Skip to main content
SpringerLink
Log in

Rapid cognitive decline, one-year institutional admission and one-year mortality: Analysis of the ability to predict and inter-tool agreement of four validated clinical frailty indexes in the safes cohort

  • JNHA: Frailty and Cognitive Decline
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

To evaluate the predictive ability of four clinical frailty indexes as regards one-year rapid cognitive decline (RCD — defined as the loss of at least 3 points on the MMSE score), and one-year institutional admission (IA) and mortality respectively; and to measure their agreement for identifying groups at risk of these severe outcomes.

Design

One-year follow-up and multicentre study of old patients participating in the SAFEs cohort study. Setting: Nine university hospitals in France.

Participants

1,306 patients aged 75 or older (mean age 85±6 years; 65% female) hospitalized in medical divisions through an Emergency department.

Measurements

Four frailty indexes (Winograd; Rockwood; Donini; and Schoevaerdts) reflecting the multidimensionality of the frailty concept, using an ordinal scoring system able to discriminate different grades of frailty, and constructed based on the accumulation of identified deficits after comprehensive geriatric assessment conducted during the first week of hospital stay, were used to categorize participants into three different grades of frailty: Gl — not frail; G2 — moderately frail; and G3 — severely frail. Comparisons between groups were performed using Fisher’s exact test. Agreement between indexes was evaluated using Cohen’s Kappa coefficient.

Results

All patients were classified as frail by at least one of the four indexes. The Winograd and Rockwood indexes mainly classified subjects as G2 (85% and 96%), and the Donini and Schoevaerdts indexes mainly as G3 (71% and 67%). Among the SAFEs cohort population, 250, 1047 and 1,306 subjects were eligible for analyses of predictability for RCD, 1-year IA and 1-year mortality respectively. At 1 year, 84 subjects (34%) experienced RCD, 377 (36%) were admitted into an institutional setting, and 445 (34%) had died With the Rockwood index, all subjects who expenenced RCD were classified in G2; and in G2 and G3 when the Donini and Schoevaerdts indexes were used No significant difference was found between frailty grade and RCD, whereas frailty grade was significantly associated with an increased risk of IA and death, whatever the frailty index considered. Agreement between the different indexes of frailty was poor with Kappa coefficients ranging from −0.02 to 0.15.

Conclusion

These findings confirm the poor clinimetric properties of these current indexes to measure frailty, underlining the fact that further work is needed to develop a better and more widely-accepted definition of frailty and therefore a better understanding of its pathophysiology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. United Nation Population Division. World population prospects: the 2008 revision population database. 2010. (Accessed February 3rd, 2011, at http://www.un.org/unpd/wpp2008/index.htm.)

  2. Lang PO, Drame M, Jolly D, Novella JL, et al. What do we learn from the SAFEs cohort to fit hospital care models for aged inpatient? Presse Med 2010;39:1132–1142.

    Article  PubMed  Google Scholar 

  3. Strandberg IE, Pitkala KH. Frailty in elderly people. Lancet 2007;369:1328–1329.

    Article  PubMed  Google Scholar 

  4. Bandeen-Roche K, Xue QL, Ferrucci L et al. Phenotype of frailty: characterization in the women’s health and aging studies. J Gerontol A Biol Sci Med Sci 2006;61:262–266.

    Article  PubMed  Google Scholar 

  5. Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59:255–263.

    Article  PubMed  Google Scholar 

  6. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M 146–156.

    Article  CAS  Google Scholar 

  7. Morley JE, Haren MT, Rolland Y, et al. Frailty. Med Clin North Am 2006;90:837–847.

    Article  PubMed  Google Scholar 

  8. Rockwood K, Stadnyk K, MacKnight C, et al. A brief clinical instrument to classify frailty in elderly people. Lancet 1999;353:205–206.

    Article  PubMed  CAS  Google Scholar 

  9. Speechley M, Tinetti M. Falls and injuries in frail and vigorous community elderly persons. J Am GeriatrSoc 1991;39:46–52.

    CAS  Google Scholar 

  10. Winograd CH, Gerety MB, Chung M, et al. Screening for frailty: criteria and predictors of outcomes. J Am Geriatr Soc 1991;39:778–784.

