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The Italian version of the “frailty index” based on deficits in health: a validation study

Abstract

Background and Aim

Several measurements were taken for frailty classification in geriatric population. “Frailty index” is based on “deficits in health,” but it is still not available in Italian version. Thus, the aim of the present work was to validate a version of “frailty index” for the Italian geriatric community.

Methods

The validation of Italian frailty index (IFi) is based on a cohort study that enrolled 1077 non-disabled outpatients aged 65 years or older (81.3 ± 6.5 years) in Naples (Italy). IFi has been expressed as a ratio of deficits present/deficits considered after a comprehensive geriatric assessment. IFi was stratified in light, moderate and severe frailty. Mortality, disability (considering an increase in ADL lost ≥1 from the baseline) and hospitalization were considered at 3, 6, 12, 18 and 24 months of follow-up. Area under curve (AUC) was evaluated for both Fried’s and IFi frailty index.

Result

At the end of follow-up, mortality increased from 1.0 to 30.3%, disability from 40.9 to 92.3% and hospitalization from 0.0 to 59.0% (p < 0.001 for trend). Multivariate analysis shows that the relative risk for unit increase in IFi is 1.09 (95% CI = 1.01–1.17, p = 0.013) for mortality, 1.04 (95% CI = 1.01–1.06, p = 0.024) for disability and 1.03 (95% CI = 1.01–1.07, p = 0.041) for hospitalization. AUC is higher in IFi with respect to Fried’s frailty index when considering mortality (0.809 vs. 0.658, respectively), disability (0.800 vs. 0.729, respectively) and hospitalization (0.707 vs. 0.646, respectively).

Conclusions

IFi is a valid measure of frailty after the comprehensive geriatric assessment in an Italian cohort of non-institutionalized patients.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Pasquale Abete.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study protocol was approved by the University of Naples Federico II (Comitato Etico per le attività Biomediche “Carlo Romano” prot. n.211/2013).

Informed consent

All participants provided informed consent at baseline and at follow-up.

Appendix 1

Appendix 1

figure a
Paziente Cart. cl. Nato il__/__/__ Altezza = m Peso = Kg Tel. P
1. Aiuto nel lavarsi SI = 1 No = 0     
2. Aiuto nel vestirsi SI = 1 No = 0     
3. Aiuto nel sedersi o alzarsi dalla sedia SI = 1 No = 0     
4. Aiuto nel camminare in casa SI = 1 No = 0     
5. Aiuto nel mangiare SI = 1 No = 0     
6. Aiuto nella cura della casa SI = 1 No = 0     
7. Aiuto nell’utilizzare il bagno SI = 1 No = 0     
8. Aiuto nel salire o scendere le scale SI = 1 No = 0     
9. Aiuto nell’alzare 4.5 kg SI = 1 No = 0     
10. Aiuto nel fare la spesa SI = 1 No = 0     
11. Aiuto nei lavori di casa SI = 1 No = 0     
12. Aiuto nel preparare i pasti SI = 1 No = 0     
13. Aiuto nell’assumere i farmaci SI = 1 No = 0     
14. Aiuto nella gestione del denaro SI = 1 No = 0     
15. Perdita di più di 4.5 kg di peso nell’ultimo anno SI = 1 No = 0     
16. Giudizio sulla propria salute Scarsa = 1 Discreta = 0.75 Buona = 0.5 Molto buona = 0.25 Eccellente = 0  
17. Come è cambiata la sua salute nell’ultimo anno? Peggiorata = 1 Migliorata/stessa = 0     
18. Persistenza a letto almeno 1/2 giornata per motivi di salute, nell’ultimo mese? SI = 1 No = 0     
19. Riduzione della solita attività nell’ultimo mese? SI = 1 No = 0     
20. Uscire <3 Giorni = 1 ≥3 Giorni = 0     
21. Affaticarsi per qualsiasi cosa Spesso = 1 Qualche volta = 0.5 Raramente = 0    
22. Sentirsi depresso Spesso = 1 Qualche volta = 0.5 Raramente = 0    
23. Sentirsi infelice Spesso = 1 Qualche volta = 0.5 Raramente = 0    
24. Social support score (vedi allegato 1) >13 = 1 6–13 = 0.5 1–5 = 0    
25. Avere difficoltà a mettersi in moto Spesso = 1 Qualche volta = 0.5 Raramente = 0    
26. Ipertensione SI = 1 Sospetta = 0.5 No = 0    
27.Angina pectoris SI = 1 Sospetta = 0.5 No = 0    
28. Insufficienza cardiaca cronica SI = 1 Sospetta = 0.5 No = 0    
29. Ictus SI = 1 Sospetta = 0.5 No = 0    
30. Cancro SI = 1 Sospetta = 0.5, No = 0    
31. Diabete SI = 1 Sospetta = 0.5 No = 0    
32. Artrosi SI = 1 Sospetta = 0.5 No = 0    
33. Broncopneumopatia cronica SI = 1 Sospetta = 0.5 No = 0    
34. MMSE <10 = 1 11–17 = 0.75 18–20 = 0.5 20–24 = 0.25 >24 = 0  
35. BMI <18.5, ≥30 = 1 25–<30 = 0.5 18.5–24.9 = 0    
36. Picco flusso espiratorio = _______L/min 1 = ______ 2 = _______ 3 = ______ ≤340 (uomo), ≤310 (donna) = 1 >340 (uomo), >310 (donna) = 0     
37. Forza muscolare sollevamento = Kg 1 = ______ 2 = _______ 3 = ______ ≤12 (uomo), ≤9 (donna) = 1 >12 (uomo), >9 (donna) = 0     
38. Forza muscolare presa = Kg 1 = ______ 2 = _______ 3 = ______ Uomo = 1 Uomo = 0     
BMI ≤24, Kg ≤29 BMI ≤24 Kg >29     
BMI 24.1–28 Kg ≤30 BMI 24.1–28 Kg >30
BMI >28 Kg ≤32 BMI >28 Kg >32
Donna = 1 Donna = 0     
BMI ≤23 Kg ≤17 BMI ≤23 Kg >17     
BMI 23.1–26 Kg ≤ 17.3 BMI 23.1–26 Kg >17
BMI 26.1–29 Kg ≤18 BMI 26.1–29 Kg >18
BMI >29 Kg ≤21 BMI >29 Kg >21
39. Mini nutritional Assessment (vedi allegato 2) <17 = 1 17–23.5 = 0.5 24 = 0    
40. Tempo impiegato per percorrere 4 metri con passo rapido (sec) >10 = 1 ≤10 = 0     
Totale

