Frailty index of deficit accumulation and falls: data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton cohort

BMC Musculoskeletal Disorders

Jonathan D Adachi²  Lehana Thabane²  Alexandra Papaioannou³  Courtney Kennedy¹  Laura Pickard³  George Ioannidis³  Guowei Li¹ 

[1] Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4 L8, Canada;St. Joseph’s Hospital, McMaster University, 25 Charlton Avenue East, Hamilton, ON L8N 1Y2, Canada;Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4 L8, Canada

关键词: Hospitalization;    Death;    Fracture;    Falls;    Frailty;   

Others  :  1127620
DOI  :  10.1186/1471-2474-15-185

 received in 2014-02-09, accepted in 2014-05-22,  发布年份 2014

【 摘 要 】

Background

To investigate the association between frailty index (FI) of deficit accumulation and risk of falls, fractures, death and overnight hospitalizations in women aged 55 years and older.

Methods

The data were from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton Cohort. In this 3-year longitudinal, observational cohort study, women (N = 3,985) aged ≥55 years were enrolled between May 2008 and March 2009 in Hamilton, Canada. A FI including co-morbidities, activities of daily living, symptoms and signs, and healthcare utilization was constructed using 34 health deficits at baseline. Relationship between the FI and falls, fractures, death and overnight hospitalizations was examined.

Results

The FI was significantly associated with age, with a mean rate of deficit accumulation across baseline age of 0.004 or 0.021 (on a log scale) per year. During the third year of follow-up, 1,068 (31.89%) women reported at least one fall. Each increment of 0.01 on the FI was associated with a significantly increased risk of falls during the third year of follow-up (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.02-1.03). The area under the curve (AUC) of the predictive model was 0.69 (95% CI: 0.67-0.71). Results of subgroup and sensitivity analyses indicated the relationship between the FI and risk of falls was robust, while bootstrap analysis judged its internal validation. The FI was significantly related to fractures (hazard ratio [HR]: 1.02, 95% CI: 1.01-1.03), death (OR: 1.05, 95% CI: 1.03-1.06) during the 3-year follow-up period and overnight hospitalizations (incidence rate ratio [IRR]: 1.02, 95% CI: 1.02-1.03) for an increase of 0.01 on the FI during the third year of follow-up. Measured by per standard deviation (SD) increment of the FI, the ORs were 1.21 and 1.40 for falls and death respectively, while the HR was 1.17 for fractures and the IRR was 1.18 for overnight hospitalizations respectively.

Conclusion

The FI of deficit accumulation increased with chronological age significantly. The FI was associated with and predicted increased risk of falls, fractures, death and overnight hospitalizations significantly.

