The predictive validity of three self-report screening instruments for identifying frail older people in the community 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. The “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies” (SPRINTT) randomized controlled trial: design and methods The Home-Based Older People's Exercise (HOPE) trial: study protocol for a randomised controlled trial Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial; “Continuum of care for frail older people” Improving Health Related Quality of Life and Independence in Community Dwelling Frail Older Adults through a Client-Centred and Activity-Oriented Program. A Pragmatic Randomized Controlled Trial. Recovery from disability among community-dwelling older persons. Hand-grip strength predicts incident disability in non-disabled older men. Validation and comparison of two frailty indexes: The MOBILIZE Boston Study. A program to prevent functional decline in physically frail, elderly persons who live at home. Frailty as a Major Factor in the Increased Risk of Death and Disability in Older People With Diabetes. Development of an easy prognostic score for frailty outcomes in the aged. Association between unmet needs for medication support and all-cause hospitalization in community-dwelling disabled elderly people. A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. A randomized, controlled trial of disability prevention in frail older patients screened in primary care: the FRASI Study. Design and baseline evaluation Activities of Daily Living and Quality of Life of Elderly Patients After Elective Surgery for Gastric and Colorectal Cancers Incidence of and predictors for chronic disability in activities of daily living among older people in Taiwan. Characteristics of frail older adult drivers. Frailty and functional decline indices predict poor outcomes in hospitalised older people. Hierarchical components of physical frailty predicted incidence of dependency in a cohort of elderly women. Development of a frailty index for patients with coronary artery disease.
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 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 The sustainability of health and social care systems is threatened by a growing population of older persons with heterogeneous needs related to multimorbidity , frailty , and increased risk of functional impairment . Since disability is difficult to reverse in old age and is extremely burdensome for individuals and society , novel strategies should be devised to preserve adequate levels of function and independence in late life . The development of mobility disability , an early event in the disablement process , precedes and predicts more severe forms of inability . Its prevention is , therefore , critical to impede the transition to overt disability . For this reason , the Sarcopenia and Physical fRailty IN older people : multi-componenT Treatment strategies ( SPRINTT ) project is conducting a r and omized controlled trial ( RCT ) to test a multicomponent intervention ( MCI ) specifically design ed to prevent mobility disability in high-risk older persons . SPRINTT is a phase III , multicenter RCT aim ed at comparing the efficacy of a MCI , based on long-term structured physical activity , nutritional counseling/dietary intervention , and an information and communication technology intervention , versus a healthy aging lifestyle education program design ed to prevent mobility disability in 1500 older persons with physical frailty and sarcopenia who will be followed for up to 36 months . The primary outcome of the SPRINTT trial is mobility disability , operationalized as the inability to walk for 400 m within 15 min , without sitting , help of another person , or the use of a walker . Secondary outcomes include changes in muscle mass and strength , persistent mobility disability , falls and injurious falls , disability in activities of daily living , nutritional status , cognition , mood , the use of healthcare re sources , cost-effectiveness analysis , quality of life , and mortality rate . SPRINTT results are expected to promote significant advancements in the management of frail older persons at high risk of disability from both clinical and regulatory perspectives . The findings are also projected to pave the way for major investments in the field of disability prevention in old age Background Frailty is common in older age , and is associated with important adverse health outcomes including increased risk of disability and admission to hospital or long-term care .  