ageing related functional and cognitive deterioration can be effectively prevented by physical exercise in institutionalized elders . It is expected that the results of this research will guide clinical practice in nursing home setting s , so that clinicians and policymakers can provide more evidence -based practice for the management of institutionalized elder people . Trial registration The protocol has been registered under the Australian and New Zeal and Clinical Trials Registry ( ANZCTR ) with the identifier : ACTRN12616001044415 Most definitions of frailty utilize US population s in their development . The concept of frailty has not been well studied in Japan , which has the largest percentage of older patients ( per capita ) in the world . We created a 5-year prospect i ve cohort study of community-dwelling older Japanese adults . Participants were not frail at baseline , based on our definition adapted from the Canadian Study for Health and Aging Clinical Frailty Scale . Participants underwent a comprehensive geriatric assessment ( CGA ) at baseline , and final assessment s were either in person or via mailed survey .  We enrolled 407 individuals ( 184 men , mean age 78 ± 4 years ; 223 women , mean age 77 ± 4 years ) . Sixty-five participants met criteria for frailty by the end of the study . In univariate analyses , eighteen separate parameters were associated with frailty , some of which included : age , gender , h and grip , timed walk , systolic blood pressure , pulse pressure , cognitive status , living alone , and hearing deficits . In multivariate analyses , the following elements remained associated with frailty : timed walk , pulse pressure , cognition deficits and hearing deficits . We established cut-off points for timed walk ( 5m/3s ) and pulse pressure ( 60 mmHg ) . We then created a simple additive score for these four factors ( present = 1 ; absent = 0 ) . A score of 0 had a 93 % negative predictive value for frailty while a score of 4 had a 70 % positive predictive value . While further study is needed , this work creates an easy-to-administer tool that may be generalizable to other population Frail older people have been systematic ally excluded from r and omised controlled trials ( RCT ) . We aim to recruit older , frail hospitalised patients in an RCT and evaluate the frailty index ( FI ) as a measure to describe the types of people included in the study . We recruited 315 hospitalised patients aged 65 years ; age ranged from 60 to 102 years . Baseline assessment scores ranged as follow : Mini‐Mental Status Examination from 7 to 30 , Barthel index from 5 to 100 and FI from 2 to 24 . Total deaths were 20 ( 6 % ) . We demonstrated that it is feasible to recruit frail older people into RCTs . The FI does not show any ‘ floor ’ or ‘ ceiling ’ effects . We can measure frailty in an RCT cohort , and we believe that clinical trials should include more frail older people and that the use of an FI can facilitate such trials and generate reliable data to guide future medical practice in a rapidly ageing society BACKGROUND The clinical syndrome of frailty identified through the assessment of weight loss , gait speed , grip strength , physical activity , and physical exhaustion has been used to identify patients with reduced reserves . We hypothesized that frailty is useful in predicting adverse outcomes in optimized elective elderly colorectal surgery patients . METHODS A prospect i ve study was conducted at 2 centers ( Singapore and Japan ) . All patients over 75 years of age undergoing colorectal resection were assessed for the presence of the syndrome of frailty .  All these patients had already had their comorbidities optimized for surgery . The outcome measure was postoperative major complications ( defined as Clavien-Dindo type II and above complications ) . RESULTS Eighty-three patients were studied from February 2008 to April 2010 . The mean age was 81.5 years ( range 75 - 93 years ) . The mean comorbidity index was 3.37 ( range 0 - 11 ) . Twenty-six ( 31.3 % ) patients were an American Society of Anesthesiologists ( ASA ) score of 3 and above . Chi-square analysis revealed that the odds ratio of postoperative major complications was 4.083 ( 95 % confidence interval , 1.433 - 11.638 ) when the patient satisfied the criteria for frailty . Albumin < 35 , ASA > 3 , comorbidity index > 5 , and Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity ( POSSUM ) scores were not predictive of postoperative major complications . CONCLUSIONS Preliminary findings show that frailty is a potent adjunctive tool of predicting postoperative morbidity . Frailty can be used to identify elderly patients needing further optimization before major surgery Background If brief and easy to use self report screening tools are available to identify frail elderly , this may avoid costs and unnecessary assessment of healthy people . This study investigates