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Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study.
J Am Geriatr Soc. 2009 Mar; 57(3):453-61.JA

Abstract

OBJECTIVES

To determine whether adding cognitive impairment to frailty improves its predictive validity for adverse health outcomes.

DESIGN

Four-year longitudinal study.

SETTING

The French Three-City Study.

PARTICIPANTS

Six thousand thirty community-dwelling persons aged 65 to 95.

MEASUREMENTS

Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. Subjects meeting one or two criteria were prefrail and those meeting none as nonfrail. The lowest quartile in the Mini-Mental State Examination (MMSE) and the Isaacs Set Test (IST) was used to identify subjects with cognitive impairment. The predictive validity of frailty for incident disability, hospitalization, dementia, and death was calculated first for frailty subgroups and then rerun after stratification according to the presence or absence of cognitive impairment.

RESULTS

Four hundred twenty-one individuals (7%) met frailty criteria. Cognitive impairment was present in 10%, 12%, and 22% of the nonfrail, prefrail, and frail subjects, respectively. Those classified as frail scored lower on the MMSE and IST than those classified as prefrail and nonfrail. After adjustment, frail persons with cognitive impairment were significantly more likely to develop disability in activities of daily living (ADLs) and instrumental ADLs over the following 4 years. The risk of incident mobility disability and hospitalization was marginally greater. Incident dementia was greater in the groups with cognitive impairment irrespective of their frailty status. Conversely, frailty was not a significant predictor of mortality.

CONCLUSION

Cognitive impairment improves the predictive validity of the operational definition of frailty, because it increases the risk of adverse health outcomes in this particular subgroup of the elderly population.

Authors+Show Affiliations

Centre de Recherche Inserm, U897, Bordeaux, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19245415

Citation

Avila-Funes, José Alberto, et al. "Cognitive Impairment Improves the Predictive Validity of the Phenotype of Frailty for Adverse Health Outcomes: the Three-city Study." Journal of the American Geriatrics Society, vol. 57, no. 3, 2009, pp. 453-61.
Avila-Funes JA, Amieva H, Barberger-Gateau P, et al. Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. J Am Geriatr Soc. 2009;57(3):453-61.
Avila-Funes, J. A., Amieva, H., Barberger-Gateau, P., Le Goff, M., Raoux, N., Ritchie, K., Carrière, I., Tavernier, B., Tzourio, C., Gutiérrez-Robledo, L. M., & Dartigues, J. F. (2009). Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. Journal of the American Geriatrics Society, 57(3), 453-61. https://doi.org/10.1111/j.1532-5415.2008.02136.x
Avila-Funes JA, et al. Cognitive Impairment Improves the Predictive Validity of the Phenotype of Frailty for Adverse Health Outcomes: the Three-city Study. J Am Geriatr Soc. 2009;57(3):453-61. PubMed PMID: 19245415.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. AU - Avila-Funes,José Alberto, AU - Amieva,Hélène, AU - Barberger-Gateau,Pascale, AU - Le Goff,Mélanie, AU - Raoux,Nadine, AU - Ritchie,Karen, AU - Carrière,Isabelle, AU - Tavernier,Béatrice, AU - Tzourio,Christophe, AU - Gutiérrez-Robledo,Luis Miguel, AU - Dartigues,Jean-François, Y1 - 2009/02/22/ PY - 2009/2/28/entrez PY - 2009/2/28/pubmed PY - 2009/3/31/medline SP - 453 EP - 61 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 57 IS - 3 N2 - OBJECTIVES: To determine whether adding cognitive impairment to frailty improves its predictive validity for adverse health outcomes. DESIGN: Four-year longitudinal study. SETTING: The French Three-City Study. PARTICIPANTS: Six thousand thirty community-dwelling persons aged 65 to 95. MEASUREMENTS: Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. Subjects meeting one or two criteria were prefrail and those meeting none as nonfrail. The lowest quartile in the Mini-Mental State Examination (MMSE) and the Isaacs Set Test (IST) was used to identify subjects with cognitive impairment. The predictive validity of frailty for incident disability, hospitalization, dementia, and death was calculated first for frailty subgroups and then rerun after stratification according to the presence or absence of cognitive impairment. RESULTS: Four hundred twenty-one individuals (7%) met frailty criteria. Cognitive impairment was present in 10%, 12%, and 22% of the nonfrail, prefrail, and frail subjects, respectively. Those classified as frail scored lower on the MMSE and IST than those classified as prefrail and nonfrail. After adjustment, frail persons with cognitive impairment were significantly more likely to develop disability in activities of daily living (ADLs) and instrumental ADLs over the following 4 years. The risk of incident mobility disability and hospitalization was marginally greater. Incident dementia was greater in the groups with cognitive impairment irrespective of their frailty status. Conversely, frailty was not a significant predictor of mortality. CONCLUSION: Cognitive impairment improves the predictive validity of the operational definition of frailty, because it increases the risk of adverse health outcomes in this particular subgroup of the elderly population. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/19245415/Cognitive_impairment_improves_the_predictive_validity_of_the_phenotype_of_frailty_for_adverse_health_outcomes:_the_three_city_study_ L2 - https://doi.org/10.1111/j.1532-5415.2008.02136.x DB - PRIME DP - Unbound Medicine ER -