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BACKGROUND: Smoking is common in China, where the population is aging rapidly. This study evaluated the relationship between smoking and frailty and their joint association with health and survival in older Chinese men and women. METHODS: Data came from the Beijing Longitudinal Study of Aging, a representative cohort study with a 15-year follow-up. Community-dwelling people (n = 3257) aged more than 55 years at baseline were followed between 1992 and 2007, during which time 51% died. A frailty index (FI) was constructed from 28 self-reported health deficits. RESULTS: Almost half (1,485 people; 45.6%) of the participants reported smoking at baseline (66.8% men, 25.3% women). On average, male smokers were frailer (FI = 0.17±0.13) than male nonsmokers (FI = 0.13±0.10; p = .038). No such differences were seen in women. Men who smoked had the lowest survival probability; female nonsmokers had the highest. Compared with female nonsmokers, the risk of death for male smokers was 1.58 (95% CI = 1.41-1.95; p < .001), adjusted for age and education. Across all FI values, female smokers and male nonsmokers had comparable survival rates. CONCLUSION: Smoking was associated with an increased rate of both worsening health and mortality. At all levels of health status, as defined by deficit accumulation, women who smoked lost the survival advantage conferred by their sex. [ABSTRACT FROM AUTHOR]

Background: On average, cognition declines as people age, but improvement can also occur. Objective: To evaluate the dynamics of age-related changes in brain structure and cognitive function in patients with mild Alzheimer's disease (AD) and mild cognitive impairment (MCI) and in healthy control (HC) older adults. Methods: High-resolution 3-Tesla MRI and clinical data were obtained from the Alzheimer's Disease Neuroimaging Initiative in 187 subjects (a cohort aged 55-91 years; AD=43, MCI=84, HC=60). At 24 months, 151 people had clinical and 128 had MRI follow-up. Brain structure was assessed using the Medial Temporal Atrophy Scale (MTAS) and the Brain Atrophy and Lesion Index (BALI). Cognition was assessed using the Mini- Mental State Examination (MMSE) and the Alzheimer Disease Assessment Scale-cognitive subscale (ADAScog). Responsiveness was tested. Changes were analysed using a multistate dynamic model, adjusted for age, gender, ApoE4 genotype and vascular risk factors. Results: Over 2 years, decline in brain structure and cognition predominated, each showing detectable effect sizes (Cohen's d=0.33 for MTAS, 0.32 for BALI, 0.41 for MMSE, 0.38 for ADAS-cog; standard response mean=0.71, 0.69, 0.50 and 0.47, respectively). Structural improvement was observed (10.2% in BALI and 0.8% in MTAS), as was cognitive improvement (23.2% MMSE, 27.2% ADAS-cog). Most people (66.7%) whose BALI score improved also improved in either the MMSE or ADAS-cog. No patient with MCI whose MTAS or BALI improved converted to AD. Conclusions: Despite average decline in brain structure, improvement was observed and related to cognition and MCI-AD conversion. Ageing-related brain changes reflect a dynamic process. [ABSTRACT FROM AUTHOR]

Objectives: Falls are well known to be associated with adverse health outcomes, especially when complicated by fracture. Falls are more common in people who are frail and readily related to several items in the frailty phenotype. Less is known about the relationship between falls and frailty defined as deficit accumulation. Our objective was to investigate the relationship between falls, fractures, and frailty based on deficit accumulation. Design: Representative cohort study, with 8 year follow-up. Setting: The Beijing Longitudinal Study of Aging (BLSA). Participants: 3,257 Chinese people aged 55+ years at baseline. Measurements: A frailty index (FI) was constructed using 33 health deficits, but excluding falls and fractures. The rates of falls, fractures and death as a function of age and the FI were analyzed. Multivariable models evaluated the relationships between frailty and the risk of recurrent falls, fractures, and mortality adjusting for age, sex, and education. Self or informant reported fall and fracture data were verified against participants' health records. Results: Of 3,257 participants at baseline (1992), 360 people (11.1%) reported a history of falls, and 238 (7.3%) reported fractures. By eight years, 1,155 people had died (35.3%). The FI was associated with an increased risk of recurrent falls (OR=1.54; 95% confidence interval (CI)=1.34-1.76), fractures (OR=1.07; 95% CI=0.94-1.22), and death (OR=1.50, 95% CI=1.41-1.60). The FI showed a significant effect on mortality in a multivariate Cox regression model (Hazard Rate=1.29, 95% CI=1.25-1.33). When adjusted for the FI, neither falls nor fractures were associated with mortality. Conclusion: Falls and fractures were common in older Chinese adults, and associated with frailty. Only frailty was independently associated with death. [ABSTRACT FROM AUTHOR]