Scala supporto sociale

1. Stato civile Vedovo o celibe = 1 Coniugato = 0
2. Figli viventi No = 1 Sì = 0
3. Fratelli e sorelle viventi No = 1 Sì = 0
4. Frequenza di rapporti familiari Mai, raramente = 1 Spesso, di frequente = 0
5. Con chi abita Solo = 1 In compagnia = 0
6. Aiuto finanziario da parte dei familiari No = 1 Sì = 0
7. Rapporti stretti con parenti non familiari No = 1 Sì = 0
8. Aiuto concreto da parte dei familiari No = 1 Sì = 0
9. Con quante persone del vicinato si vede almeno una volta a settimana? Nessuno = 1 Almeno una = 0
10. Ha amici intimi? No = 1 Sì = 0
11. Frequenza rapporti? Mai, raramente = 1 Spesso, di frequente = 0
12. Frequenta posti pubblici? Mai, raramente = 1 Spesso, di frequente = 0
13. Frequenta cinema-teatri? Mai, raramente = 1 Spesso, di frequente = 0
14. Frequenta associazioni di volontariato-ricreative? Mai, raramente = 1 Spesso, di frequente = 0
15. Legge i giornali? Mai, raramente = 1 Spesso, di frequente = 0
16. Ascolta radio e/o vede TV? Mai, raramente = 1 Spesso, di frequente = 0
17. Si prende cura dei bambini? Mai, raramente = 1 Spesso, di frequente = 0
Totale
  1. Dalla analisi della tabella si ottiene uno score in cui i punteggi più alti individuano i soggetti con un basso livello di supporto sociale: il più basso livello si individua con un punteggio di 17
  2. Supporto sociale buono: 1–5
  3. Supporto sociale discreto: 6–13
  4. Supporto sociale scarso: 14–17

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Abete, P., Basile, C., Bulli, G. et al. The Italian version of the “frailty index” based on deficits in health: a validation study. Aging Clin Exp Res 29, 913–926 (2017). https://doi.org/10.1007/s40520-017-0793-9

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Keywords

  • Frailty
  • Frailty index
  • Deficits in health