Exercise interventions for frail older people have the potential to reduce the risk of these adverse outcomes by increasing muscle strength and improving mobility . Methods / Design The Home-Based Older People 's Exercise ( HOPE ) trial is a two arm , assessor blind pilot r and omised controlled trial ( RCT ) to assess the effectiveness of a 12 week exercise intervention ( the HOPE programme ) design ed to improve the mobility and functional abilities of frail older people living at home , compared with usual care . The primary outcome is the timed-up- and -go test ( TUGT ) , measured at baseline and 14 weeks post-r and omisation . Secondary outcomes include the Barthel Index of activities of daily living ( ADL ) , EuroQol Group 5-Dimension Self-Report Question naire ( EQ-5D ) quality of life measure and the geriatric depression scale ( GDS ) , measured at baseline and 14 weeks post-r and omisation . We will record baseline frailty using the Edmonton Frail Scale ( EFS ) , record falls and document muscle/joint pain . We will test the feasibility of collection of data to identify therapy re sources required for delivery of the intervention . Discussion The HOPE trial will explore and evaluate a home-based exercise intervention for frail older people . Although previous RCTs have used operationalised , non-vali date d methods of measuring frailty , the HOPE trial is , to our knowledge , the first RCT of an exercise intervention for frail older people that includes a vali date d method of frailty assessment at baseline . Trial registration IS RCT N : IS RCT 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 Background The intervention ; “ Continuum of Care for Frail Older People ” , was design ed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person ’s own home . The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living ( ADL ) . Methods The study is a non-blinded controlled trial with participants r and omised to either the intervention group or a control group with follow-ups at three- , six- and 12 months . The intervention involved collaboration between a nurse with geriatric competence at the emergency department , the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub . Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal , Sweden were asked to participate . Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL . Analyses were made on the basis of the intention-to-treat principle . Outcome measures were ADL independence and eight frailty indicators . These were analysed , using Chi-square and odds ratio ( OR ) . Results A total of 161 participated in the study , 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study . There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up . At both the three- and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control ( OR 2.37 , 95 % CI ; 1.20 – 4.68 ) and ( 2.04 , 95 % CI ; 1.03 – 4.06 ) respectively . At six months the intervention group had halved their odds for decreased ADL independence ( OR 0.52 , 95 % CI ; 0.27 – 0.98 ) compared to the control group . Conclusions The intervention has the potential to reduce dependency in ADLs , a valuable benefit both for the individual and for society . Trial registration Clinical Trials.gov : INTRODUCTION AND AIM In the ageing society , a considerable part of the older adults are frail . Frailty has a major impact on the individual 's quality of life , independence and also on his environment . This study aim ed to investigate - as a secondary prevention of disability - the effectiveness of a client-centred and activity-oriented intervention program for frail community living older adults . It was hypothesized that this program could be effective in improving basic Activities of Daily Living ( b-ADL ) and increasing Health Related Quality of Life ( HRQoL ) . METHOD This study was a single blind r and omized controlled trial with an intervention and a control group ( pre-test-post-test control group design ) . Analysis of covariance ( ANCOVA ) was used to compare the outcome across groups with post-test as outcome and baseline values as a covariate . Data were analysed using the intention-to-treat principle . RESULTS The intervention group ( n = 86 ) experienced more improvement on b-ADL and HRQoL compared with the control group ( n = 82 ) . These effects were statistically significant for the b-ADL index ( p = 0.013 ) and the ' physical subscale pain ' ( p = 0.049 ) . DISCUSSION AND CONCLUSION These positive results can be seen as promising for further development of intervention strategies , although follow-up study should be conducted to determine long term effectiveness CONTEXT Previous studies have found that a sizeable minority of newly disabled older persons recover independent function ; however , long intervals between assessment s have led to difficulty in determining the true incidence and duration of disability , and therefore in accurately characterizing the probability and course of recovery . OBJECTIVES To determine the rate of and time to recovery of independent function in community-dwelling older persons who become newly disabled in their activities of daily living ( ADLs ) , to determine the duration of recovery , and to compare the likelihood of recovery among pertinent subgroups of older persons . