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Mitnitski A.,Dalhousie University | Fallah N.,Geriatric Medicine Research Unit | Rockwood M.R.H.,Geriatric Medicine Research Unit | Rockwood K.,Dalhousie University
Journal of Nutrition, Health and Aging | Year: 2011

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. © 2011 Serdi and Springer Verlag France.

Shi J.,Beijing Institute of Geriatrics | Shi J.,Geriatric Medicine Research Unit | Yang Z.,Geriatric Medicine Research Unit | Yang Z.,Crandall University | And 9 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2014

Background. On average, as people age, they accumulate more health deficits and have an increased risk of death. The deficit accumulation-based frailty index (FI) can quantify health and its outcomes in aging. Previous studies have suggested that women show higher FI values than men and that the highest FI score (the limit to frailty) occurs at a value of FI ~ 0.7. Even so, gender differences in the limit to frailty have not been reported. Methods. Data for this analysis were obtained from the Beijing Longitudinal Study of Aging that involved 3,257 community-dwelling Chinese people, aged 55+ years at baseline. The main outcome measure was 5-year mortality. An FI consisting of 35 health-related variables was constructed. The absolute and 99% FI limits were calculated for different age groups and analyzed by sex. Results. The mean level of the FI increased with age and was lower in men than in women (F = 67.87, p <. 001). The 99% FI limit leveled off slightly earlier with a relatively lower value in men (60 years; 0.44 ± 0.02) compared with that in women (65 years; 0.52 ± 0.04). The highest absolute FI value was 0.61 in men and 0.69 in women. In both groups, people with an FI greater than or equal to the 99% limit showed close to 100% mortality by 5 years. Conclusion. Compared with men, women appeared to better tolerate deficits in health, yielding both relatively lower mortality and higher limit values to the FI. Even so, the FI did not exceed 0.7 in any individual. © 2013 The Author.

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