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A Comparison of Frailty Indexes for the Prediction of Falls, Disability, Fractures, and Mortality in Older Men |
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| Authors: | Kristine E Ensrud MD MPH Susan K Ewing MS Peggy M Cawthon PhD Howard A Fink MD MPH Brent C Taylor PhD Jane A Cauley DrPH Thuy-Tien Dam MD Lynn M Marshall ScD Eric S Orwoll MD Steven R Cummings MD for the Osteoporotic Fractures in Men Research Group |
| Institution: | From the Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota;;Division of Epidemiology and Community Health, Department of Medicine, University of Minnesota, Minneapolis, Minnesota;;Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California;;Research Institute, California Pacific Medical Center, San Francisco, California;;Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania;;Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, California;;Bone and Mineral Unit, Department of Medicine;and;Division of Epidemiology, Department of Public Health and Preventive Medicine, Oregon Health Sciences University, Portland, Oregon. |
| Abstract: | OBJECTIVES: To compare the validity of a parsimonious frailty index (components: weight loss, inability to rise from a chair, and poor energy (Study of Osteoporotic Fractures (SOF) index)) with that of the more complex Cardiovascular Health Study (CHS) index (components: unintentional weight loss, low grip strength, poor energy, slowness, and low physical activity) for prediction of adverse outcomes in older men. DESIGN: Prospective cohort study. SETTING: Six U.S. centers. PARTICIPANTS: Three thousand one hundred thirty-two men aged 67 and older. MEASUREMENTS: Frailty status categorized as robust, intermediate stage, or frail using the SOF index and criteria similar to those used in CHS index. Falls were reported three times for 1 year. Disability (≥1 new impairments in performing instrumental activities of daily living) ascertained at 1 year. Fractures and deaths ascertained during 3 years of follow-up. Analysis of area under the receiver operating characteristic curve (AUC) statistics compared for models containing the SOF index versus those containing the CHS index. RESULTS: Greater evidence of frailty as defined by either index was associated with greater risk of adverse outcomes. Frail men had a higher age-adjusted risk of recurrent falls (odds ratio (OR)=3.0–3.6), disability (OR=5.3–7.5), nonspine fracture (hazard ratio (HR)=2.2–2.3), and death (HR=2.5–3.5) ( P <.001 for all models). AUC comparisons revealed no differences between models with the SOF index and models with the CHS index in discriminating falls (AUC=0.63, P =.97), disability (AUC=0.68, P =.86), nonspine fracture (AUC=0.63, P =.90), or death (AUC=0.71 for model with SOF index and 0.72 for model with CHS index, P =.19). CONCLUSION: The simple SOF index predicts risk of falls, disability, fracture, and mortality in men as well as the more-complex CHS index. |
| Keywords: | frailty older men hip fracture mortality |