Frailty in Older Men: Prevalence, Progression, and Relationship with Mortality Peggy M. Cawthon, PhD, MPH, à Lynn M. Marshall, ScD, wz Yvonne Michael, ScD, w Thuy-Tien Dam, MD, § Kristine E. Ensrud, MD, MPH, k # Elizabeth Barrett-Connor, MD, § and Eric S. Orwoll, MD, Ãà for the Osteoporotic Fractures in Men Research Group OBJECTIVES: To describe the association between frailty and health status, the progression of frailty, and the rela- tionship between frailty and mortality in older men. DESIGN: Cross-sectional and prospective cohort study. SETTING: Six U.S. clinical centers. PARTICIPANTS: Five thousand nine hundred ninety-three community-dwelling men aged 65 and older. MEASUREMENTS: Frailty was defined as three or more of the following: sarcopenia (low appendicular skeletal mass adjusted for height and body fat), weakness (grip strength), self-reported exhaustion, low activity level, and slow walking speed. Prefrail men met one or two criteria; robust men had none. Follow-up averaged 4.7 years. RESULTS: At baseline, 240 subjects (4.0%) were frail, 2,395 (40.0%) were prefrail, and 3,358 were robust (56.0%). Frail men were less healthy in most measures of self-reported health than prefrail or robust men. Frailty was somewhat more common in African Americans (6.6%) and Asians (5.8%) than Caucasians (3.8%). At the second visit, men who were frail at baseline tended to remain frail (24.2%) or die (37.1%) or were unable to complete the follow-up visit (26.2%); robust men tended to remain ro- bust (54.4%). Frail men were approximately twice as likely to die as robust men (multivariate hazard ratio (MHR) 5 2.05, 95% confidence interval (CI) 5 1.55–2.72). Mortality risk for frail men was greater in all weight cate- gories than for nonfrail men but was highest for normal- weight frail men (MHR 5 2.39, 95% CI 5 1.51–3.79, P for interaction 5 .01). The relationship between frailty and mor- tality was somewhat stronger in younger men than older men (P for interaction 5 .01). CONCLUSION: Frailty in older men is associated with poorer health and a greater risk of mortality. J Am Geriatr Soc 55:1216–1223, 2007. Key words: frailty; aging; mortality; men F railty has been described as ‘‘an excess vulnerability to stressors, with reduced ability to maintain or regain homeostasis after a destabilizing event.’’ 1 A conceptual framework for the syndrome of frailty as an accumulation of weight loss, sarcopenia (age-associated muscle loss), re- duced muscular strength and power, slower walking speed, less physical activity, and poor endurance has been pro- posed. 2 This construct of frailty describes a physical syn- drome that is distinct from comorbidity and disability. A working definition for this proposed phenotype of frailty has been developed using data from the Cardiovascular Health Study (CHS). The CHS frailty definition comprises five domains of physical health: shrinking or sarcopenia, weakness, slowness, low energy or endurance, and low ac- tivity level. 3 Individuals who had three or more of these components were considered frail, participants with one or two components were considered prefrail, and those with no components were considered robust. Subsequent studies in women have confirmed an association between the CHS frailty definition of frailty and health status and mortality, 4–7 although confirmatory data using the CHS frailty definition are lacking for older men. Studies using alternative constructs of frailty have demonstrated an association between frailty and mortality in older men, 8,9 although the frailty definitions used in these analyses were much broader than the CHS frailty definition, because these studies used frailty indicators that included measures such as cognitive ability and disability. Studies in older women have demonstrated that the as- sociation between the CHS frailty definition and mortality is consistent across body mass index (BMI) categories of underweight, normal weight, overweight, and obese. 7 In Address correspondence to Peggy M. Cawthon, PhD, MPH, Research Institute, California Pacific Medical Center, 185 Berry Street, Lobby 4, Suite 5700, San Francisco, CA 94107-1762. E-mail: pcawthon@sfcc-cpmc.net DOI: 10.1111/j.1532-5415.2007.01259.x From the à Research Institute, California Pacific Medical Center, San Francisco, California; w Department of Public Health and Preventive Medicine, and z Bone and Mineral Unit, Ãà Department of Medicine, Oregon Health and Science University, Portland, Oregon; § Department of Family and Preventive Medicine, School of Medicine, University of California at San Diego, La Jolla, California; k Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; and # Department of Medicine, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota. JAGS 55:1216–1223, 2007 r 2007, Copyright the Authors Journal compilation r 2007, The American Geriatrics Society 0002-8614/07/$15.00