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study , with monthly assessment s of  ADL function , for 754 initially nondisabled , community-dwelling persons aged 70 years or older , performed in a small urban area from March 1998 to May 2003 . MAIN OUTCOME MEASURES Demographic features , chronic conditions , cognitive function , and physical frailty were determined during comprehensive assessment s at 18-month intervals . Disability , defined as needing personal assistance with 1 or more key ADLs ( bathing , dressing , walking , and transferring ) , was assessed during monthly telephone interviews . RESULTS A total of 420 participants ( 56 % ) experienced disability during a median follow-up of 51 months . Of these participants , 399 ( 81 % ) recovered ( ie , regained independence in all 4 ADLs ) within 12 months of their initial disability episode , and a majority ( 57 % ) of these maintained independence for at least 6 months . Among participants who experienced 3 or more consecutive months of disability , a majority ( 60 % ) recovered , but only a third of these maintained independence for at least 6 months . Persons who were cognitively impaired , physically frail , or severely disabled ( ie , in 3 - 4 ADLs ) at onset were less likely to recover than those who were cognitively intact , nonfrail , or mildly disabled , respectively . Nonetheless , a majority of participants within each subgroup recovered . CONCLUSIONS Newly disabled older persons recover independent ADL function at rates far exceeding those that have been previously reported . Recovery from disability , however , is often short-lasting , suggesting that additional efforts are warranted to maintain independence in this high-risk group OBJECTIVES To verify if h and -grip performance in older men is a predictor of disability . DESIGN Population -based prospect i ve study . SETTING A sample from the Italian rural cohorts of the FINE study ( Finl and , Italy , Netherl and s Elderly ) , representative of the general population of elderly men surveyed in 1991 and 1995 . PARTICIPANTS 140 men aged 71 - 91 years who reported no disability in performing activities of daily living ( ADLs ) , instrumental activity of daily living ( IADLs ) and mobility activities at baseline examination and provided information on their functional status at follow-up 4 years later . MEASUREMENTS Disability was defined as needing help in performing ADLs , IADLs and mobility . H and -grip strength  was evaluated at baseline by a mechanical dynamometer . RESULTS After adjusting for potential confounding variables , a lower concentration of high-density lipoprotein cholesterol was the only factor predicting disability in men aged 76 years or younger and only reduced h and -grip strength predicted incident disability in men 77 years or older . CONCLUSION Poor h and strength as measured by h and -grip is a predictor of  disability  in older people . The h and -grip test is an easy and inexpensive screening tool to identify elderly people at risk of disability OBJECTIVES To vali date two established frailty indexes and compare their ability to predict adverse outcomes in a diverse , elderly , community-dwelling sample of men and women . DESIGN Prospect i ve observational study . SETTING A diverse defined geographic area of Boston . PARTICIPANTS Seven hundred sixty-five community-dwelling participants in the Maintenance of Balance , Independent Living , Intellect , and Zest in the Elderly Boston Study . MEASUREMENTS Two published frailty indexes , recurrent falls , disability , overnight hospitalization , emergency department ( ED ) visits , chronic medical conditions , self-reported health , physical function , cognitive ability ( including executive function ) , and depression . One index was developed from the Study of Osteoporotic Fractures ( SOF ) and the other from the Cardiovascular Health Study ( CHS ) . RESULTS The SOF frailty index classified 77.1 % as robust , 18.7 % as prefrail , and 4.2 % as frail . The CHS frailty index classified 51.2 % as robust , 38.8 % as prefrail , and 10.0 % as frail . Both frailty indexes ( SOF ; CHS ) were similar in their ability to predict key geriatric outcomes such as recurrent falls ( hazard ratio (HR)(frail)=2.2 , 95 % confidence interval (CI)=1.2 - 4.0 ; HR(frail)=1.9 , 95 % CI=1.2 - 3.1 ) , overnight hospitalization ( odds ratio (OR)(frail)=3.5 , 95 % CI=1.5 - 8.0 ; OR(frail)=4.4 , 95 % CI=2.4 - 8.2 ) , ED visits ( OR(frail)=3.5 , 95 % CI=1.4,8.8 ; OR(frail)=3.1 , 95 % CI=1.6 - 5.9 ) , and disability ( OR(frail)=5.4 , 95 % CI=2.3 - 12.3 ; OR(frail)=7.7 , 95 % CI=4.0 - 14.7 ) , as well as chronic medical conditions , physical function , cognitive ability , and depression . CONCLUSION Two established frailty indexes were vali date d using an independent elderly sample of diverse men and women ; both indexes were good at distinguishing geriatric conditions and predicting recurrent falls , overnight hospitalization , and ED visits according to level of frailty . Although both indexes are good measures of frailty , the simpler SOF index may be easier and more practical in a clinical setting BACKGROUND Functional decline in physically frail , elderly persons is associated with substantial morbidity . It is uncertain whether such functional decline can be prevented . METHODS We r and omly assigned 188 persons 75 years of age or older who were physically frail and living at home to undergo a six-month , home-based intervention program that included physical therapy and that focused primarily on improving underlying impairments