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.

Links

Publisher Full Text
Aggregator Full Text

Authors+Show Affiliations

Avila-Funes JA
Centre de Recherche Inserm, U897, Bordeaux, France.
Amieva H
No affiliation info available
Barberger-Gateau P
No affiliation info available
Le Goff M
No affiliation info available
Raoux N
No affiliation info available
Ritchie K
No affiliation info available
Carrière I
No affiliation info available
Tavernier B
No affiliation info available
Tzourio C
No affiliation info available
Gutiérrez-Robledo LM
No affiliation info available
Dartigues JF
No affiliation info available

MeSH

Activities of Daily LivingAgedAged, 80 and overBody Mass IndexCognition DisordersComorbidityDementia, VascularFemaleFrail ElderlyFranceGeriatric AssessmentHealth Status IndicatorsHumansMaleMental Status ScheduleMobility LimitationNeuropsychological TestsPhenotypePsychometricsRisk FactorsSocioeconomic FactorsWeight Loss

Pub Type(s)

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

Language

eng

PubMed ID

19245415