Journal of the American Geriatrics Society

Preliminary Evidence for Subdimensions of Geriatric Frailty: The MacArthur Study of Successful Aging

Catherine A. Sarkisian MD, MSPH

From the ^* Veterans Affairs Greater Los Angeles Healthcare System Geriatric Research, Education, and Clinical Center, Los Angeles, California ^† Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ^‡ Departments of ^§ Medicine and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.

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Tara L. Gruenewald PhD, MPH,

Tara L. Gruenewald PhD, MPH

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W. John Boscardin PhD,

W. John Boscardin PhD

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Teresa E. Seeman PhD,

Teresa E. Seeman PhD

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Catherine A. Sarkisian MD, MSPH,

Catherine A. Sarkisian MD, MSPH

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Tara L. Gruenewald PhD, MPH,

Tara L. Gruenewald PhD, MPH

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W. John Boscardin PhD,

W. John Boscardin PhD

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Teresa E. Seeman PhD,

Teresa E. Seeman PhD

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First published: 02 December 2008

https://doi.org/10.1111/j.1532-5415.2008.02041.x

Citations: 71

Address correspondence to Catherine A. Sarkisian, MD, MSPH, VA Greater Los Angeles Healthcare System, Geriatric Research Education Clinical Center (GRECC), Building 220, Room 315 (11G), 11301 Wilshire Blvd., Los Angeles, CA 90073. E-mail: [email protected]

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Abstract

OBJECTIVES: To identify frailty subdimensions.

DESIGN: Longitudinal cohort (MacArthur Study).

SETTING: Three U.S. urban centers.

PARTICIPANTS: One thousand one hundred eighteen high-functioning subjects aged 70 to 79 in 1988.

MEASUREMENTS: Participants with three or more of five Cardiovascular Health Study (CHS) frailty criteria (weight loss, weak grip, exhaustion, slow gait, and low physical activity) in 1991 were classified as having the CHS frailty phenotype. To identify frailty subdimensions, factor analysis was conducted using the CHS variables and an expanded set including the CHS variables, cognitive impairment, interleukin-6 (IL-6), C-reactive protein (CRP), subjective weakness, and anorexia. Participants with four or more of 10 criteria were classified as having an expanded frailty phenotype. Predictive validity of each identified frailty subdimension was assessed using regression models for 4-year disability and 9-year mortality.

RESULTS: Two subdimensions of the CHS phenotype and four subdimensions of the expanded frailty phenotype were identified. Cognitive function was consistently part of a subdimension including slower gait, weaker grip, and lower physical activity. The CHS subdimension of slower gait, weaker grip, and lower physical activity predicted disability (adjusted odds ratio (AOR)=1.7, 95% confidence interval (CI)=1.3–2.2) and mortality (AOR=1.5, 95% CI=1.3–1.8). Subdimensions of the expanded model with predictive validity were higher IL-6 and CRP (AOR=1.2 for mortality); slower gait, weaker grip, lower physical activity, and lower cognitive function (AOR=1.8 for disability; AOR=1.5 for mortality), and anorexia and weight loss (AOR=1.2 for disability).

CONCLUSION: This study provides preliminary empirical support for subdimensions of geriatric frailty, suggesting that pathways to frailty differ and that subdimension-adapted care might enhance care of frail seniors.

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Volume56, Issue12

December 2008

Pages 2292-2297

Preliminary Evidence for Subdimensions of Geriatric Frailty: The MacArthur Study of Successful Aging

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Preliminary Evidence for Subdimensions of Geriatric Frailty: The MacArthur Study of Successful Aging

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