Background: Archetypal symptoms and signs are commonly absent in frail older people who are acutely unwell. This challenges both recognition of illness and monitoring of disease progression in people at high risk of prolonged hospital stays, institutionalization and death.Objective: To determine whether bedside assessment of balance and mobility could track acute changes in the health status of older people admitted to hospital.Design: Prospective cohort study.Participants: Four hundred nine patients, with a mean age of 81.8 years, admitted to general medical and rehabilitation wards at a tertiary care teaching hospital in Halifax, Nova Scotia. No patient refused assessment, and the only exclusion criterion was age.Interventions: The Hierarchical Assessment of Balance and Mobility (HABAM) was completed daily during the first 2 weeks of admission. For each patient, frailty status was measured on admission by a Frailty Index based on a Comprehensive Geriatric Assessment (FI-CGA).Main Measures: Death and discharge destination.Key Results: Poor performance in balance, transfers and mobility was associated with adverse outcomes. Forty-eight percent of patients with the lowest scores in all three domains died, compared with none with the highest scores. The relative risk of death for people who deteriorated during the first 48 h of admission was 17.1 (95% confidence interval: 4.9-60.3). Changes in HABAM scores were related to the discharge destination: patients discharged home showed the greatest rate of improvement, whereas those discharged to institutions stabilised at a lower level of performance. Fitter patients tended to have better performance on admission and faster recovery.Conclusions: Daily bedside observation of mobility and balance allows assessment of acute changes in the health of older people. Frailty slows recovery of mobility and balance, and reduces recovery potential. By identifying patients most vulnerable to adverse outcomes, the HABAM and FI-CGA may facilitate risk stratification in older people admitted to hospital. [ABSTRACT FROM AUTHOR]

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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: Prospective 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. [ABSTRACT FROM AUTHOR]

In this study, we combined a Poisson regression model with neural networks (neural network Poisson regression) to relax the traditional Poisson regression assumption of linearity of the Poisson mean as a function of covariates, while including it as a special case. In four simulated examples, we found that the neural network Poisson regression improved the performance of simple Poisson regression if the Poisson mean was nonlinearly related to covariates. We also illustrated the performance of the model in predicting five-year changes in cognitive scores, in association with age and education level; we found that the proposed approach had superior accuracy to conventional linear Poisson regression. As the interpretability of the neural networks is often difficult, its combination with conventional and more readily interpretable approaches under the generalized linear model can benefit applications in biomedicine. [ABSTRACT FROM AUTHOR]

Purpose: To analyze cognitive changes in relation to frailty, using a multistate transition model. Methods: In a prospective cohort study of older Canadians (n = 9266), cognitive states were defined as the errors in the Modified Mini-Mental State Examination score. Frailty states were defined using a Frailty Index based on 40 self-reported deficits. Five-year transition probabilities were modeled by the use of a truncated Poisson distribution with the Poisson mean dependent on the baseline cognitive state, frailty, and other covariates. Results: In multivariable analyses, age, frailty status, and education level were independently associated with cognitive changes, whereas only age and frailty were related to the risk of death. Frail people less often showed cognitive improvement (13.4%; 95% confidence interval [CI], 11.8–15) or stabilization (8.9%; 95% CI, 7.5–10.3) compared with non-frail people, of whom 23.9% improved (95% CI, 22.8–25) and 17% (95% CI, 16.1–17.9) maintained their cognitive status. Frail people were more likely to die (47.4%; 95% CI, 44.8%–50%) versus 22.3% (95% CI, 20.1%–24.5%) of non-frail older adults. Conclusion: A multistate transition model can be used to estimate simultaneously the chances of cognitive improvement/stability, decline, and death, and to analyze how these outcomes depend on frailty and other covariates. [Copyright &y& Elsevier]

