The ability of three different models of frailty to predict all-cause mortality: Results from the European Male Aging Study (EMAS)

Rathi Ravindrarajah, DM Lee, Stephen Pye, Evelien Gielen, Steven Boonen, Dirk Vanderschueren, Neil Pendleton, Joseph Finn, Abdelouahid Tajar, Matthew D L O'Connell, Kenneth Rockwood, György Bartfai, Felipe Casanueva, Gianni Forti, Aleksander Giwercman, Thang S. Han, Ilpo Huhtaniemi, Krzysztof Kula, Michael E J Lean, Margus PunabFrederick Wu, Terence W. O'Neill, Luisa Petrone, Giovanni Corona, Herman Borghs, Jolanta Slowikowska-Hilczer, Renata Walczak-Jedrzejowska, Ana I. Castro, Philip Steer, Imre Földesi, Imre Fejes, Paul Korrovitz, Min Jiang, DM Lee, SR Pye, JD Finn, MD O'Connell, TW O'Neill, European Male Ageing Study Group

Research output: Contribution to journalArticlepeer-review


Few studies have directly compared the ability of the most commonly used models of frailty to predict mortality among community-dwelling individuals. Here, we used a frailty index (FI), frailty phenotype (FP), and FRAIL scale (FS) to predict mortality in the EMAS. Participants were aged 40-79 years (n=2929) at baseline and 6.6% (n=193) died over a median 4.3 years of follow-up. The FI was generated from 39 deficits, including self-reported health, morbidities, functional performance and psychological assessments. The FP and FS consisted of five phenotypic criteria and both categorized individuals as robust when they had 0 criteria, prefrail as 1-2 criteria and frail as 3+ criteria. The mean FI increased linearly with age (r2=0.21) and in Cox regression models adjusted for age, center, smoking and partner status the hazard ratio (HR) for death for each unit increase of the FI was 1.49. Men who were prefrail or frail by either the FP or FS definitions, had a significantly increased risk of death compared to their robust counterparts. Compared to robust men, those who were FP frail at baseline had a HR for death of 3.84, while those who were FS frail had a HR of 3.87. All three frailty models significantly predicted future mortality among community-dwelling, middle-aged and older European men after adjusting for potential confounders. Our data suggest that the choice of frailty model may not be of paramount importance when predicting future risk of death, enabling flexibility in the approach used. © 2013 Elsevier Ireland Ltd.
Original languageEnglish
Pages (from-to)360-368
Number of pages8
JournalArchives of Gerontology and Geriatrics
Issue number3
Publication statusPublished - Nov 2013


  • Aging
  • Frailty index
  • Frailty phenotype
  • Male health
  • Mortality
  • Population-based


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