in physical abilities , including balance , muscle strength , ability to transfer from one position to another , and mobility , or to undergo an educational program ( as a control ) . The primary outcome was the change between base line and 3 , 7 , and 12 months in the score on a disability scale based on eight activities of daily living : walking , bathing , upper- and lower-body dressing , transferring from a chair , using the toilet , eating , and grooming . Scores on the scale ranged from 0 to 16 , with higher scores indicating more severe disability . RESULTS Participants in the intervention group had less functional decline over time , according to their disability scores , than participants in the control group . The disability scores in the intervention and control groups were 2.3 and 2.8 , respectively , at base line ; 2.0 and 3.6 at 7 months ( P=0.008 for the comparison between the groups in the change from base line ) ; and 2.7 and 4.2 at 12 months ( P=0.02 ) . The benefit of the intervention was observed among participants with moderate frailty but not those with severe frailty . The frequency of admission to a nursing home did not differ significantly between the intervention group and the control group ( 14 percent and 19 percent , respectively ; P=0.37 ) . CONCLUSIONS A home-based program targeting underlying impairments in physical abilities can reduce the progression of functional decline among physically frail , elderly persons who live at home 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 BACKGROUND identification of frailty is recommended in geriatric practice . However , there is a lack of frailty scores combining easy-to-collect predictors from multiple domains . OBJECTIVE to develop a frailty score including only self-reported information and easy-to-perform st and ardised measurements recommended in routine geriatric practice . DESIGN prospect i ve population -based study . SETTING / PARTICIPANTS included 1,007 Italian subjects aged 65 and over . MEASUREMENTS seventeen baseline possible mortality predictors from several domains , 4-year risk of mortality and other adverse health outcomes associated with frailty [ fractures , hospitalisation , and new and worsening activities of daily living ( ADL ) disability ] . METHODS a multivariate Cox model was used to identify the best sub-group of independent predictors and to develop a mortality prognostic score , defined as the number of adverse predictors present . Logistic regression was used to verify whether the score also predicted risk of other frailty outcomes in the cohort survivors . RESULTS nine independent mortality predictors were identified . Among subjects with score > or =3 , each one point increase in the score was associated with a doubling in mortality risk and , among survivors , with an increased risk of all the other adverse health outcomes . CONCLUSIONS nine easy-to-collect predictors may identify aged people at increased risk of adverse health outcomes associated with frailty OBJECTIVES To clarify the association between unmet medication management need and 3-year mortality and hospitalization for community-dwelling older people with various levels of disabilities . DESIGN Prospect i ve cohort study ( the Nagoya Longitudinal Study for Frail Elderly ) . SETTING Community-based . PARTICIPANTS One thous and seven hundred seventy-two community-dwelling elderly subjects ( 611 men , 1,161 women ) . MEASUREMENTS Data included the clients ' demographic characteristics , a rating for basic and instrumental activities of daily living ( ADLs ) , number of prescribed medications and physician-diagnosed chronic diseases , medication adherence , ability to manage medication  , and  presence or absence of medication assistance .  Cox proportional hazard models and the Kaplan-Meier method were used to assess the association between the medication management at baseline and mortality or hospitalization during a 3-year period . RESULTS Of 1,772 participants , 681 reported no difficulty with self-medication management , and 1,091 experienced difficulty with self-medication . Of participants with difficulty with self-medication management , 929 had  medication assistance  , and 162 did not . During a 3-year follow up , 424 participants died , and 758 were admitted to hospitals . The baseline data demonstrated that participants not receiving medication assistance were younger and had better ADL status and fewer comorbidities . Multivariate Cox regression models adjusting for potential confounders showed that the lack of assistance in those who needed medication assistance was associated with hospitalization but not mortality during the study period . CONCLUSION In community-dwelling disabled elderly people , lack of medication assistance in those needing medication support was associated with higher risk of hospitalization BACKGROUND In-home preventive visits with multidimensional geriatric assessment s can delay the onset of disabilities in older people . METHODS This was a stratified r and omized trial . There were 791 participants , community-dwelling people in Bern , Switzerl and , older than 75 years . The participants ' risk status was based on 6 baseline predictors of functional deterioration . The intervention consisted of annual multidimensional assessment s and quarterly follow-up in-home visits by 3 public health nurses ( nurses A , B , and C ) , who , in collaboration with geriatricians , evaluated problems , gave recommendations , facilitated adherence with recommendations , and provided health education . Each nurse was responsible for conducting the home visits in 1 ZIP code area . RESULTS After 3 years , surviving participants at low baseline risk in the intervention group were less dependent in instrumental activities of daily living ( ADL ) compared with controls ( odds ratio , 0.6 ; 95 % confidence interval , 0.3 - 1.0 ; P = .04 ) . Among subjects at high baseline risk , there were no favorable intervention effects on ADL and an unfavorable increase in nursing home admissions ( P= .02 ) . Despite the similar health status of subjects , nurse C identified fewer problems in the subjects who were visited compared with those assessed by nurses A and B. Subgroup analysis revealed that among low-risk subjects visited by nurses A and B , the intervention had favorable effects on instrumental ADL ( P = .005 ) and basic ADL ( P = .009 ) , reduced nursing home admissions ( P = .004 ) , and result ed in net cost savings in the third year ( US $ 1403 per person per year ) . Among low-risk subjects visited by nurse C , the intervention had no favorable effects . CONCLUSIONS These data suggest that this intervention can reduce disabilities among elderly people at low risk but not among those at high risk for functional impairment , and that these effects are likely related to the home visitor 's performance in conducting the visits Background and aims : We describe the enrollment and intervention phases of FRASI ( FRAilty , Screening and Intervention ) , a r and omized controlled trial aim ed at preventing ADL disability in frail older persons screened in primary care . Methods : Patients , 70–85 years old , non-disabled and non-cognitively impaired , were screened for frailty ( score ≤9 on the Short Physical Performance Battery , SPPB ) during primary care visits . Of 447 eligible persons , 410 came to the study clinic and 251 were r and omized into treatment ( n=126 ) and control groups ( n=125 ) . The active group received an intensive medical intervention , and sixteen 90-minute supervised exercise sessions over 8 weeks . The primary outcome was time to ADL disability onset or death in the 12-month period after study enrollment . Results : The two study arms were similar for demographics , cognitive function , physical function and health status . Compared with a population -based sample selected according to FRASI inclusion criteria except SPPB score , FRASI participants had significantly worse health and functional status . Restricting the comparison to persons with SPPB ≤9 , all differences disappeared . The 99 participants ( 78.6 % of 126 ) who completed the intervention participated in a mean of 15.3±1.6 exercise sessions . Conclusions : Screening in primary care for non-disabled , older persons with SPPB ≤9 yields individuals with substantial morbidity , impairments and functional limitations that can be successfully involved in an intensive medical and exercise intervention . Whether such an intervention effectively prevents new disability remains to be confirmed Objective : To establish reliable st and ards for surgical application to elderly patients 75 years old or older with gastric or colorectal cancer with special reference to the postoperative recovery of activities of daily living ( ADL ) and quality of life ( QOL ) . Summary Background Data : ADL and QOL are important outcomes of surgery for the elderly . However , there has been only limited evidence on the natural course of recovery of functional independence . Methods : Two hundred twenty-three patients 75 years old or older with gastric or colorectal cancer were prospect ively examined .  Physical conditions , ADL , and QOL  were evaluated preoperatively and at the first , third , and sixth postoperative month . Results : The mortality and morbidity rates were 0.4 % and 28 % , respectively . Twenty-four percent of patients showed a decrease in ADL at 1 month postoperatively , but most patients recovered from this transient reduction , with only 3 % showing a decline at the sixth postoperative month ( 6POM ) . ADL of these patients was likely to decrease after discharge from the hospital . QOL of the patients showed a recovery to an extent equal to or better than their average preoperative scores . Conclusions : Of the patients 75 years old or older who underwent elective surgery for gastric or colorectal cancer , only a few showed a protracted decline in ADL and most exhibited better QOL after surgery . This indicates that surgical treatment should be considered , whenever needed , for elderly patients 75 years old or older with gastric or colorectal cancer . Estimation of Physical Ability and Surgical Stress is useful for predicting postoperative declines in ADL and protracted disability ; this could aid