• Dan K Kiely, L Adrienne Cupples, and Lewis A Lipsitz.
• Institute for Aging Research, Hebrew SeniorLife, 1200 Centre St, Boston, MA 02131, USA. kiely@hrca.harvard.edu
• J Am Geriatr Soc. 2009 Sep 1; 57 (9): 1532-9.

ObjectivesTo validate two established frailty indexes and compare their ability to predict adverse outcomes in a diverse, elderly, community-dwelling sample of men and women.DesignProspective observational study.SettingA diverse defined geographic area of Boston.ParticipantsSeven hundred sixty-five community-dwelling participants in the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly Boston Study.MeasurementsTwo 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).ResultsThe 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.ConclusionTwo established frailty indexes were validated 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.

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