Skip to main content
SpringerLink
Log in

A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans

  • Published:
The journal of nutrition, health & aging

Abstract

Objective

To validate the FRAIL scale.

Design

Longitudinal study.

Setting

Community.

Participants

Representative sample of African Americans age 49 to 65 years at onset of study.

Measurements

The 5-item FRAIL scale (Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight), at baseline and activities of daily living (ADLs), instrumental activities of daily living (IADLs), mortality, short physical performance battery (SPPB), gait speed, one-leg stand, grip strength and injurious falls at baseline and 9 years. Blood tests for CRP, SIL6R, STNFR1, STNFR2 and 25 (OH) vitamin D at baseline.

Results

Cross-sectionally the FRAIL scale correlated significantly with IADL difficulties, SPPB, grip strength and one-leg stand among participants with no baseline ADL difficulties (N=703) and those outcomes plus gait speed in those with no baseline ADL dependencies (N=883). TNFR1 was increased in pre-frail and frail subjects and CRP in some subgroups. Longitudinally (N=423 with no baseline ADL difficulties or N=528 with no baseline ADL dependencies), and adjusted for the baseline value for each outcome, being pre-frail at baseline significantly predicted future ADL difficulties, worse one-leg stand scores, and mortality in both groups, plus IADL difficulties in the dependence-excluded group. Being frail at baseline significantly predicted future ADL difficulties, IADL difficulties, and mortality in both groups, plus worse SPPB in the dependence-excluded group.

Conclusion

This study has validated the FRAIL scale in a late middle-aged African American population. This simple 5-question scale is an excellent screening test for clinicians to identify frail persons at risk of developing disability as well as decline in health functioning and mortality.

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. Morley JE, Perry HM III, Miller DK. Editorial: Something about frailty. J Gerontol A Biol Sci Med Sci 2002;57:M698–M704.

    Article  PubMed  Google Scholar 

  2. 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 

  3. Morley JE. Developing novel therapeutic approaches to frailty. Curr Pharm Des 2009;15:3384–3395.

    Article  PubMed  CAS  Google Scholar 

  4. Theou O, Stathokostas L, Roland KP, et al. The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res 2011;56:91–94.

    Google Scholar 

  5. Morley JE, Argiles JM, Evans WJ, et al. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc 2010;11:391–396.

    Article  PubMed  Google Scholar 

  6. Srinivas-Shankar U, Roberts SA, Connolly MJ, et al. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab 2010;95:639–650.

    Article  PubMed  CAS  Google Scholar 

  7. 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:M146–M156.

    Article  PubMed  CAS  Google Scholar 

  8. Ensrud KE, Ewing SK, Taylor BC, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 2008;168:382–389.

    Article  PubMed  Google Scholar 

  9. 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 

  10. Abellan van Kan G, Rolland YM, Morley JE, Vellas B. Frailty: toward a clinical definition. J Am Med Dir Assoc 2008;9:71–72.

    Article  PubMed  Google Scholar 

  11. Newman AB, Gottdiener JS, McBurnie MA, et al. Associations of subclinical cardiovascular disease with frailty. J Gerontol A Biol Sci Med Sci 2001;56:M158–M166.

    Article  PubMed  CAS  Google Scholar 

  12. Rockwood K, Hogan DB, MacKnight C. Conceptualisation and measurement of frailty in elderly people. Drugs Aging 2000;17:295–302.

    Article  PubMed  CAS  Google Scholar 

  13. Hirsch C, Anderson ML, Newman A, et al. The association of race with frailty: The Cardiovascular Health Study. Ann Epidemiol 2006;16:545–553.

    Article  PubMed  Google Scholar 

  14. Mendes de Leon CF, Barnes LL, Bienias JL, et al. Racial disparities in disability: recent evidence from self-reported and performance-based disability measures in a populationbased study of older adults. J Gerontol B Psychol Sci Soc Sci 2005;60:S263–S271.

    Article  PubMed  Google Scholar 

  15. Miller DK, Wolinsky FD, Malmstrom TK, et al. Inner city, middle-aged African Americans have excess frank and subclinical disability. J Gerontol A Biol Sci Med Sci 2005;60:207–212.

    Article  PubMed  Google Scholar 

  16. Miller DK, Malmstrom TK, Joshi S, et al. Clinically relevant levels of depressive symptoms in community-dwelling middle-aged African Americans. J Am Geriatr Soc 2004;52:741–748.

    Article  PubMed  Google Scholar 

  17. Wolinsky FD, Miller DK, Andresen EM, et al. Health-related quality of life in middleaged African Americans. J Gerontol B Psychol Sci Soc Sci 2004;59:S118–S123.

