Frailty Assessment


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    Frailty is widely viewed by geriatricians as a syndrome of late life decline that is closely linked to adverse health outcomes. Because of the heterogeneity of frailty, it has been difficult to identify and study frailty and its biological underpinnings. Using clinical observations of the most vulnerable older adults, a group of geriatricians have developed a clinical phenotype of frailty that includes both physical measurements and questions related to low activity and fatigue increasingly prevalent with old age. This phenotype was first operationalized in the Cardiovascular Health Study (CHS)1. The CHS criteria were later adapted to the Women’s Health and Aging Study (WHAS) sample at baseline, given the measures available in WHAS2. The phenotype of frailty has been validated in several populations of ambulatory, community dwelling older adults and clearly identifies those who are most vulnerable to the development of disability, hospitalizations, and early mortality. This phenotype has been implemented in many populations of older adults, and has helped to identify inflammatory pathway activation and endocrinological changes as major physiological correlates of frailty.

In an attempt to standardize the practice of frailty assessment and the computing algorithm, this Online Frailty Assessment Tool was developed by the Johns Hopkins Older Americans Independence Center to maximize the inference validity for cross-study comparisons or meta analysis. This tool currently uses the WHAS criteria by default, as it is anticipated that its briefer extent will be considered preferable by many users in light of the available validation data. But users will be given the option to opt out to CHS if desired when initiating a new project. To view the actual criteria used in WHAS and CHS and a discussion of major differences between the two criteria,
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1. 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 Mar;56(3):M146-56. PMID: 11253156

2. Bandeen-Roche K, Xue QL, Ferrucci L, Walston J, Guralnik JM, Chaves P, Zeger SL, Fried LP. Phenotype of frailty: characterization in the women's health and aging studies. J Gerontol A Biol Sci Med Sci. 2006 Mar;61(3):262-6. PMID: 16567375


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