Maturitas 74 (2013) 54–60 Contents lists available at SciVerse ScienceDirect Maturitas jo ur n al hom ep age : www.elsevier.com/locate/maturitas Frailty and mortality, disability and mobility loss in a Spanish cohort of older adults: The FRADEA Study Pedro Abizanda ∗ , Luis Romero, Pedro M. Sánchez-Jurado, Marta Martínez-Reig, Llanos Gómez-Arnedo, Sergio A. Alfonso Complejo Hospitalario Universitario de Albacete,Spain a r t i c l e i n f o Article history: Received 2 August 2012 Received in revised form 25 September 2012 Accepted 28 September 2012 Keywords: Frail elderly Mortality Disability Mobility impairment a b s t r a c t Background: Original Fried’s frailty criteria have not demonstrated their prognostic validity of mortality, disability and mobility loss in European cohorts. Objectives: To analyze whether frailty implies increased risk of death, incident disability in basic (BADL) or instrumental (IADL) activities of daily living, or mobility impairment. Design: Concurrent cohort study. Setting: Albacete City, Spain. Participants: 993 participants over age 70 from the FRADEA Study. Measurements: Mortality, BADL and mobility using the Barthel Index, and IADL using the Lawton IADL Index, were recorded. BADL disability was defined as loss of the ability to perform bathing, grooming, dressing, toilet use, or feeding, while deterioration of mobility was defined as loss of ability to perform transfers, walk, or use stairs, and IADL disability as losing any of the activities included in the Lawton Index. The risk of presenting adverse events was determined by Cox and Kaplan–Meier proportional hazard analysis and logistic regression adjusted for age, sex, function, and comorbidity. Results: Mean follow-up was 534 days (SD 153), during which 105 participants (10.6%) died. Mean time to death was 363 days (SD 218), while 192 (25.4%) lost at least one BADL, 492 (60%) at least one IADL, and 222 (28.9%) lost mobility. Frail subjects had a greater adjusted risk of death (HR 5.5, CI 95% 1.5–20.2), of losing BADL (HR 2.5, CI 95% 1.3–4.8), of losing mobility (HR 2.7, CI 95% 1.5–5.0), and of losing IADL (HR 1.9, CI 95% 1.1–3.3) than non-frail patients. Conclusion: Fried’s frailty criteria are associated with death, incident disability, and mobility impairment in a Spanish cohort of older adults. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Frailty is defined as a “biologic syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiologic systems, leading to loss of homeostatic capability and vulnerability to adverse outcomes”, according to Campbell and Buchner [1]. Different ways to characterize this syn- drome in daily clinical practice have been described with varying results [2], although the most commonly used is the application of the phenotype described by Fried et al. in 2001 [3], which includes unintentional weight loss, weakness, exhaustion, slow walking speed, and low level of physical activity. These criteria have shown good construct validity in various cohorts of older adults [4], with a prevalence of frailty ranging from 4% to 23.1% according to different ∗ Corresponding author at: Hospital Perpetuo Socorro, C/Seminario 4, 02006 Albacete, Spain. Tel.: +34 967597651; fax: +34 967597635. E-mail address: pabizanda@sescam.jccm.es (P. Abizanda). studies, depending on the setting, sociodemographic conditions, age, and the employed criteria [3,5–11]. The relevance of frailty lies in its being an important predic- tor of serious adverse events in the elderly, such as death (up to 45% per year in the frail), institutionalization, falls, reduced mobil- ity, hospitalization, and increased dependence in basic activities of daily living (BADL), and instrumental activities of daily living (IADL) [4,12], while older adults with an intermediate stage of frailty, or pre-frailty (1 or 2 criteria), present increased risk of becoming frail within three years [12]. Frailty therefore can be considered a stage of pre-disability for which screening may allow the use of primary or secondary prevention measures in a population at high risk of presenting adverse events [12,13]. To date, only 13 international studies have assessed the longi- tudinal association between frailty and adverse events, nine in the United States [3,4,14–20], one in Canada [21], two in Europe [7,22], and one in China [23]. Almost all these studies assessed associa- tion with mortality and disability using the BADL, but fewer did so using mobility impairment [3,7] or disability according to IADL 0378-5122/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.maturitas.2012.09.018