    PubMed  CAS  Google Scholar 

  11. Chin APMJ, Dekker JM, Feskens EJ, et al. How to select a frail elderly population? A comparison of three working definitioa. J Clin Epidemiol 1999;52:1015–1021.

    Article  Google Scholar 

  12. Lang PO, Michel JP, Zekry D. Frailty syndrome: a transitional state in a dynamic process. Gerontology 2009;55:539–549.

    Article  PubMed  Google Scholar 

  13. Fried LP, Hadley EC, Walston JD, et al. From bedside to bench: research agenda for frailty. Sci Aging Knowledge Environ 2005;2005:pe24.

    Article  PubMed  Google Scholar 

  14. Lang PO, Mitchell WA, Lapenna A, et al. Immunological pathogenesis of main age-related disease and frailty: role of immunosenscence. European Geriatric Medicine 2010;1:112–121.

    Article  Google Scholar 

  15. Fulop T, Larbi A, Witkowski JM, et al. Aging, frailty and age-related diseases. Biogerontology 2010;Epub ahead of print.

  16. Abellan van Kan G, Rolland Y, Bergman H, et al. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 2008;12:29–37.

    Article  PubMed  CAS  Google Scholar 

  17. Somme D, Lazarovici C, Drame M, et al. The geriatric patient: use of acute geriatrics units in the emergency care of elderly patients in France. Arch Gerontol Geriatr 2011;52:40–45.

    Article  PubMed  CAS  Google Scholar 

  18. Lang PO, Meyer N, Heitz D, et al. Loss of independence in Katz’s ADL ability in connection with an acute hospitalization: early clinical markers in French older people. Eur J Epidemiol 2007;22:621–630.

    Article  PubMed  Google Scholar 

  19. Lang PO, Heitz D, Hedelin G, et al. Early markers of prolonged hospital stays in older people: a prospective, multicenter study of 908 inpatients in French acute hospitals. JAm GeriatrSoc 2006;54:1031–1039.

    Google Scholar 

  20. Levers MJ, Estabrooks CA, Roos Kerr JC. Factor contributing to frailty: literature review. J Adv Nurs 2006;44:58–68.

    Google Scholar 

  21. de Vries NM, Staal JB, van Ravensberg CD, et al, Nijhuis-van der Sanden. Outcome instruments to measure frailty: asystematic review. Ageing Res Rev 2011;10:104–114.

    Article  PubMed  Google Scholar 

  22. De Lepeleire LJ, Iliffe S, Mann E, et al. Frailty: an emerging concept for general practice. Br J Gen Pract 2009;59:el77–e182.

    Google Scholar 

  23. Stuck AE, Walhert JM, Nikolaus T, Bula C, Hohmann C, Beck JC. Risk factors for functional status decline in community-dwelling elderly people: a systematic literature review. Soc Sci Med 1999;48:445–469.

    Article  PubMed  CAS  Google Scholar 

  24. Stuck A, Egger M, Beck JC. A controlled trial of geriatric evaluation. N Engl J Med 2002;347:371–373.

    PubMed  Google Scholar 

  25. National Institutes of Health. Consensus Development Conference Statement: Geriatrics assessment methods for clinical decision making. J Am Geriatr Soc 1988;36:342–347.

    Google Scholar 

  26. Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B. The assessment of frailty in older adults. Clin Geriatr Med 2010;26:275–286.

    Article  PubMed  Google Scholar 

  27. Donini LM, Savina C, Rosano A, et al. MNA predictive value in the follow-up of geriatric patients. J Nutr Health Aging 2003;7:282–293.

    PubMed  CAS  Google Scholar 

  28. Schoevaerdts D, Biettlot S, Malhomme B, et al. Identification précoce du profil gériatrique en salle d’urgences: presentation de la grille SEGA. Rev Gériatrie 2004;29 169–176.

    Google Scholar 

  29. Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burdea. Gerontologist 1980;20:649–655.

    Article  PubMed  CAS  Google Scholar 

  30. Katz S, Akpom CA. A measure of primary sociobiological functions. Int J Health Serv 1976;6:493–508.

    Article  PubMed  CAS  Google Scholar 

  31. Vellas BJ, Wayne SJ, Romero L, et al. One-leg balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc 1997;45:735–738.