    Article  PubMed  Google Scholar 

  18. National Center for Health Statistics. Data File Documentation, National Health Interview Second Supplement on Aging, 1994 (machine readable data file and documentation). Hyattsville, MD: National Center for Health Statistics, 1998.

    Google Scholar 

  19. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–186.

    Article  PubMed  CAS  Google Scholar 

  20. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85–M94.

    Article  PubMed  CAS  Google Scholar 

  21. Volpato S, Cavalieri M, Sioulis F, et al. Predictive value of the short physical performance battery following hospitalization in older patients. J Gerontol A Biol Sci Med Sci 2011;66:89–96.

    Article  PubMed  Google Scholar 

  22. Miller DK, Wolinsky FD, Andresen EM, et al. Adverse outcomes and correlates of change in the Short Physical Performance Battery over 36 months in the African American Health project. J Gerontol A Biol Sci Med Sci 2008;63:487–494.

    Article  PubMed  Google Scholar 

  23. Miller DK, Malmstrom TK, Miller JP, et al. Predictors of change in grip strength over 3 years in the African American Health project. J Aging Health 2010;22:183–196.

    Article  PubMed  Google Scholar 

  24. Andresen EM, Wolinsky FD, Miller JP et al. Cross-sectional and longitudinal risk factors for falls, fear of falling, and the falls efficacy in a cohort of middle-aged African Americans. Gerontologist 2006;46(2):249–257.

    Article  PubMed  Google Scholar 

  25. Haren MT, Malmstrom TK, Miller DK, et al. Higher C-reactive protein and soluble tumor necrosis factor receptor levels are associated with poor physical function and disability: A cross-sectional analysis of a cohort of late middle-aged African Americans. J Gerontol A Biol Sci Med Sci 2010;65:274–281.

    Article  PubMed  Google Scholar 

  26. Hyde Z, Flicker L, Almeida OP, et al. Low free testosterone predicts frailty in older men: The Health in Men Study. J Clin Endocrniol Metab 2010;3165-3172.

  27. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005:173;489–495.

    Article  PubMed  Google Scholar 

  28. Liu CK, Fielding RA. Exercise as an intervention for frailty. Clin Geriatr Med 2011;27:101–110.

    Article  PubMed  CAS  Google Scholar 

  29. Basaria S, Coviello AD, Travison TG, et al. Adverse events associated with testosterone administration. N Engl J Med 2010;363:109–122.

    Article  PubMed  CAS  Google Scholar 

  30. Leng SX, Xue QL, Tian J, Walston JD, Fried LP. Inflammation and frailty in older women. J Am Geriatr Soc 2007;55:864–871.

    Article  PubMed  Google Scholar 

  31. Spate U, Schulze PC. Proinflammatory cytokines and skeletal muscle. Curr Opin Clin Nutr Metab Care 2004;7:265–269.

    Article  PubMed  Google Scholar 

  32. Ferrucci L, Harris TB, Guralnik JM, et al. Serum IL-6 level and the development of disability in older persons. J Am Geriatr Soc 1999;47:639–646.

    PubMed  CAS  Google Scholar 

  33. Rolland Y, Czerwinski S, Abellan van Kan G, et al. Sarcopenia: Its assessment, etiology, pathogenesis, consequences and future perspectives. J Nutr Health Aging 2008;12:433–450.

    Article  PubMed  CAS  Google Scholar 

  34. Morley JE. Vitamin D redux. J Am Med Dir Assoc 2009;10:591–592.

    Article  PubMed  Google Scholar 

  35. Shardell M, Hicks GE, Miller RR, et al. Association of low vitamin D levels with the frailty syndrome in men and women. J Gerontol A Biol Sci Med Sci 2009;64:69–75.

    Article  PubMed  Google Scholar 

  36. Ensrud KE, Blackwell TL, Cauley JA, et al. Circulating 25-hydroxyvitamin D levels and frailty in older men: the osteoporotic fractures in men study. J Am Geriatr Soc 2011;59:101–106.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Geriatrics, Department of Internal Medicine, 1402 South Grand Boulevard, St. Louis, MO, 63104, USA

    John E. Morley, T. K. Malmstrom & D. K. Miller

Authors
  1. John E. Morley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. K. Malmstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. K. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John E. Morley.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morley, J.E., Malmstrom, T.K. & Miller, D.K. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 16, 601–608 (2012). https://doi.org/10.1007/s12603-012-0084-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-012-0084-2

Key words

Search

Navigation