Frailty Index Predicts All-Cause Mortality for Middle-Aged and Older Taiwanese: Implications for Active-Aging Programs

Background Frailty Index, defined as an individual’s accumulated proportion of listed health-related deficits, is a well-established metric used to assess the health status of old adults; however, it has not yet been developed in Taiwan, and its local related structure factors remain unclear. The objectives were to construct a Taiwan Frailty Index to predict mortality risk, and to explore the structure of its factors. Methods Analytic data on 1,284 participants aged 53 and older were excerpted from the Social Environment and Biomarkers of Aging Study (2006), in Taiwan. A consensus workgroup of geriatricians selected 159 items according to the standard procedure for creating a Frailty Index. Cox proportional hazard modeling was used to explore the association between the Taiwan Frailty Index and mortality. Exploratory factor analysis was used to identify structure factors and produce a shorter version–the Taiwan Frailty Index Short-Form. Results During an average follow-up of 4.3 ± 0.8 years, 140 (11%) subjects died. Compared to those in the lowest Taiwan Frailty Index tertile (< 0.18), those in the uppermost tertile (> 0.23) had significantly higher risk of death (Hazard ratio: 3.2; 95% CI 1.9–5.4). Thirty-five items of five structure factors identified by exploratory factor analysis, included: physical activities, life satisfaction and financial status, health status, cognitive function, and stresses. Area under the receiver operating characteristic curves (C-statistics) of the Taiwan Frailty Index and its Short-Form were 0.80 and 0.78, respectively, with no statistically significant difference between them. Conclusion Although both the Taiwan Frailty Index and Short-Form were associated with mortality, the Short-Form, which had similar accuracy in predicting mortality as the full Taiwan Frailty Index, would be more expedient in clinical practice and community settings to target frailty screening and intervention.

[1]  Mattijs E Numans,et al.  Prediction of adverse health outcomes in older people using a frailty index based on routine primary care data. , 2013, The journals of gerontology. Series A, Biological sciences and medical sciences.

[2]  A. Mitnitski,et al.  Assessing biological aging: the origin of deficit accumulation , 2013, Biogerontology.

[3]  Dennis Child,et al.  The essentials of factor analysis , 1970 .

[4]  Kenneth Rockwood,et al.  Prevalence and 10‐Year Outcomes of Frailty in Older Adults in Relation to Deficit Accumulation , 2010, Journal of the American Geriatrics Society.

[5]  T. Gill,et al.  A standard procedure for creating a frailty index , 2008, BMC geriatrics.

[6]  M. Cesari,et al.  How the Frailty Index May Support the Allocation of Health Care Resources: An Example From the INCUR Study. , 2016, Journal of the American Medical Directors Association.

[7]  J. Woo,et al.  Comparison of Frailty Indicators Based on Clinical Phenotype and the Multiple Deficit Approach in Predicting Mortality and Physical Limitation , 2012, Journal of the American Geriatrics Society.

[8]  L. Fried,et al.  Frailty in older adults: evidence for a phenotype. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[9]  Kenneth Rockwood,et al.  Changes in relative fitness and frailty across the adult lifespan: evidence from the Canadian National Population Health Survey , 2011, Canadian Medical Association Journal.

[10]  A. Sheikh,et al.  Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2 , 2008, BMJ : British Medical Journal.

[11]  A. Mitnitski,et al.  Frailty in relation to the accumulation of deficits. , 2007, The journals of gerontology. Series A, Biological sciences and medical sciences.

[12]  H. Allore,et al.  A program to prevent functional decline in physically frail, elderly persons who live at home. , 2002, The New England journal of medicine.

[13]  Wei‐Ju Lee,et al.  The impact of influenza vaccination on hospitalizations and mortality among frail older people. , 2014, Journal of the American Medical Directors Association.

[14]  A. Mitnitski,et al.  Trajectories of changes over twelve years in the health status of Canadians from late middle age , 2012, Experimental Gerontology.