    PubMed  CAS  Google Scholar 

  32. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–148.

    PubMed  CAS  Google Scholar 

  33. American Psychiatry Association, ed. DSM-PV, Diagnosis and Statistical Manual of Mental Disorders. 4th ed. Washington: American Psychiatry Association; 1994.

    Google Scholar 

  34. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.

    Article  PubMed  CAS  Google Scholar 

  35. Viatonou S, Drame M, Jolly D, et al. Predictor of rapid cognitive decline among demented subjects aged 75 or more: (’sujet Age Fragile-Evaluation et Suivi’ Cohort-SAFES). Int J Geriatr Psychiatry 2009;24:709–715.

    Article  PubMed  Google Scholar 

  36. Gilleard CJ, Willmott M, Vaddadi KS. Self-report measures of mood and morale in elderly depressives. Br J Psychiatry 1981;138:230–235.

    Article  PubMed  CAS  Google Scholar 

  37. Norton D, McLaren R, Exton-Smith A. An investigation of nursing problems in hospitals. New-York: Churchill Livingstone; 1975.

    Google Scholar 

  38. Sundararajan V, Henderson T, Perry C, et al. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 2004;57:1288–1294.

    Article  PubMed  Google Scholar 

  39. Buntinx F, Niclaes L, Suetens C, et al. Evaluation of Charlson’s comorbidity index in elderly living in nursing homes. J Clin Epidemiol 2002;55:1144–1147.

    Article  PubMed  CAS  Google Scholar 

  40. O’Hara R, Thompson JM, Kraemer HC, et al. Which Alzheimer patients are at risk for rapid cognitive decline? J Geriatr Psychiatry Neurol 2002;15:233–238.

    PubMed  Google Scholar 

  41. Dramé M, Fierobe F, Lang PO, et al. Predictors of Institution Admission in the Year Following Acute Hospitalisation of Elderly People. J Nutr Health Aging 2011;15(5):399–403.

    Article  PubMed  Google Scholar 

  42. Drame M, Novella JL, Lang PO, et al. Derivation and validation of a mortality-risk index from a cohort of frail elderly patients hospitalised in medical wards via emergencies: The SAFES study. Eur J Epidemiol 2008;23:783–791.

    Article  PubMed  CAS  Google Scholar 

  43. Cohen J. A coefficient of agreement for nominal scales. Educational Psychological Measurement 1960;20:27–46.

    Article  Google Scholar 

  44. Kuh D. A life course approach to healthy aging, frailty, and capability. J Gerontol A BiolSci 2007;62A:717–721.

    Article  Google Scholar 

  45. Barrett-Connor E, Edelstein SL, Corey-Bloom J, et al. Weight loss precedes dementia in community-dwelling older adults. J Am GeriatrSoc 1996;44:1147–1152.

    CAS  Google Scholar 

  46. Nourhashemi F, Andrieu S, Gillette-Guyonnet S, et al. Is there a relationship between fat-free soft tissue mass and low cognitive function? Results from a study of 7,105 women. J Am GeriatrSoc 2002;50:1796–1801.

    Article  Google Scholar 

  47. Nourhashemi F, Deschamps V, Larrieu S, et al. Body mass index and incidence of dementia Paquid study. Neurology 2003;60:117–119.

    PubMed  CAS  Google Scholar 

  48. Barberger-Gateau P, Dartigues JF, Letenneur L. Four instrumental activities of daily living score as a predictor of one-year incident dementia. Age Ageing 1993;22:457–463.

    Article  PubMed  CAS  Google Scholar 

  49. Boyle PA, Buchman AS, Wilson RS, et al. Physical frailty is associated with incident mild cognitive impairment in community-based older persons. J Am Geriatr Soc 2010;58:248–255.

    Article  PubMed  Google Scholar 

  50. Ferrucci L, Guralnik JM, Studenski S, et al. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 2004;52:625–634.

    Article  PubMed  Google Scholar 

  51. Mitnitski AB, Song X, Rockwood K. The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. J Gerontol A Biol Sci Med Sci 2004;59:M627–632.

