CLINICAL RESEARCH STUDY
Frailty, hospitalization, and progression of disability in a
cohort of disabled older women
Cynthia M. Boyd, MD, MPH,
Qian-Li Xue, PhD,
Crystal F. Simpson, MD, MHS,
Jack M. Guralnik, MD, PhD,
Linda P. Fried, MD, MPH
Division of Geriatric Medicine and Gerontology, Center on Aging and Health, and
Department of Medicine, Laboratory
of Epidemiology, Demography, and Biometry, National Institute on Aging, Baltimore, Md.
PURPOSE: To determine the association between a previously validated frailty phenotype and the
development of new-onset dependence in activities of daily living, independent of hospitalizations and
other established predictors of disability.
SUBJECTS: Seven hundred and forty-nine women enrolled in the Women’s Health and Aging Study-I
who were independent in all activities in daily living when enrolled in the cohort.
METHODS: Assessments and interviews were conducted through home visits at 6-month intervals for
3 years. Frailty was classiﬁed using a validated phenotype (Ն3 of the following: weight loss,
exhaustion, slow walking, sedentariness, and weak grip), and hospitalizations were identiﬁed by
self-report. Grouped-time proportional hazard models assessed associations among frailty, hospitaliza-
tion, and the development of dependence in activities in daily living, adjusting for other factors.
RESULTS: Twenty-ﬁve percent of the cohort (186/749) were frail at baseline; 56% (104/186) of frail
versus 20% (23/117) of nonfrail women developed dependence in activities in daily living (P Ͻ.001).
In multivariate analysis, frailty was independently associated with the development of dependence in
activities in daily living (hazard ratio [HR] ϭ 2.2; 95% conﬁdence interval [CI]: 1.4 to 3.6), adjusting
for hospitalization status, age, race, education, baseline functional status, cognition, depressive symp-
toms, number of chronic diseases, and self-reported health status. Additionally, a dose-response
relationship existed between the number of frailty criteria that a woman had and the hazard of
subsequent dependence in activities in daily living.
CONCLUSION: Frailty, conceptualized as an underlying vulnerability, and hospitalization, which marks
an acute deterioration in health, were strongly and independently associated with new-onset dependence
in activities in daily living. Additional research is needed to determine if dependence can be minimized
by targeting resources and programs to frail older persons.
© 2005 Elsevier Inc. All rights reserved.
Activities of daily
This work was performed while Dr. Boyd was a Hartford/AFAR
Academic Geriatrics Fellow and post-doctoral fellow under training grant
NIH-T32-AG00120. The Women’s Health and Aging Study was funded by
NIA contract NO-1AG-1-2112.
Requests for reprints should be addressed to Cynthia M. Boyd, MD,
MPH, Division of Geriatric Medicine and Gerontology and the Center on
Aging and Health, The Johns Hopkins University School of Medicine,
Suite 2-700, 2024 E. Monument St., Baltimore, MD 21210.
E-mail address: firstname.lastname@example.org.
AJM Theme Issue: Women’s Health
0002-9343/$ -see front matter © 2005 Elsevier Inc. All rights reserved.
The American Journal of Medicine (2005) 118, 1225-1231