the predictive validity of three self-report instruments for identifying community-dwelling frail elderly . Methods This is a prospect i ve study with 1-year follow-up among community-dwelling elderly aged 70 or older ( n = 430 ) to test sensitivity , specificity , and positive and negative predicted values of the Groningen Frailty Indicator , Tilburg Frailty Indicator and Sherbrooke Postal Question naire on development of disabilities , hospital admission and mortality . Odds ratios were calculated to compare frail versus non-frail groups for their risk for the adverse outcomes . Results Adjusted odds ratios show that those identified as frail have more than twice the risk ( GFI , 2.62 ; TFI , 2.00 ; SPQ , 2,49 ) for developing disabilities compared to the non-frail group ; those identified as frail by the TFI and SPQ have more than twice the risk of being admitted to a hospital . Sensitivity and specificity for development of disabilities are 71 % and 63 % ( GFI ) , 62 % and 71 % ( TFI ) and 83 % and 48 % ( SPQ ) . Regarding mortality , sensitivity for all tools are about 70 % and specificity between 41 % and 61 % . For hospital admission , SPQ scores the highest for sensitivity ( 76 % ) . Conclusion All three instruments do have potential to identify older persons at risk , but their predictive power is not sufficient yet . Further research on these and other instruments is needed to improve targeting frail elderly BACKGROUND The decision as to whether a patient can tolerate surgery is often subjective and can misjudge a patient 's true physiologic state . The concept of frailty is an important assessment tool in the geriatric medical population , but has only recently gained attention in surgical patients . Frailty potentially represents a measureable phenotype , which , if quantified with a st and ardized protocol , could reliably estimate the risk of adverse surgical outcomes . STUDY DESIGN Frailty was prospect ively evaluated in the clinic setting in patients consenting for major general , oncologic , and urologic procedures . Evaluation included an  established assessment tool ( Hopkins Frailty Score ) , self-administered question naires , clinical assessment of performance status , and biochemical measures .  Primary outcome was 30-day postoperative complications . RESULTS There were 189 patients evaluated : 117 from urology , 52 from surgical oncology , and 20 from general surgery clinics . Mean age was 62 years , 59.8 % were male , and 71.4 % were Caucasian . Patients who scored intermediately frail or frail on the Hopkins Frailty Score were more likely to experience postoperative complications ( odds ratio [ OR ] 2.07 , 95 % CI 1.05 to 4.08 , p = 0.036 ) . Of all other preoperative assessment tools , only higher hemoglobin ( p = 0.033 ) had a significant association and was protective for 30-day complications . CONCLUSIONS The aggregate score of patients as " intermediately frail or frail " on the Hopkins Frailty Score was predictive of a patient experiencing a postoperative complication . This preoperative assessment tool may prove beneficial when weighing the risks and benefits of surgery , allowing objective data to guide surgical decision-making and patient counseling Physical frailty has been recognized as a clinical syndrome result ing from declines in various physiological systems ; however , the role of the central nervous system in the pathophysiology of frailty remains unclear . The I‐Lan Longitudinal Aging Study r and omly sample d community‐dwelling people aged 50 or older for a brain magnetic resonance imaging study . All participants were assessed for frailty status ( robust , prefrail , and frail ) based on the presence of five frailty components : slow walking speed , muscle weakness , low physical activity , exhaustion and weight loss ( Fried criteria ) . Gray matter volume ( GMV ) changes associated with frailty status and individual frailty components were examined . Overall , 456 participants ( 64.0 ± 8.5 years , 47.6 % women ) were included in this study . The prefrail ( n = 178 , 39.0 % ) and frail ( n = 19 , 4.2 % ) subjects were grouped for analysis . The prefrail – frail group showed reduced GMV , compared to the robust group ( n = 259 , 56.8 % ) , in the cerebellum , hippocampi , middle frontal gyri , and several other cerebral regions ( corrected P < 0.05 ) . Each frailty component was associated with GMV changes in functionally related brain areas . Hierarchical cluster analysis categorized these components into three subsets . Motor‐related components , including weakness , low activity , and slowness , comprised one subset with a common cerebellar involvement . Exhaustion and weight loss were the other two subsets without cerebellar changes . To conclude , physical frailty is associated with a decreased reserve in specific brain regions , especially cerebellum . Further longitudinal studies are needed to