    Article  PubMed  Google Scholar 

  52. Buchman AS, Boyle PA, Wilson RS et al. Frailty is associated with incident Alzheimer’s disease and cognitive decline in the elderly. Psychosom Med 2007;69:483–489.

    Article  PubMed  Google Scholar 

  53. Drame M, Dia PA, Jolly D, et al. [Factors predictive of long-term mortality in patients aged 75 years or older hospitalized from the emergency department: the SAFES cohort]. Presse Med 2009;38:1068–1075.

    Article  PubMed  Google Scholar 

  54. Drame M, Jovenin N, Novella JL, et al. Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: the SAFES cohort study. J Nutr Health Aging 2008;12:599–604.

    Article  PubMed  CAS  Google Scholar 

  55. Laniece I, Couturier P, Drame M, et al. Incidence and main factors associated with early unplanned hospital readmission among French medical inpatients aged 75 and over admitted through emergency units. Age Ageing 2008;37:416–422.

    Article  PubMed  Google Scholar 

  56. Lang PO, Zekry D, Michel JP, et al. Early markers of prolonged hospital stay in demented inpatients: a multicentre and prospective study. J Nutr Health Aging 2010;14:141–147.

    Article  PubMed  Google Scholar 

  57. Viatonou S, Drame M, Jolly D, et al. Predictors of rapid cognitive decline among demented subjects aged 75 or more: (’sujet Age Fragile-Evaluation et Suivi’ Cohort-SAFES). Int J Geriatr Psychiatry 2009;24:709–715.

    Article  PubMed  Google Scholar 

  58. Gobbens RJ, van Assen MA, Luijkx KG, et al. Determinants of frailty. J Am Med Dir Assoc 2010;11:356–364.

    Article  PubMed  Google Scholar 

  59. Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, et al. In search of an integral conceptual definition of frailty: opinion of experts. J Am Med Dir Assoc 2010:11:338–343.

    Article  PubMed  Google Scholar 

  60. Katunananthan S, Wolfson C, Bergman H, et al. A multidisciplinary systemic literature review on frailty: overview of the methodology used by the Canadian Initiative on frailty and Aging. BMC MedRes Methodol 2009;68(9).

  61. Xue QL, Beamer BA, Chaves PHM, et al. Heterogeneity in rate of decline in grip, hip and knee strength and the risk of all-cause mortality: the women’s health and aging study II. J Am Geriatr Soc 2010;58:2076–2084.

    Article  PubMed  Google Scholar 

  62. Bortz WM, 2nd. The physics of frailty. J Am Geriatr Soc 1993;41:1004–108.

    PubMed  Google Scholar 

  63. MacAdam M, Capitman J, Yee D, et al. Case management for frail elders: The Robert Wood Johnson Foundation’s program for hospital initiatives in long-term care. Gerontologist 1989;29:737–744.

    Article  PubMed  CAS  Google Scholar 

  64. Pawlson LG. Hospital length of stay of frail elderly patients. Primary care by general internists versus geriatricians. J Am Geriatr Soc 1988;36:202–208.

    PubMed  CAS  Google Scholar 

  65. Williams FM, Wynne H, Woodhouse KW, et al. Plasma aspirin esterase: the influence of old age and frailty. Age Ageing 1989;18:39–42.

    Article  PubMed  CAS  Google Scholar 

  66. Gillick M. Long-term care options for the frail elderly. J Am Geriatr Soc 1989;37:1198–1203.

    PubMed  CAS  Google Scholar 

  67. Kay D. Ageing of the population: measuring the need for care. Age Ageing 1989;18:73–76.

    Article  PubMed  CAS  Google Scholar 

  68. Rockwood K, Fox RA, Stolee P, et al. Frailty in elderly people: an evolving concept. Cmaj 1994;150:489–495.

    PubMed  CAS  Google Scholar 

  69. Woodhouse KW, Wynne H, Baillie S, et al. Who are the frail elderly? Q J Med 1988;68:505–506.

    PubMed  CAS  Google Scholar 

  70. Buchner DM, Wagner EH. Preventing frail health. Clin Geriatr Med 1992;8:1–17.

    PubMed  CAS  Google Scholar 

  71. Campbell AJ, Buchner DM. Unstable disability and the fluctuations of frailty. Age Ageing 1997;26:315–318.

    Article  PubMed  CAS  Google Scholar 

  72. Chin APMJ, Dekker JM, Feskens EJ, et al. How to select a frail elderly population? A comparison of three working definitions. J Clin Epidemiol 1999;52:1015–1021.