【 授权许可】

   
2014 Li et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Rockwood K, Mitnitski A: Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007, 62(7):722-727.
• [2]Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K: Frailty in elderly people. Lancet 2013, 381(9868):752-762.
• [3]Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM: Toward a conceptual definition of frail community dwelling older people. Nurs Outlook 2010, 58(2):76-86.
• [4]Collard RM, Boter H, Schoevers RA, Oude Voshaar RC: Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 2012, 60(8):1487-1492.
• [5]Sternberg SA, Wershof Schwartz A, Karunananthan S, Bergman H, Mark Clarfield A: The identification of frailty: a systematic literature review. J Am Geriatr Soc 2011, 59(11):2129-2138.
• [6]Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001, 56(3):M146-M156.
• [7]Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A: A global clinical measure of fitness and frailty in elderly people. CMAJ 2005, 173(5):489-495.
• [8]Kulminski AM, Ukraintseva SV, Kulminskaya IV, Arbeev KG, Land K, Yashin AI: Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc 2008, 56(5):898-903.
• [9]Sanders JL, Boudreau RM, Fried LP, Walston JD, Harris TB, Newman AB: Measurement of organ structure and function enhances understanding of the physiological basis of frailty: the Cardiovascular Health Study. J Am Geriatr Soc 2011, 59(9):1581-1588.
• [10]De Vries N, Staal J, Van Ravensberg C, Hobbelen J, Olde Rikkert M, Nijhuis-Van Der Sanden M: Outcome instruments to measure frailty: a systematic review. Ageing Res Rev 2011, 10(1):104-114.
• [11]Karlsson MK, Vonschewelov T, Karlsson C, Coster M, Rosengen BE: Prevention of falls in the elderly: a review. Scand J Public Health 2013, 41(5):442-454.
• [12]Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med 1988, 319(26):1701-1707.
• [13]Tinetti ME, Doucette J, Claus E, Marottoli R: Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995, 43(11):1214-1221.
• [14]Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM: Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 2007, 62(7):744-751.
• [15]Rothman MD, Leo-Summers L, Gill TM: Prognostic significance of potential frailty criteria. J Am Geriatr Soc 2008, 56(12):2211-2116.
• [16]Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, Dam TT, Marshall LM, Orwoll ES, Cummings SR: A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc 2009, 57(3):492-498.
• [17]Tom SE, Adachi JD, Anderson FA Jr, Boonen S, Chapurlat RD, Compston JE, Cooper C, Gehlbach SH, Greenspan SL, Hooven FH, Nieves JW, Pfeilschifter J, Roux C, Silverman S, Wyman A, LaCroix AZ, GLOW Investigators: Frailty and fracture, disability, and falls: a multiple country study from the global longitudinal study of osteoporosis in women. J Am Geriatr Soc 2013, 61(3):327-334.
• [18]Hooven FH, Adachi JD, Adami S, Boonen S, Compston J, Cooper C, Delmas P, Diez-Perez A, Gehlbach S, Greenspan SL, LaCroix A, Lindsay R, Netelenbos JC, Pfeilschifter J, Roux C, Saag KG, Sambrook P, Silverman S, Siris E, Watts NB, Anderson FA Jr: The Global Longitudinal Study of Osteoporosis in Women (GLOW): rationale and study design. Osteoporos Int 2009, 20(7):1107-1116.
• [19]Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K: A standard procedure for creating a frailty index. BMC Geriatr 2008, 8:24. BioMed Central Full Text
• [20]Mitnitski A, Song X, Skoog I, Broe GA, Cox JL, Grunfeld E, Rockwood K: Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality. J Am Geriatr Soc 2005, 53(12):2184-2189.
• [21]Song X, Mitnitski A, Rockwood K: Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc 2010, 58(4):681-687.
• [22]Steyerberg EW, Harrell FE Jr, Borsboom GJ, Eijkemans MJ, Vergouwe Y, Habbema JD: Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol 2001, 54(8):774-781.
• [23]Grambsch PM, Therneau TM: Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 1994, 81(3):515-526.
• [24]Fang X, Shi J, Song X, Mitnitski A, Tang Z, Wang C, Yu P, Rockwood K: Frailty in relation to the risk of falls, fractures, and mortality in older Chinese adults: results from the Beijing Longitudinal Study of Aging. J Nutr Health Aging 2012, 16(10):903-907.
• [25]Roth PL, Switzer FS III: Missing data: Instrument-level heffalumps and item-level woozles. Research Methods Forum 1999, 1999(4):5.
• [26]Horton NJ, Kleinman KP: Much ado about nothing. Am Stat 2007., 61(1)
• [27]Graham JW: Missing data analysis: Making it work in the real world. Annu Rev Psychol 2009, 60:549-576.
• [28]Rockwood K, Mitnitski A: How might deficit accumulation give rise to frailty. J Frailty Aging 2012, 1:8-12.
• [29]Markle Reid M, Browne G: Conceptualizations of frailty in relation to older adults. J Adv Nurs 2003, 44(1):58-68.
• [30]Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM: In search of an integral conceptual definition of frailty: opinions of experts. J Am Med Dir Assoc 2010, 11(5):338-343.
• [31]Sourial N, Wolfson C, Bergman H, Zhu B, Karunananthan S, Quail J, Fletcher J, Weiss D, Bandeen-Roche K, Béland F: A correspondence analysis revealed frailty deficits aggregate and are multidimensional. J Clin Epidemiol 2010, 63(6):647-654.