explore if the cerebellum‐ and noncerebellum‐based frailty components reflect a distinctive future risk for developing frailty . Hum Brain Mapp 36:3666–3676 , 2015 . © 2015 Wiley Periodicals , Background and aims : Objectives were to develop a frailty index ( FI ) based on a st and ard comprehensive geriatric assessment ( CGA ) derived from a clinical examination ; to assess the validity of the FI-CGA and to compare its precision with other frailty measures . Methods : Design : Secondary analysis of a prospect i ve cohort study , with five-year follow-up data . Setting : Second phase of the Canadian Study of Health and Aging ( CSHA-2 ) ; clinical examinations were performed in clinics , nursing homes , and patients ’ homes . Participants : People selected ( as either cognitively impaired cases or unimpaired controls ) to receive the CSHA-2 clinical examination ( n=2305 ; women=1431 ) . Measurements : Clinical and performance-based measures and diagnostic data were extracted to correspond to the 10 impairment domains and the single comorbidity domain of a CGA . The proportion of deficits accumulated in each domain was calculated to yield the FI-CGA . The FI-CGA was vali date d and its predictive ability compared with other frailty measures . Results : Within the seven grade s of fitness/frailty identified , subjects with greater frailty were older , less educated , and more likely to be women . The FI-CGA correlated highly with a previously vali date d , empirically-derived frailty index ( r=0.76 ) . Frailty was associated with higher risk of death ( for each increment in frailty , the hazard ratio , adjusted for age , sex and education , was 1.23 ( 95 % CI 1.18–1.29 ) and institutionalization ( HR 1.20 ; 1.10–1.32 ) . Conclusions : In a population survey , the FI-CGA is a valid means of quantifying frailty from routinely collected data BACKGROUND chronological age is widely used as a marker of frailty in clinical practice . However there can be wide variation in frailty between individuals of a similar age .  Grip strength is a powerful predictor of disability , morbidity and mortality which has been used in a number of frailty scores but not as a single marker of frailty . OBJECTIVE to investigate the potential of  grip strength  as a single marker of frailty in older people of similar chronological age . DESIGN cross-sectional study with prospect i ve collection of mortality data . SETTING North Hertfordshire , UK . SUBJECTS 717 men and women , aged 64 - 74 , born and still living in North Hertfordshire , who took part in a previous study to investigate the relationship between size at birth and ageing processes in later life . METHODS the number of significant associations between grip strength and the ageing markers was compared with numbers between chronological age and the ageing markers . RESULTS in men , lower grip strength correlated significantly with ten ageing markers compared to chronological age which was significantly associated with seven . In women , there were six significant relationships for grip compared to three for age . The greater number of relationships between grip strength and ageing markers was not explained by the association between grip strength and age , and remained after adjustment for adult size . CONCLUSIONS grip strength was associated with more markers of frailty than chronological age within the narrow age range studied . Grip strength may prove a more useful single marker of frailty for older people of similar age than chronological age alone . Its validity in a clinical setting needs to be tested OBJECTIVES To construct and vali date a frailty index ( FI ) that is clinical ly sensible and practical for geriatricians by basing it on a routinely used comprehensive geriatric assessment ( CGA ) instrument . DESIGN Secondary analysis of a 3-month r and omized , controlled trial of a specialized mobile geriatric assessment team . SETTING Rural Nova Scotia . Participants were seen in their homes . PARTICIPANTS Frail older adults , of whom 92 were in the intervention group and 77 in the control group . MEASUREMENTS A st and ard CGA form that accounts for impairment , disability , and comorbidity burden was scored and summed as a frailty index ( FI-CGA ) . The FI-GCA was stratified to describe three levels of frailty . Patients were followed for up to 12 months to determine how well the index predicted adverse outcomes ( institutionalization or mortality , whichever came first ) . RESULTS The three levels of frailty were mild ( FI-CGA 0 - 7 ) , moderate ( FI-CGA 7 - 13 ) , and severe ( FI-CGA>13 ) . Demographic and social traits were similar across groups , but greater frailty was associated with worse function ( r=0.55 ) and mental status ( r=0.33 ) . Those with moderate and severe frailty had a greater risk of adverse outcomes than those with mild frailty ( unadjusted hazard ratio=1.9 and 5.5 , respectively ) . There