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A global clinical measure of fitness and frailty in elderly people

From the Division of Geriatric Medicine, Dalhousie University, Halifax, NS (Rockwood, Song, MacKnight, Mitnitski); the Division of Geriatric Medicine, McGill University, Montréal, Que. (Bergman); the Division of Geriatric Medicine, University of Calgary, Calgary, Alta. (Hogan); and the Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont. (McDowell)

Correspondence to: Dr. Kenneth Rockwood, Centre for Health Care of the Elderly, 1421—5955 Veterans' Memorial Lane, Halifax NS B3H 2E1; fax 902 473-1050; kenneth.rockwood{at}dal.ca

Background: There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use.

Methods: We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools.

Results: The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%–30.6%) and entry into an institution (23.9%, 95% CI 8.8%–41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality).

Interpretation: Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.

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