Toward a comprehensive model of frailty: An emerging concept from the Hong Kong centenarian study

Abstract

Objectives A better understanding of the essential components of frailty is important for future developments of management strategies. We aimed to assess the incremental validity of a Comprehensive Model of Frailty (CMF) over Frailty Index (FI) in predicting self-rated health and functional dependency amongst near-centenarians and centenarians.

Design Cross-sectional, community-based study.

Setting Two community-based social and clinical networks.

Participants One hundred twenty-four community-dwelling Chinese near-centenarians and centenarians.

Measurements Frailty was first assessed using a 32-item FI (FI-32). Then, a new CMF was constructed by adding 12 items in the psychological, social/family, environmental, and economic domains to the FI-32. Hierarchical multiple regressions explored whether the new CMF provided significant additional predictive power for self-rated health and instrumental activities of daily living (IADL) dependency.

Results Mean age was 97.7 (standard deviation 2.3) years, with a range from 95 to 108, and 74.2% were female. Overall, 16% of our participants were nonfrail, 59% were prefrail, and 25% were frail. Frailty according to FI-32 significantly predicted self-rated health and IADL dependency beyond the effect of age and gender. Inclusion of the new CMF into the regression models provided significant additional predictive power beyond FI-32 on self-rated health, but not IADL dependency.

Conclusions A CMF should ideally be a multidimensional and multidisciplinary construct including physical, cognitive, functional, psychosocial/family, environmental, and economic factors.