Definition of frailty in older men according to questionnaire data (RAND-36/SF-36): The Helsinki Businessmen study

Abstract

OBJECTIVE: To explore the association of frailty according to questionnaire data (modified Fried criteria) with important endpoints in older men. DESIGN AND SETTING: Prospective cohort study (the Helsinki Businessmen Study) in Finland. PARTICIPANTS AND MEASUREMENTS: In 1974, clinically healthy men (born 1919-1934, n=1815) of similar socioeconomic status were identified. After a 26-year follow-up in 2000 (mean age 73 years), disease prevalence, mobility-disability, and frailty status (80.9% of survivors, n=1125) were appraised using a postal questionnaire including RAND-36. Four criteria were used for definition: 1) >5% weight loss from midlife, or body mass index (BMI) <21 kg/m2; 2) reported physical inactivity; 3) low vitality (RAND-36); 4) physical weakness (RAND-36). Responders with 3-4, 1-2, and zero criteria were classified as frail (n=108), prefrail (n=567), and nonfrail (n=450), respectively. Eight-year mortality was assessed from registers, and in 2007, survivors were re-assessed with questionnaires. RESULTS: Nonfrail as referent and adjusted for age, BMI and smoking, both prefrail (HR 2.26; 95% CI, 1.57-3.26), and frail status (4.09; 95% CI, 2.60-6.44) were significant predictors of mortality. Nonfrailty predicted better survival independently of the frailty components, diseases, and disability, and also predicted faster walking speed and less disability 7 years later. CONCLUSIONS: Frailty, and also prefrailty, as defined using questionnaire data (RAND-36) independently predicted important endpoints in older men.