[15]  E. DeLong,et al.  Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. , 1988, Biometrics.

[16]  Alan D. Lopez,et al.  Measuring the global burden of disease. , 2013, The New England journal of medicine.

[17]  Kenneth Rockwood,et al.  Accumulation of Deficits as a Proxy Measure of Aging , 2001, TheScientificWorldJournal.

[18]  K. Rockwood,et al.  Accumulation of Non-Traditional Risk Factors for Coronary Heart Disease Is Associated with Incident Coronary Heart Disease Hospitalization and Death , 2014, PloS one.

[19]  A. Mitnitski,et al.  Analysis of frailty and survival from late middle age in the Beijing Longitudinal Study of Aging , 2011, BMC geriatrics.

[20]  N. Lackey,et al.  Making Sense of Factor Analysis: The Use of Factor Analysis for Instrument Development in Health Care Research , 2003 .

[21]  A. Mitnitski,et al.  Social Vulnerability, Frailty and Mortality in Elderly People , 2008, PloS one.

[22]  A. Fletcher,et al.  A reliable measure of frailty for a community dwelling older population , 2010, Health and quality of life outcomes.

[23]  Linda P Fried,et al.  Frailty in the clinical scenario , 2015, The Lancet.

[24]  F. Hsiao,et al.  Comparisons of annual health care utilization, drug consumption, and medical expenditure between the elderly and general population in Taiwan , 2016 .

[25]  S. Pocock,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. , 2007, Preventive medicine.

[26]  T. Strandberg,et al.  Frailty in elderly people , 2007, The Lancet.

[27]  L. Ferrucci,et al.  Comparing the Prognostic Accuracy for All-Cause Mortality of Frailty Instruments: A Multicentre 1-Year Follow-Up in Hospitalized Older Patients , 2012, PloS one.

[28]  Shu-Hui Lin,et al.  Cohort Profile: The Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan. , 2016, International journal of epidemiology.

[29]  J. Stevens,et al.  Exploratory and Confirmatory Factor Analysis , 2012 .

[30]  L. Peng,et al.  Effectiveness of short-term interdisciplinary intervention on postacute patients in Taiwan. , 2011, Journal of the American Medical Directors Association.

[31]  Konstantin G Arbeev,et al.  Cumulative Deficits Better Characterize Susceptibility to Death in Elderly People than Phenotypic Frailty: Lessons from the Cardiovascular Health Study , 2008, Journal of the American Geriatrics Society.

[32]  M. Echteld,et al.  Predicting 3‐Year Survival in Older People with Intellectual Disabilities Using a Frailty Index , 2015, Journal of the American Geriatrics Society.

[33]  L. Peng,et al.  Soluble ICAM-1, Independent of IL-6, Is Associated with Prevalent Frailty in Community-Dwelling Elderly Taiwanese People , 2016, PloS one.

[34]  Nobhojit Roy,et al.  Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition , 2015, The Lancet.

[35]  J. Dartigues,et al.  Frailty Index and Mortality in Nursing Home Residents in France: Results From the INCUR Study. , 2015, Journal of the American Medical Directors Association.

[36]  Ming-Hsien Lin,et al.  Association between Frailty, Osteoporosis, Falls and Hip Fractures among Community-Dwelling People Aged 50 Years and Older in Taiwan: Results from I-Lan Longitudinal Aging Study , 2015, PloS one.

[37]  G. Ostir,et al.  Mexican Americans and frailty: findings from the Hispanic established populations epidemiologic studies of the elderly. , 2009, American journal of public health.

[38]  R. Gonzalez.  Applied Multivariate Statistics for the Social Sciences , 2003 .

[39]  S. Brooks,et al.  Applied Multivariate Statistics for the Social Sciences , 1993 .

[40]  H. Arai,et al.  Differences in lifestyle, physical performance and quality of life between frail and robust Brazilian community‐dwelling elderly women , 2016, Geriatrics & gerontology international.