was no difference between frailty groups in mean 3-month goal -attainment scaling scores . Intrarater reliability was 0.95 . CONCLUSION The FI-CGA is a valid , reliable , and sensible clinical measure of frailty that permits risk stratification of future adverse outcomes Background Disease management programs ( DMP ) improve outcomes in patients with heart failure . Because older heart failure patients represent a heterogeneous population , the aim of this study was to determine which patients benefit mostly from a DMP , by means of their frailty profile . Setting Heart failure outpatient clinic . Methods Consecutive ( n = 173 ) patients aged more than 70 years were r and omized to a  multidisciplinary DMP  ( n = 86 ) or usual care ( n = 87 ) . A modified frailty score ( range 1–6 ) was used as an index of global functional impairment . Results Mild to moderate frailty ( frailty score = 2–3 ) was associated with significant improvements in outcomes ( death and /or heart failure admission , heart failure admissions and all-cause admissions ) in DMP patients vs. usual care . Even in more frail patients ( frailty score = 4–6 ) a significant reduction in heart failure admissions was observed . By contrast , nonfrail patients ( frailty score = 1 ) did not derive significant benefit . In the cost-effectiveness analysis , the mean savings per patient , stratified according to their frailty score , were & U20AC ; −1003.31 for frailty score 1 ( 95 % confidence interval −3717.00–1709.00 ) , & U20AC ; 1104.72 for frailty score 2 ( −280.6–2491.00 ) , & U20AC ; 2635.42 for frailty score 3 ( 352.60–4917.00 , P = 0.025 ) and & U20AC ; 419.53 for frailty score 4–6 ( −1909.00–2749.00 ) . Intervention was therefore significantly cost saving in moderately frail , but not in nonfrail or severely frail patients . Thus , DMP was dominant ( i.e. both less costly and more effective than usual care ) in moderately frail patients . At sensitivity analysis ,  DMP  remained dominant even to changes in cost of intervention and hospitalizations . Conclusion This suggests that an intensive , hospital-based DMP appears to be more effective in older patients with mild-to-moderate levels of frailty . Thus , a multidimensional assessment of frailty seems to be a useful tool for appropriate selection of model of care Background Frailty is a well known and accepted term to clinicians working with older people . The study aim was to determine whether an intervention could reduce frailty and improve mobility . Methods We conducted a single center , r and omized , controlled trial among older people who were frail in Sydney , Australia . One group received an intervention targeting the identified characteristics of frailty , whereas the comparison group received the usual health care and support services . Outcomes were assessed by raters masked to treatment allocation at 3 and 12 months after study entry . The primary outcomes were frailty as assessed by the Cardiovascular Health Study criteria , and mobility as assessed by the Short Physical Performance Battery . Secondary outcome measures included disability , depressive symptoms and health-related quality of life . Results A total of 216 participants ( 90 % ) completed the study . Overall , 68 % of participants were women and the mean age was 83.3 years ( st and ard deviation , 5.9 ) . In the intention-to-treat analysis , the between-group difference in frailty was 14.7 % at 12 months ( 95 % confidence interval : 2.4 % , 27.0 % ; P = 0.02 ) . The score on the Short Physical Performance Battery , in which higher scores indicate better physical status , was stable in the intervention group and had declined in the control group ; with the mean difference between groups being 1.44 ( 95 % confidence interval , 0.80 , 2.07 ; P < 0.001 ) at 12 months . There were no major differences between the groups with respect to secondary outcomes . The few adverse events that occurred were exercise-associated musculoskeletal symptoms . Conclusions Frailty and mobility disability can be successfully treated using an interdisciplinary multifaceted treatment program . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : Chronic diseases and degenerative conditions are strongly linked with the geriatric syndrome of frailty and account for a disproportionate percentage of the health care budget . Frailty increases the risk of falls , hospitalization , institutionalization , disability , and death . By definition , frailty syndrome is characterized by declines in lean body mass , strength , endurance , balance , gait speed , activity and energy levels , and organ physiologic reserve . Collectively , these changes lead to the loss of homeostasis and capability to withst and stressors and result ing vulnerabilities . There is a strong link between frailty , inflammation , and the impaired ability to repair tissue injury due to decreases in endogenous stem