To explore the associations between frailty and reproductive axis hormones (as an important regulatory system) in middle aged and older men. Cross-sectional. The European Male Aging Study. Three thousand two hundred nineteen community-dwelling European men aged 40 to 79. Interviewer-assisted questionnaires to assess physical activity, health status, and mood were administered. Testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH), dehydroepiandrosterone sulfate (DHEAS), and sex hormone-binding globulin (SHBG) were measured in a fasting morning blood sample. Frailty was assessed as an index (FI) according to the number (out of 43 possible) of health deficits (symptoms, signs, and functional impairments). Relationships between FI and hormone levels (as outcomes) were explored using regression models. Mean FI was 0.12 ± 0.11 (range 0-0.67) was highest in the oldest group. After adjustment for confounders, higher levels of FI were significantly associated with lower levels of total T, free T, and DHEAS and higher levels of gonadotropins and SHBG; a 1-standard deviation cross-sectional increase in FI was associated with a regression coefficient of −0.30 nmol/L (95% confidence interval (CI)=−0.53 to −0.07) decrease in total T and 0.66 U/L (95% CI=0.48-0.83) increase in LH. The associations between high FI, high gonadotropins, and well-maintained circulating T suggest that these changes are markers of aging-related disruptions of multiple physiological regulation, of which alterations in pituitary-testicular function represent a sensitive marker rather than an underlying pathogenic mechanism for frailty. [ABSTRACT FROM AUTHOR]

To investigate how changes in frailty status and mortality risk relate to baseline frailty state, mobility performance, age, and sex. Cohort study. The Yale Precipitating Events Project, New Haven, Connecticut. Seven hundred fifty-four community-dwelling people aged 70 and older at baseline followed up at 18, 36, and 54 months. Frailty status, assessed at 18-month intervals, was defined using a frailty index (FI) as the number of deficits in 36 health variables. Mobility was defined as time in seconds on the rapid gait test, in which participants walked back and forth over a 20-foot course as quickly as possible. Multistate transition probabilities were calculated with baseline frailty, mobility, age, and sex estimated using Poisson and logistic regressions in survivors and those who died, respectively. In multivariable analyses, baseline frailty status and age were significantly associated with changes in frailty status and risk of death, whereas mobility was significantly associated with the frailty but not with mortality. At all values of the FI, participants with better mobility were more likely than those with poor mobility to remain stable or to improve. For example, at 54 months, 20.6% (95% confidence interval (CI)=16-25.2) of participants with poor mobility had the same or fewer deficits, compared with 32.4% (95% CI=27.9-36.9) of those with better mobility. A multistate transition model effectively measured the probability of change in frailty status and risk of death. Mobility, age, and baseline frailty were significant factors in frailty state transitions. [ABSTRACT FROM AUTHOR]

Background: Frailty in individuals can be operationalized as the accumulation of health deficits, for which several trends have been observed in Western countries. Less is known about deficit accumulation in China, the country with the world's largest number of older adults. Methods: This study analyzed data from the Beijing Longitudinal Study of Aging, to evaluate the relationship between age and deficit accumulation in men and women and to evaluate the impact of frailty on mortality. Community dwelling people aged 55+ years at baseline (n = 3275) were followed every two to three years between 1992 and 2000, during which time 36% died. A Frailty Index was constructed using 35 deficits, drawn from a range of health problems, including symptoms, disabilities, disease, and psychological difficulties. Results: Most deficits increased the eight-year risk of death and were more lethal in men than in women, although women had a higher mean level of frailty (Frailty Index = 0.11 ± 0.10 for men, 0.14 ± 0.12 for women). The Frailty Index increased exponentially with age, with a similar rate in men and women (0.038 vs. 0.039; r > 0.949, P < 0.01). A dose-response relationship was observed as frailty increased. Conclusions: A Frailty Index employed in a Chinese sample, showed properties comparable with Western data, but deficit accumulation appeared to be more lethal than in the West. [ABSTRACT FROM AUTHOR]