• [32]Streiner DL, Norman GR: Health measurement scales: A Guide to Their Development and Use. 4th edition. New York: Oxford University Press; 2008.
• [33]Kulminski A, Yashin A, Arbeev K, Akushevich I, Ukraintseva S, Land K, Manton K: Cumulative index of health disorders as an indicator of aging-associated processes in the elderly: Results from analyses of the National Long Term Care Survey. Mech Ageing Dev 2007, 128(3):250-258.
• [34]Rockwood K, Mitnitski A: Limits to deficit accumulation in elderly people. Mech Ageing Dev 2006, 127(5):494-496.
• [35]Tinetti ME, Kumar C: The patient who falls. JAMA 2010, 303(3):258-266.
• [36]Moncada LVV: Management of falls in older persons: a prescription for prevention. Am Fam Physician 2011, 84(11):1267-1276.
• [37]Ensrud KE, Cauley J, Lipschutz R, Cummings SR: Weight change and fractures in older women. Arch Intern Med 1997, 157(8):857.
• [38]Fugate Woods N, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB: Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc 2005, 53(8):1321-1330.
• [39]Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, Hillier TA, Cauley JA, Hochberg MC, Rodondi N, Tracy JK, Cummings SR: Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 2008, 168(4):382-389.
• [40]Klein BE, Klein R, Knudtson MD, Lee KE: Frailty, morbidity and survival. Arch Gerontol Geriatr 2005, 41(2):141-149.
• [41]Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G: A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort. Arch Gerontol Geriatr 2012, 54(1):16-20.
• [42]Rockwood K, Andrew M, Mitnitski A: A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci 2007, 62(7):738-743.
• [43]Rockwood K, Howlett SE, MacKnight C, Beattie BL, Bergman H, Hébert R, Hogan DB, Wolfson C, McDowell I: Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging. J Gerontol A: Biol Med Sci 2004, 59(12):1310-1317.
• [44]Rockwood K, Mitnitski A, Song X, Steen B, Skoog I: Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc 2006, 54(6):975-979.
• [45]Diez-Perez A, Adachi JD, Adami S, Anderson FA Jr, Boonen S, Chapurlat R, Compston JE, Cooper C, Gehlbach SH, Greenspan SL, Hooven FH, LaCroix AZ, Nieves JW, Netelenbos JC, Pfeilschifter J, Rossini M, Roux C, Saag KG, Silverman S, Siris ES, Wyman A, Rushton-Smith SK, Watts NB, Global Longitudinal Study of Osteoporosis in Women (GLOW) Investigators: Risk factors for treatment failure with antiosteoporosis medication: The global longitudinal study of osteoporosis in women (GLOW). J Bone Miner Res 2013, 29(1):260-267.
• [46]Guggina P, Flahive J, Hooven FH, Watts NB, Siris ES, Silverman S, Roux C, Pfeilschifter J, Greenspan SL, Diez-Perez A, Cooper C, Compston JE, Chapurlat R, Boonen S, Adachi JD, Anderson FA Jr, Gehlbach S, GLOW Investigators: Characteristics associated with anti-osteoporosis medication use: data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) USA cohort. Bone 2012, 51(6):975-980.
• [47]Nguyen N, Frost S, Center J, Eisman J, Nguyen T: Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int 2008, 19(10):1431-1444.
• [48]Kanis J, Johnell O, Odén A, Johansson H, McCloskey E: FRAX™ and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008, 19(4):385-397.
• [49]Stapleton C, Hough P, Oldmeadow L, Bull K, Hill K, Greenwood K: Four‒item fall risk screening tool for subacute and residential aged care: The first step in fall prevention. Australas J Ageing 2009, 28(3):139-143.
• [50]Hundrup YA, Hoidrup S, Obel EB, Rasmussen NK: The validity of self-reported fractures among Danish female nurses: comparison with fractures registered in the Danish National Hospital Register. Scand J Public Health 2004, 32(2):136-143.
• [51]Rahman A, Gibney L, Person SD, Williams OD, Kiefe C, Jolly P, Roseman J: Validity of self-reports of reasons for hospitalization by young adults and risk factors for discordance with medical records: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Epidemiol 2005, 162(5):491-498.
• [52]Bergmann MM, Byers T, Freedman DS, Mokdad A: Validity of self-reported diagnoses leading to hospitalization: a comparison of self-reports with hospital records in a prospective study of American adults. Am J Epidemiol 1998, 147(10):969-977.
• [53]Peel N: Validating recall of falls by older people. Accid Anal Prev 2000, 32(3):371-372.
• [54]Chen Z, Kooperberg C, Pettinger MB, Bassford T, Cauley JA, LaCroix AZ, Lewis CE, Kipersztok S, Borne C, Jackson RD: Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Women’s Health Initiative observational study and clinical trials. Menopause (New York, NY) 2004, 11(3):264-274.
• [55]Gregson C, Dennison EM, Compston JE, Adami S, Adachi JD, Anderson FA Jr, Boonen S, Chapurlat R, Díez-Pérez A, Greenspan SL, Hooven FH, LaCroix AZ, Nieves JW, Netelenbos JC, Pfeilschifter J, Rossini M, Roux C, Saag KG, Silverman S, Siris ES, Watts NB, Wyman A, Cooper C, GLOW Investigators: Disease-specific perception of fracture risk and incident fracture rates: GLOW cohort study. Osteoporos Int 2014, 25(1):85-95.