in establishing a directed rehabilitation program for preventing protracted disability in elderly patients OBJECTIVES To estimate the incidence of chronic activities of daily living ( ADL ) disability and to analyze the sociodemographic , health status , adverse lifestyle , and leisure-time physical activity predictors for chronic ADL disability . DESIGN We recruited a cohort of community-dwelling older people in Taipei , Taiwan , who were not ADL disabled in August 1993 , and we followed them until August 1996 . SETTING S AND PARTICIPANTS The study subjects were 1321 community-dwelling people aged 65 years or older who were ADL intact at the initial interview in August 1993 . The study sample was a subset of a probability sample ( n = 1583 ) r and omly selected from household registration s in the four districts of the Taipei metropolitan area . MEASUREMENTS Baseline information regarding various factors potentially associated with the development of chronic ADL disability was assessed and collected at the beginning of the study . Study participants were assessed annually for ADL function by a structured home interview using a six-item scale . Participants who were unable to perform independently at least one of the six items -- eating , bathing , dressing , toileting ,  transfers , and walking inside the house -- for more than 3 months were considered chronically ADL disabled . Cox proportional hazard regression models were utilized to examine the independent effect of the potential predictors on risk of chronic ADL disability . RESULTS During the 3-year study period , 145 ( 11.0 % ) participants developed chronic ADL disability , 58 ( 4.4 % ) participants were lost to follow-up , and 83 ( 6.3 % ) participants died . Multiple hazard regression analysis showed that individuals aged 70 to 79 years or older than age 80 had increased risk of ADL disability ( relative risk : 2.05 ( 95 % confidence interval ( CI ) , 1.35 - 3.11 ) and 3.89 ( 95%CI , 2.33 - 6.50 ) , respectively ) compared with those participants younger than age 70 . Risk of chronic ADL disability was inversely associated with routine exercise ( RR = 0.52 ; 95 % CI , 0.39 - 0.68 ) . CONCLUSIONS Age is the most significant predictor of chronic ADL disability . Lack of routine exercise is also a significant predictor of ADL disability in older adults OBJECTIVES To determine the prevalence of driving in older adults with mild to moderate physical frailty and to compare characteristics of current frail older adult drivers with those of former drivers in the sample . DESIGN Retrospective study of frail older adults enrolled in r and omized trials of exercise and hormone replacement therapy . SETTING Urban , academic medical center . PARTICIPANTS One hundred eighty-three sedentary community-dwelling men and women aged 75 and older with mild to moderate physical frailty , as defined by two of the following three criteria : modified Physical Performance Test ( PPT ) score between 18 and 32 , peak oxygen uptake ( VO2 ) between 10 and 18 mL/kg per minute , and self-report of difficulty or assistance with one activity of daily living  (  ADL ) or two instrumental ADLs . Participants were classified as current or former drivers . MEASUREMENTS Demographic characteristics , medical diagnoses , medication use , modified PPT score , and psychometric tests . RESULTS The majority ( 85 % ) of the participants were drivers . Former drivers were more likely to be older , be female , reside in congregate independent living for the elderly , have a higher incidence of arthritis and congestive heart failure , take sedating medications , have lower total ADL scores , have lower VO2 peak scores , and have more impairment on tests of cognition and physical strength , although only age , type of residence , and grip strength were independent predictors of driving cessation in the regression analysis . CONCLUSION Despite the presence of physical frailty , many older adults choose to continue to drive . Further studies are needed to better underst and the driving behaviors of frail older adults and explore opportunities for optimizing driving abilities BACKGROUND admission to a Geriatric Evaluation and Management Unit ( GEMU ) can optimise a patient 's chance of functional recovery . OBJECTIVE to evaluate the ability of several commonly used frailty and functional decline indices to predict GEMU outcomes , both at discharge and at 6 months . DESIGN prospect i ve , observational study . SETTING AND PARTICIPANTS consecutive GEMU patients aged ≥70 years . METHODS patients were classified as ' frail ' or ' at high risk of functional decline ' using several frailty and functional decline instruments . Predictive ability was evaulated using logistic regression and area under receiver operator characteristic ( ROC ) curves ( auROC ) . RESULTS a total of 172 patients were included . Frailty prevalence varied from 24 to 94 % depending on the instrument used . Several instruments predicted patients at risk of poor outcome , including the Frailty Index of Accumulative Deficits ( FI-CD ) , Fried 's Cardiovascular Health Study index , the Study of Osteoporotic