The concept of frailty as a medically distinct syndrome has evolved based on the clinical experience of geriatricians and is clinically well recognizable. Frailty is a nonspecific state of vulnerability, which reflects multisystem physiological change. These changes underlying frailty do not always achieve disease status, so some people, usually very elderly, are frail without a specific life threatening illness. Current thinking is that not only physical but also psychological, cognitive and social factors contribute to this syndrome and need to be taken into account in its definition and treatment. Together, these signs and symptoms seem to reflect a reduced functional reserve and consequent decrease in adaptation (resilience) to any sort of stressor and perhaps even in the absence of extrinsic stressors. The overall consequence is that frail elderly are at higher risk for accelerated physical and cognitive decline, disability and death. All these characteristics associated with frailty can easily be applied to the definition and characterization of the aging process per se and there is little consensus in the literature concerning the physiological/biological pathways associated with or determining frailty. It is probably true to say that a consensus view would implicate heightened chronic systemic inflammation as a major contributor to frailty. This review will focus on the relationship between aging, frailty and age-related diseases, and will highlight possible interventions to reduce the occurrence and effects of frailty in elderly people. [ABSTRACT FROM AUTHOR]

Introduction: Although, on average, cognition declines with age, cognition in older adults is a dynamic process. Hypertension is associated with greater decline in cognition with age, but whether treatment of hypertension affects this is uncertain. Here, we modelled dynamics of cognition in relation to the treatment of hypertension, to see if treatment effects might better be discerned by a model that included baseline measures of cognition and consequent mortality Methodology/Principal Findings: This is a secondary analysis of the Hypertension in the Very Elderly Trial (HYVET), a double blind, placebo controlled trial of indapamide, with or without perindopril, in people aged 80+ years at enrollment. Cognitive states were defined in relation to errors on the Mini-Mental State Examination, with more errors signifying worse cognition. Change in cognitive state was evaluated using a dynamic model of cognitive transition. In the model, the probabilities of transitions between cognitive states is represented by a Poisson distribution, with the Poisson mean dependent on the baseline cognitive state. The dynamic model of cognitive transition was good (R² = 0.74) both for those on placebo and (0.86) for those on active treatment. The probability of maintaining cognitive function, based on baseline function, was slightly higher in the actively treated group (e.g., for those with the fewest baseline errors, the chance of staying in that state was 63% for those on treatment, compared with 60% for those on placebo). Outcomes at two and four years could be predicted based on the initial state and treatment. Conclusions/Significance: A dynamic model of cognition that allows all outcomes (cognitive worsening, stability improvement or death) to be categorized simultaneously detected small but consistent differences between treatment and control groups (in favour of treatment) amongst very elderly people treated for hypertension. The model showed good fit, and suggests that most change in cognition in very elderly people is small, and depends on their baseline state and on treatment. Additional work is needed to understand whether this modelling approach is well suited to the valuation of small effects, especially in the face of mortality differences between treatment groups. [ABSTRACT FROM AUTHOR]

Purpose: To analyze cognitive changes in relation to mortality with the use of a multistate transition model. Methods: In a prospective cohort study of Japanese Americans living in King County, WA, study (n = 1985) cognitive states were defined as the errors in the Cognitive Abilities Screening Instrument score. Transition probabilities were modeled by the use of a modified Poisson distribution with the Poisson mean and mortality dependent on the cognitive state and covariates. Results: During an 8-year follow-up, 21.5% died (95% confidence interval [95% CI], 19.3–23.7), 26.6% experienced cognitive decline (95% CI, 24.2–29.1), and 51.9% remained stable or improved cognitively (95% CI, 49.2–54.6). In multivariable analyses, improvements were notably more likely to occur among younger, more-educated people and in women. Older age, male sex, and less education were each significantly related to mortality. Conclusions: A multistate transition model can be used to estimate the impact of covariates on the individual probabilities of cognitive improvement, stability, decline, and death. This approach can have advantages for considering how interventions might work on patterns of cognitive change over time, especially if factors associated with the prevention of decline are also associated with risk of death. [Copyright &y& Elsevier]

