Self-rated Frailty and Mortality in Old Men: The Manitoba Follow-up Study

Abstract

Background: While a multitude of definitions and operationalizations of frailty have been developed, rarely have these considered the perspective of the older adult themselves. This knowledge gap was addressed by examining older adults’ self-rating of frailty. Objectives: To assess the validity of self-rated frailty and to determine whether self-rated frailty relates to mortality. Design: The Manitoba Follow-up Study was initiated in 1948 as a prospective cohort study of 3,983 men. Setting: Community dwelling older adult men. Participants: Survivors of the original cohort (231 men) were sent a quality of life survey in 2015. A response was received from 186 men, including 146 surveys completed by the participant himself and thus were eligible to include (completion rate of 78.4%). Measurements: The quality of life survey is sent out annually to the study participants to ascertain information about mental, physical, and social functioning. In 2015, the Clinical Frailty Scale was adapted and added to the survey as a simple self-rating of frailty. Results: The mean age of the 146 respondents in 2015 was 93.7 years (SD 2.7) Self-ratings of “moderate-severe” frailty, received from 132 men, were associated with worse measures of physical health and functional impairment, thus supporting the significance of self-rated frailty. Adjusted for age, the Hazard Ratio for mortality over the next 3 years was 3.3 (95% CI: 1.5, 7.1) for those who rated themselves as “mildly to severely frail” vs. “very fit or well, with no disease”. Conclusion: The present study has illustrated that self-rated frailty is associated with other measures of health and that self-rated frailty predicts mortality over a three-year period. These findings support the utilization of older adult’s self-ratings of frailty for new avenues of operationalizing frailty.