Fractures index , an adapted Katz score of activities of daily living ( ADL ) , Instrumental ADL , the Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie ( SHERPA ) and grip strength [ odds ratio ( OR ) range of 2.06 - 6.47 ] . Adequate discriminatory power for discharge outcome was achieved by the FI-CD ( auROC = 0.735 , P < 0.001 ) and an adapted Katz score ( auROC = 0.704 , P = < 0.001 ) . The FI-CD also showed adequate discriminatory power for a poor 6-month outcome ( auROC = 0.702 , P < 0.001 ) . CONCLUSION frailty and functional decline instruments can predict older patients at risk of poor outcome . However , only the FI-CD showed adequate discriminatory power for outcome prediction at both follow-up time-points OBJECTIVE To identify the most important predictors of early disability  incidence and devise a simple score of physical frailty . METHODS A cohort of 545 high-functioning women aged 75 years and older was followed for 7 years . Every year , the self-reported loss of at least one instrumental activity of daily living was chosen as definition of disability . An extension of the logistic regression for repeated responses , the r and om-effect model , was used to assess the effects of baseline predictors . The regression coefficients of the final multivariate model were scaled and rounded to create a practical score . RESULTS The proportion of women reporting disability increased from 22.1 % to 52.1 % throughout the follow-up . In the multivariate model , increasing age , lower performances in mobility and balance tests , bad perceived health , lower muscle strength , higher body mass index , lower educational level , and lower reported physical activity were strong predictors of disability . Evaluating the predictive value of the simplified predictive score on an independent cohort gave a c-statistic equal to .71 . CONCLUSION The use of a powerful fitting method allows to establish a hierarchy between the components of physical frailty and to provide a predictive score with substantial practical value for clinicians and public health professionals OBJECTIVES To construct a brief frailty index for older patients with coronary artery disease ( CAD ) undergoing coronary angiography  that includes physical , cognitive , and psychosocial criteria and accurately predicts future disability and decline in health-related quality of life ( HRQL ) . DESIGN Prospect i ve cohort . SETTING An urban tertiary care hospital in Alberta , Canada . PARTICIPANTS Three hundred seventy-four patients aged 60 and older ( 73 % male ) undergoing cardiac catheterization for CAD between October 2003 and May 2007 . MEASUREMENTS Potential frailty criteria examined at baseline ( before the procedure ) included measures of  balance , gait speed , cognition , self-reported health , body mass index ( BMI ) , depressive symptoms , and living alone . The outcomes assessed over 1 year were dependency in activities of daily living ( ADLs ) and HRQL . RESULTS The five best-fitting criteria from regression analyses for ADL decline were poor balance ( risk ratio (RR)=2.4 , 95 % confidence interval (CI)=1.4–4.0 ) , abnormal BMI ( RR=1.8 , 95 % CI=1.1–3.0 ) , impaired Trail-Making Test Part B performance ( RR=2.3 , 95 % CI=1.3–4.2 ) , depressive symptoms ( RR=1.8 , 95 % CI=1.1–3.1 ) , and living alone ( RR=2.2 , 95 % CI=1.3–3.8 ) . Using the five criteria as separate variables or as a summary frailty index yielded identical areas under the receiver operating characteristic curve ( 0.76 , 95 % CI=0.66–0.84 ) . Patients with three or more criteria ( vs none ) were at statistically significant greater risk for increased disability ( RR=10.4 , 95 % CI=4.4–24.2 ) and decreased HRQL ( RR=4.2 , 95 % CI=2.3–7.4 ) after 1 year . CONCLUSION This brief frailty index including physical , cognitive , and psychosocial criteria was predictive of increased disability and decreased HRQL at 1 year in older patients with CAD undergoing angiography . This index may have applications for clinicians and research ers but requires further validation
Conclusions This review shows that physical frailty indicators can predict ADL disability in community-dwelling elderly people .
Slow gait speed and low physical activity/exercise seem to be the most powerful predictors followed by weight loss , lower extremity function , balance , muscle strength , and other indicators .
Nevertheless , our study suggests that monitoring physical frailty indicators in community-dwelling elderly people might be useful to identify elderly people who could benefit from disability prevention programs
Background Disability in Activities of Daily Living ( ADL ) is an adverse outcome of frailty that places a burden on frail elderly people , care providers and the care system .
Knowing which physical frailty indicators predict ADL disability is useful in identifying elderly people who might benefit from an intervention that prevents disability or increases functioning in daily life .
The objective of this study was to systematic ally review the literature on the predictive value of physical frailty indicators on ADL disability in community-dwelling elderly people .