    Article  Google Scholar 

  73. Fried LP, Waltson JD. Frailty and failure to thrive. In: Hazzard WR, Blass JP, Ettinger WH, Halter JB, Ouslander JG, eds. Principles of geriatric medicine and gerontology. 4th ed. New York: McGraw Hill; 1998:1387–1402.

    Google Scholar 

  74. Fried LP, Xue QL, Cappola AR et al. Nonlinear multisystem physiological dysregulation associated with frailty in older women: implication for etiologiy and treatment. J Gerontol A Biol Sci Med Sci 2009;64:1049–1057.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine, E.A 3797, Univeisity of Reims Champagne-Ardenne, Reims, F-51092, France

    M. Drame, J. -L. Novella, D. Jolly, F. Blanchard & Pierre Olivier Lang

  2. Department of Clinical Gerontology, Reims Teaching Hospitals, Maison Blanche Hospital, Reims, F-51092, France

    M. Drame, J. -L. Novella & F. Blanchard

  3. Clinical Research Coordination Unit, Reims Univeisity Hospitals, Robert Debré Hospital, Reims, F-51092, France

    D. Jolly

  4. Hospital of La Tronche, Geriatrics Department, Grenoble Univeisity Hospitals, Grenoble, F-38700, France

    I. Laniece & P. Couturier

  5. Geriatric Department, Public Assistance - Hospitals of Paris, Georges Pompidou European Hospital, Paris, F-75905, France

    D. Somme & O. Saint-Jean

  6. Department of Internal Medicine and Geriatrics, Strasbourg University Hospitals Hospital of La Robertsau, Strasbourg, F-67015, France

    D. Heitz

  7. Geriatrics Centre, Regional Hospitals of Orléans, Hospital of Porte Madeleine, Orléans, F-45032, France

    J. -B. Gauvain

  8. Department of Internal Medicine and Clinical Gerontology, Toulouse University Hospitals, Rangueil Hospital, Toulouse, F-31400, France

    T. Voisin

  9. Department of Internal Medicine and Geriatrics, Nîmes University Hospitals, Gaston Doumergues Hospital, Nîmes, F-30029, France

    B. De Wazieres

  10. Department of Clinical Gerontology, Saint Etienne University Hospitals, Hospital of La Charité, Saint Etienne, F-42055, France

    R. Gonthier

  11. Clinical Gerontology Centre, Montpellier University Hospitals, Hospital of La Colombière, Montpellier, F-34295, France

    C. Jeandel

  12. Centre of Gerontology, Public Assistance - Hospitals of Paris, Sainte-Perine Hospital, Paris, F-75015, France

    J. Ankri

  13. Rehabilitation and Geriatrics, University Hospitals and Medical school of Geneva, Department of Internal Medicine, Geneva, CH-1226, Switzerland

    M. Drame, J. -L. Novella, D. Jolly, I. Laniece, D. Somme, D. Heitz, J. -B. Gauvain, T. Voisin, B. De Wazieres, R. Gonthier, C. Jeandel, P. Couturier, O. Saint-Jean, J. Ankri, F. Blanchard & Pierre Olivier Lang

Authors
  1. M. Drame
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. -L. Novella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Jolly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. Laniece
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Somme
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Heitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. -B. Gauvain
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T. Voisin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. B. De Wazieres
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. R. Gonthier
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. C. Jeandel
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. P. Couturier
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. O. Saint-Jean
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. J. Ankri
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. F. Blanchard
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Pierre Olivier Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pierre Olivier Lang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Drame, M., Novella, J.L., Jolly, D. et al. Rapid cognitive decline, one-year institutional admission and one-year mortality: Analysis of the ability to predict and inter-tool agreement of four validated clinical frailty indexes in the safes cohort. J Nutr Health Aging 15, 699–705 (2011). https://doi.org/10.1007/s12603-011-0164-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-011-0164-8

Key words

Search

Navigation