cell production . Although exercise and nutritional supplementation provide benefit to frail patients , there are currently no specific therapies for frailty . Bone marrow-derived allogeneic mesenchymal stem cells ( MSCs ) provide therapeutic benefits in heart failure patients irrespective of age . MSCs contribute to cellular repair and tissue regeneration through their multilineage differentiation capacity , immunomodulatory , and anti-inflammatory effects , homing and migratory capacity to injury sites , and stimulatory effect on endogenous tissue progenitors . The advantages of using MSCs as a therapeutic strategy include st and ardization of isolation and culture expansion techniques and safety in allogeneic transplantation . Based on this evidence , we performed a r and omized , double-blinded , dose-finding study in elderly , frail individuals and showed that intravenously delivered allogeneic MSCs are safe and produce significant improvements in physical performance measures and inflammatory biomarkers . We thus propose that frailty can be treated and the link between frailty and chronic inflammation offers a potential therapeutic target , addressable by cell therapy Objectives Cognitive decline is related to frailty . Frailty can be operationalized in different ways , which have an unknown impact on the estimation of risk . Here , we compared 3 frailty measures in relation to cognitive changes and mortality in the Canadian Study of Health and Aging ( CSHA ) . Design Prospect i ve population -based study , with 5 year follow up . Participants / Setting 2,305 subjects aged 70 + years . Methods For each participant , cognitive status was measured by the errors in the Modified Mini-Mental State Examination ( 3MS ) score .  Three frailty measures were used : a Frailty Index based on the Comprehensive Geriatric Assessment ( FI-CGA ) evaluated from 47 potential deficits , a Clinical Frailty Score and the Fried frailty phenotype . Multivariate Poisson regression and multivariate logistic regression were used to examine the association between baseline cognitive errors and frailty and death , respectively , while controlling for possible confounders ( age , sex , education , and baseline cognitive status ) . Results Changes in cognitive status were strongly associated with baseline cognition and frailty , however defined . In multivariate models adjusted for age , sex and education , each frailty measure was associated with cognitive decline and with mortality . The frailest people ( from the highest FI-CGA tertile ) rarely showed cognitive improvement or stabilization ( 1.5 % , 95 % CI=0.002%–2.8 % ) compared with non-frail people ( from the lowest tertile of the FI-CGA ) , of whom 27.8 % ( 95 % CI=24.5%–31.1 % ) did not deteriorate . Conclusions Frail elderly people have an increased risk of cognitive decline . All frailty measures allowed quantification of individual vulnerability and predict both cognitive changes and mortality OBJECTIVES To define frailty using simple indicators ; to identify risk factors for frailty as targets for prevention ; and to investigate the predictive validity of this frailty classification for death , hospitalization , hip fracture , and activity of daily living ( ADL ) disability . DESIGN Prospect i ve study , the Women 's Health Initiative Observational Study . SETTING Forty U.S. clinical centers . PARTICIPANTS Forty thous and six hundred fifty-seven women aged 65 to 79 at baseline . MEASUREMENTS Components of frailty included self-reported muscle weakness/impaired walking , exhaustion , low physical activity , and unintended weight loss between baseline and 3 years of follow-up . Death , hip fractures , ADL disability , and hospitalizations were ascertained during an average of 5.9 years of follow-up . RESULTS Baseline frailty was classified in 16.3 % of participants , and incident frailty at 3-years was 14.8 % . Older age , chronic conditions , smoking , and depressive symptom score were positively associated with incident frailty , whereas income , moderate alcohol use , living alone , and self-reported health were inversely associated . Being underweight , overweight , or obese all carried significantly higher risk of frailty than normal weight . Baseline frailty independently predicted risk of death ( hazard ratio (HR)=1.71 , 95 % confidence interval (CI)=1.48 - 1.97 ) , hip fracture ( HR=1.57 , 95 % CI=1.11 - 2.20 ) , ADL disability ( odds ratio (OR)=3.15 , 95 % CI=2.47 - 4.02 ) , and hospitalizations ( OR=1.95 , 95 % CI=1.72 - 2.22 ) after adjustment for demographic characteristics , health behaviors , disability , and comorbid conditions . CONCLUSION These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women . Underweight , obesity , smoking , and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention OBJECTIVES To assess the role of frailty in predicting death and incident disability in older adults