This paper introduces a methodological approach to the dynamics of cognitively normal (i.e., successful) aging compared with aging accompanied by different types of cognitive impairment and dementia. Using secondary analysis of a national representative database (Canadian Study of Health and Aging, 1991–1992), the authors show that the soccurrence of an adverse event (symptom, sign, or disease), or the accumulation of a number of events, may be modeled as a logistic function of chronologic age in a population. In the cognitively normal, a linear relation between the logarithm of the odds of events and chronologic age was present for the majority of symptoms and signs. This regression represents the accumulation of each sign in a cognitively successful, aging population. The authors then estimated which ages for this cognitively unimpaired group correspond to the odds of the occurrence of symptoms found for a cognitively impaired population at any given chronologic age. This may be regarded as functional age, based upon the accumulation of a particular functional deficit in the impaired population, analogous to the concept of frailty. The dynamics of aging are a complex process of accumulation of deficits (morbidity), whereby decline from some previously healthy level of synergistically associated symptoms and signs results in distinct patterns of disease and staging. The modeling of these dynamics takes us a step further toward the definition and refinement of disease and normal aging. Am J Epidemiol 1999; 150: 1045-54. [ABSTRACT FROM PUBLISHER]

Background Lacking long-term placebo-controlled trials of cholinesterase inhibitors (ChEIs) in Alzheimer's disease, how decline is modeled is crucial to interpreting the effects of long-term, open-label use. We aimed to: 1) understand changes in cognition and function in people taking galantamine; (2) identify treatment subgroups. Methods This is an open-label long-term extension (up to 48 months) of two placebo-controlled clinical trials from Europe and Canada. At baseline, 240 patients with mild-moderate Alzheimer's disease at baseline had received galantamine continuously for 36 months. The trajectory of scores on the Alzheimer's Disease Assessment Scale—Cognitive Subscale (ADAS-Cog) and the Disability Assessment for Dementia (DAD) was modeled over 48 months. Goodness of fit was compared using normalized residuals and by calculating correlation coefficients between observed and fitted data. Iterative K-means clustering identified subgroups. Results Of 240 patients, 51 (21%) withdrew between months 36–48 (nine died and 12 with adverse events). The mean ADAS-Cog worsened from 22.6 (mean) ± 8.6 (SD) at baseline to 31.3 ± 3.1, with similar changes in the DAD. The logistic function fit better (ADAS-Cog norm of residuals = 2.05, r = 0.993; DAD = 2.21, r = 0.998) than the commonly used Stern equation (ADAS-Cog = 4.22, r = 0.944; DAD = 7.51, r = 0.986). K-means clustering identified three stable groups; least decline (n = 82), persistent progression (n = 75), and an intermediate group (n = 82). Initial conditions were important: the mean ADAS-Cog score for those with least decline was 15 ± 8, better than both the intermediate group (20 ± 9) and persistent progressors (30 ± 10; p < 0.001). Conclusions Alzheimer's disease patients show variable long-term decline that is best modeled as a logistic function, not as linear decline. Over 48 months, about one-third of patients showed little decline, while one-third showed important decline. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The daily clinical practice of geriatric medicine is a grapple with complexity. The elderly patients who come to geriatricians typically have multiple, interacting, age-related physiological impairments, some of which manifest as medical problems. These interact with various social vulnerability factors to put them at risk, and to define them as being frail. This view of frailty, as a multiple-determined state of vulnerability has broad support, but how best to operationalize frailty is rather more controversial. Some of the proposed operational definitions receive more widespread support than others. In particular, the ?phenotypic? definition of frailty used in the Cardiovascular Health Study (CHS) has been endorsed at consensus conferences and employed by several groups. Indeed, it has even been claimed that ?the terms ?frail? and ?frailty? should be avoided except when used in the context of a CHS assessment.? [ABSTRACT FROM AUTHOR]

