Self-Reported Assessment Provides Reliable Measure of Frailty Interview with

Oleg Zaslavsky PhD Assistant Professor at the department of Biobehavioral Nursing and Health System School of Nursing University of Washington

Dr. Oleg Zaslavsky

Oleg Zaslavsky PhD
Assistant Professor at the department of Biobehavioral Nursing and Health System
School of Nursing
University of Washington What is the background for this study? What are the main findings?

Response: Frailty is a common, but serious medical condition among older adults. It is characterized by weight and muscle loss, fatigue, slow walking and low levels of physical activity. It’s important to accurately diagnose and treat frailty, especially because demographic trends show the percentage of U.S. adults age 65 years and older will increase 19% by 2030.

Frailty is commonly assessed by the Cardiovascular Health Study (CHS) frailty phenotype, which includes a set of physical measurements for slowness, weakness, fatigue, low physical activity and body-weight loss. According to the CHS phenotype, individuals with three or more of these characteristics are at increased risk for falls, hip fractures, disability and mortality. Although the CHS phenotype is good for predicting adverse conditions, it requires direct measurement of physical performance. Refining the phenotype so it doesn’t involve physical measurements of patients in a doctor’s office has practical advantages for research and clinical purposes.

For this study, University of Washington School of Nursing researchers worked with Fred Hutchinson Cancer Research Center faculty to refine the Women’s Health Initiative (WHI) frailty phenotype, originally developed in 2005. This new phenotype uses self-reporting from patients instead of measurements of physical performance to determine frailty and associated health outcomes.

In this report, we show that our newly-proposed WHI measuring scheme performs as well as the more complex CHS phenotype in predicting death, hip fractures and falls in older women. What should readers take away from your report?

Response: Through the Women’s Health Initiative (WHI) frailty phenotype, patients are able to self-report characteristics associated with adverse health conditions without ever leaving their home.

It is more convenient and cost effective for patients to self-report through a mailed survey or over then phone than to come into a doctor’s office for physical measurement.

In the CHS phenotype, subjects’ functional performance is measured by grip strength and timed walking-speed tests. The WHI phenotype relies on subjects’ self-perception of their own functional limitations with mild, moderate and severe response categories. Participants were also asked if they have felt worn out or tired in the previous four weeks as this can indicate exhaustion.

Our study found that self-reporting in this context was just as predictive of adverse outcomes as physical measurements. In some areas, subjects may even have a better understanding of their own health and performance than what can be gaged by physical measurements. For example, self-reporting through the WHI measures was a more sensitive predictor of falls than physical measurements through the CHS criteria. What recommendations do you have for future research as a result of this study?

Response: Our study succeeded in confirming the value of the WHI phenotype in screening older women for risk of mortality, falls and fracture. The study had several strengths, including a large sample size, careful interpretation of outcomes, and completeness of long-term follow-up.

However, there were several limitations to this study that call for future exploration in this area.

  • First, our findings are gender specific and need to be replicated in a more diverse, older population that includes male participants.
  • Second, older women with low levels of functioning and health were less likely than women with better functioning to participate in performance-based assessments and complete self-reported questionnaires. Loss to follow-up may underestimate the proportion of frail women at risk of adverse events.
  • Third, using proxy measures for some areas, including weakness and slowness, might be less informative for biological research. However, simplicity of measurement is advantageous for clinical purposes.
  • Finally, the self-reported nature of the WHI phenotype and falls may imply that participants who misreport weakness might also misreport falls, leading to overestimation of the strength of association. However, the fact that the WHI frailty phenotype was also associated with higher rates of hip fracture supports the validity of the association with falls. Thank you for your contribution to the community.


J Am Geriatr Soc. 2016 Jun 16. doi: 10.1111/jgs.14233. [Epub ahead of print]
Comparison of Frailty Phenotypes for Prediction of Mortality, Incident Falls, and Hip Fracture in Older Women.
Zaslavsky O1, Zelber-Sagi S2, Gray SL3, LaCroix AZ4, Brunner RL5, Wallace RB6, O’Sullivan MJ7, Cochrane B1, Woods NF1.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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