with type 2 diabetes mellitus . DESIGN Prospect i ve cohort study . SETTING Community dwelling . PARTICIPANTS A total of 1825 individuals ≥65 years old recruited between June 2006 and September 2009 were followed for a median of 5.5 years for mortality and 4.98 years for incident functional disability in activities of daily living . Self-reported diabetes , comorbidities ( Charlson index ) , cardio- and cerebrovascular diseases , drug treatments , Frailty Trait Score ( FTS ) and Frailty Index ( FI ) , activities of daily living , heart rate , and blood pressure among others were collected at baseline . MAIN OUTCOME MEASURES Survival analysis ( Kaplan-Meier ) , adjusted Cox proportional-hazards models , and binary logistic regression were used to assess the relationship between frailty , comorbidity , and vascular diseases and time to death and incident disability . RESULTS A total of 363 people had diabetes . Among them , 83 deaths and 84 cases of incident disability occurred during follow-up . People with diabetes died more frequently than those without diabetes [ hazard ratio = 1.36 , 95 % confidence interval ( CI ) 1.06 - 1.75 ; P = .002 ] , showing a poorer functional status at baseline . Survival analysis showed a relationship between frailty quartiles and the risk of death . In the adjusted Cox-models , only age and frailty indices , but not comorbidity or cardio/cerebrovascular diseases , were associated with the risk of death and incident disability after adjusting for measures of frailty . The hazard ratio for death was 1.51 ( 95 % CI 1.28 - 1.77 ) and 1.83 ( 95 % CI 1.49 - 2·26 ) for each 10 points increase in the FTS and FI ; odds ratio for incident disability was 1·64 ( 95 % CI 1.22 - 2.20 ) and 1·35 ( 95 % CI 1.09 - 1.67 ) when using FI and FTS , respectively . CONCLUSIONS Frailty is an important risk factor for death and disability in older adults with diabetes , supporting the recent recommendations that frailty status should be routinely assessed in these patients OBJECTIVES To examine the association between consumption of dairy products and risk of frailty  in community-dwelling older adults . DESIGN Prospect i ve cohort study . SETTING General population from the older cohort of the Study on Nutrition and Cardiovascular Risk in Spain . PARTICIPANTS Community-dwelling adults aged 60 and older free of frailty at baseline ( N = 1,871 ) . MEASUREMENTS From 2008 to 2010 ,  food consumption was assessed using a vali date d diet history . Participants were examined again in 2012 to assess incident frailty , defined as at least three of the five Fried criteria ( exhaustion , weakness , low physical activity , slow walking speed , unintentional weight loss ) . Adjusted odds ratios ( OR ) for the main confounders were obtained using logistic regression . RESULTS During follow-up , 134 new cases of frailty were identified . Participants consuming seven or more servings per week of low-fat milk and yogurt had lower incidence of frailty ( OR = 0.52 ; 95 % confidence interval ( CI ) = 0.29 - 0.90 ; P for trend = .03 ) than those consuming less than one serving per week . Specifically , consumers of seven or more servings per week of low-fat milk and yogurt had less risk of slow walking speed ( OR = 0.64 , 95 % CI = 0.44 - 0.92 , P trend = .01 ) and of weight loss ( OR = 0.54 , 95 % CI = 0.33 - 0.87 , P trend = .02 ) . Consuming seven or more servings per week of whole milk or yogurt ( OR = 1.53 , 95 % CI = 0.90 - 2.60 , P trend = .10 ) or of cheese ( OR = 0.91 , 95 % CI = 0.52 - 1.61 ; P trend = .61 ) was not associated with incident frailty . CONCLUSION Higher consumption of low-fat milk and yogurt was associated with lower risk of frailty and , specifically , of slow walking speed and weight loss . Current recommendations to prevent frailty include protein supplementation ; thus , although experimental research is needed , increasing the consumption of low-fat yogurt and milk might prevent frailty in older adults
Conclusions The TFI has the most robust evidence of reliability and validity and has been the most extensively examined in terms of psychometric properties .
However , there is insufficient evidence at present to determine the best tool for use in research and clinical practice .
Background Frailty is widely recognised as a distinct multifactorial clinical syndrome that implies vulnerability .
The links between frailty and adverse outcomes such as death and institutionalisation have been widely evidence d. There is currently no gold st and ard frailty assessment tool ; optimizing the assessment of frailty in older people therefore remains a research priority .
The objective of this systematic review is to identify existing multi-component frailty assessment tools that were specifically developed to assess frailty in adults aged ≥60 years old and to systematic ally and critically evaluate the reliability and validity of these tools .