Multivariable modeling in dementia risk factor studies is limited by the number of factors that can be analyzed practicably. Index variables, which integrate exposures, can efficiently reduce dimensionality. The Consortium to Investigate Vascular Impairment of Cognition study, a Canadian memory-clinic-based 30-month cohort study of 1,347 patients, used a vascular risk factor index (from 20 exposures) and a vascular clinical profile index (17 items). Patients with vascular cognitive impairment had higher index counts compared to those without cognitive impairment (0.16 ± 0.11 vs. 0.07 ± 0.07 for the risk factor index and 0.21 ± 0.16 vs. 0.09 ± 0.07 for the clinical profile index; p < 0.05). Both the death rate and the rate of cognitive impairment increased exponentially with the index variable (r > 0.90 for each index). The risk ratio for death was 1.12 (95% CI 1.09–1.15) for each increment of the risk factor index and was 1.23 (95% CI 1.1–1.28) for each increment of the clinical profile index. With each index, the areas under the receiver operating characteristic curves for predicting death and institutionalization ranged from 0.73 ± 0.01 to 0.75 ± 0.01. Construction of index variables that integrate multidimensional factors is a promising approach to assessing risk in multidetermined states. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

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 aimed 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 prospectively; 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 clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information. [ABSTRACT FROM AUTHOR]

To evaluate the potential of an artificial neural network (ANN) in predicting survival in elderly Canadians, using self-report data. Cohort study with up to 72 months follow-up. Forty self-reported characteristics were obtained from the community sample of the Canadian Study of Health and Aging. An individual frailty index score was calculated as the proportion of deficits experienced. For the ANN, randomly selected participants formed the training sample to derive relationships between the variables and survival and the validation sample to control overfitting. An ANN output was generated for each subject. A separate testing sample was used to evaluate the accuracy of prediction. A total of 8,547 Canadians aged 65 to 99, of whom 1,865 died during 72 months of follow-up. The output of an ANN model was compared with an unweighted frailty index in predicting survival patterns using receiver operating characteristic (ROC) curves. The area under the ROC curve was 86% for the ANN and 62% for the frailty index. At the optimal ROC value, the accuracy of the frailty index was 70.0%. The ANN accuracy rate over 10 simulations in predicting the probability of individual survival mean±standard deviation was 79.2±0.8%. An ANN provided more accurate survival classification than an unweighted frailty index. The data suggest that the concept of biological redundancy might be operationalized from health survey data. [ABSTRACT FROM AUTHOR]

A frailty index is a quantitative measure of frailty, based on the nonspecific accumulation of deficits. In the general population the frailty index strongly predicts death and deterioration of independence and health. Few studies focus on frailty in people with intellectual disabilities ( ID). However, because of the increasing longevity of people with ID, frailty will become a major healthcare challenge in this population. Here we argue the benefits of using a frailty index to measure frailty in people with ID, as it was suggested that this tool would lead to flawed results in this specific population. Most important, as the exact content of the frailty index is relatively free, the frailty index can include problems that are often present in the ID population, as well as use diagnostic questionnaires that have been validated in people with ID. In addition, as the frailty index is designed using a well-evaluated standardized procedure, results can be compared to the general population. The frailty index is applicable to the ID population and predicts negative health outcomes, making it a useful instrument for policy and research. However, further research on its clinical applicability is required. [ABSTRACT FROM AUTHOR]

Frailty is measured to understand its nature and biology, to aid diagnosis and care planning, to measure outcomes and to stratify risk. Such goals oblige two types of frailty measures -- for screening and for assessment -- and recognition that not all measures will serve all purposes. When the goal is broad identification of people at risk, a dichotomised approach (frailty is present or absent) is appropriate. If, however, the degree of risk varies, strategies to test grades of frailty will be required. Frailty measures should be implemented and evaluated in relation to the goal for their use. [ABSTRACT FROM AUTHOR]