Home › Research › How common it is
Frailty in Older Adults: Evidence for a Phenotype
Linda P. Fried, Catherine M. Tangen, Jeremy D Walston, Anne B. Newman, Calvin H. Hirsch, John S. Gottdiener, Teresa E. Seeman, Russell P. Tracy, Willem J. Kop, Gregory L. Burke, Mary Ann McBurnie. The Journals of Gerontology Series A, 2001-03-01
Topic: Risk, prevention and care in population studies
BACKGROUND: Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established. METHODS: To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality. RESULTS: Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline). CONCLUSIONS: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.
Why it matters
Proposes a standard definition of frailty in older adults, using data on 5,317 people aged 65 and older from the Cardiovascular Health Study: three or more of unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity. Frailty affected 6.9% of this community-dwelling group and predicted falls, worsening mobility or disability, hospitalization, and death.
New to this subject? Start with our plain-English guide: Alzheimer's in numbers →
How this study scored 52/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on strength of evidence, so that was left out: it earned 49 of the 95 points we could judge it on, which is 52 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (The Journals of Gerontology Series A) |
| Journal's citation record | 3 / 4 | The Journals of Gerontology Series A: journal h-index 274 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | — / 5 | No evidence rating recorded — left out of this score |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2001 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 7 / 7 | Cited 24,713 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 915.3 citations a year over 27 year(s) since 2001 |
| Impact for its field and year | 5 / 6 | Cited 30.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 4 / 4 | Cited 6,199 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Mary Ann McBurnie: h-index 33 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,306 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 11253156) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 49 / 95 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 49 of the 95 points we could judge it on is 52 out of 100. |
| Total | 52 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
May need a subscription OpenAlex found no free copy of the full text (checked 6 Feb 1020), so the publisher may charge for it. The PubMed abstract is free.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 11 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Fried, L. P., Tangen, C. M., Walston, J. D., Newman, A. B., Hirsch, C. H., Gottdiener, J. S., et al. (2001). Frailty in Older Adults: Evidence for a Phenotype. The Journals of Gerontology Series A. https://doi.org/10.1093/gerona/56.3.m146
Vancouver
Fried LP, Tangen CM, Walston JD, Newman AB, Hirsch CH, Gottdiener JS, et al. Frailty in Older Adults: Evidence for a Phenotype. The Journals of Gerontology Series A. 2001. doi:10.1093/gerona/56.3.m146. PMID: 11253156.
BibTeX
@article{fried2001-11253156,
author = {Fried, Linda P. and Tangen, Catherine M. and Walston, Jeremy D and Newman, Anne B. and Hirsch, Calvin H. and Gottdiener, John S. and Seeman, Teresa E. and Tracy, Russell P. and Kop, Willem J. and Burke, Gregory L. and McBurnie, Mary Ann},
title = {{Frailty in Older Adults: Evidence for a Phenotype}},
journal = {The Journals of Gerontology Series A},
year = {2001},
doi = {10.1093/gerona/56.3.m146},
pmid = {11253156},
url = {https://doi.org/10.1093/gerona/56.3.m146}
}
Related studies in How common it is
Also tagged “delirium”
858 studies in the library carry the topic tag “delirium”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 858 tagged studies.