Operationalizing frailty among older residents of assisted living facilities

BMC Geriatrics

Table 1 Details of measures and cut-points employed for select frailty criteria

Criterion	Measure	CHS-specified¹ absolute cut-points	AL population-based relative cut-points
Slow gait	Determined by taking the better of two timed 3-meter walks.	≥ 7 seconds², men ≤ 173 cm ≥7 seconds, women ≤159 cm ≥ 6 seconds, men > 173 cm ≥ 6 seconds, women > 159 cm	Slowest quartile ³ of walk times: > 9 seconds, men > 10 seconds, women
Muscle weakness	Average of three grip strength readings using a handheld dynamometer.⁴	BMI-specific thresholds: ≤ 29-32 kg, men ≤ 17-21 kg, women	Lowest quartile‡ of grip strength readings: < 15 kg, men < 7 kg, women
Low physical activity	Reported minutes over two weeks per activity type - from the interRAI-AL "Exercise or Leisure Activities" ⁵	Activities were mapped to Minnesota Leisure Time Activity Questionnaire.⁶ Kcals per week calculated based on the intensity codes: < 383 Kcals/week, men < 270 Kcals/week, women	< 140 minutes/two weeks (< 10 minutes/day on average⁷)
Unintentional weight loss	Answer to question: "In the past year have you lost more than 10 pounds unintentionally" ⁸	Response of Yes	Response of Yes
Exhaustion	Answers to 3 questions: "In the past month, on average, have you been: 1) Feeling unusually tired during the day?; 2) Feeling unusually weak?; and/or, 3) Feeling an unusually low energy level?"⁹	Response of Yes to any of the 3 questions	Response of Yes to any of the 3 questions

CHS = Cardiovascular Health Study, AL = assisted living, cm = centimeters, BMI = body mass index, kg = kilograms, kcals = kilocalories.
¹ as detailed in Fried et al., 2001 [5]
² sex and height-specific thresholds.
³ a standard cut-point [32].
⁴ JAMAR^®, Sammons Preston Rolyan, Bolingbrook, IL.
⁵ include: aquasize/swimming; bowling; dancing; exercise bike/treadmill; exercise program; floor curling/lawn bowling; gardening; household chores; shuffleboard/pool; Tai chi/yoga; walking/wheeling indoors & outdoors.
⁶ as detailed in [45].
⁷ levels above this cut-point shown to be beneficial in otherwise sedentary people [33].
⁸ CHS also allowed actual unintentional 5% weight loss over 1-year (not assessed in ACCES).
⁹ CHS used 2 items from the CES-D Scale [46]: "I feel that everything I do is an effort" and "I cannot get going" (those reporting feeling this way at least 3-4 days/previous week fulfilled the criterion).

ISSN: 1471-2318