Validation of the Modified Frailty Phenotype Measure in Older Mexican Americans

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Abstract

OBJECTIVES: Develop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE) and related studies. DESIGN: Expert-based panel evaluation of content validity, cross-sectional analysis of construct validity, and longitudinal analysis of criterion validity for a modified version of the frailty phenotype measure. SETTING: Five southwestern states. PARTICIPANTS: A total of 1833 community-dwelling Mexican Americans aged 67 years or older. MEASUREMENTS: Frailty was assessed using the frailty phenotype measure (weight loss, weakness, exhaustion, slowness, and low physical activity) and a modified frailty phenotype measure (replacing “low physical activity” with “limitations in walking half a mile”). Each individual was classified as non-frail, pre-frail, or frail based on both frailty measures (original vs modified). Expert panel consensus was used to examine content validity. Spearman correlation, κ, weighted κ, and bootstrapping κ examined construct validity (n = 1833). Generalized linear mixed models, odds ratios, Cox proportional regression models, hazard ratios, and C statistics were used to analyze criterion validity (n = 1446) across four outcomes: hospitalization, physician visits, disability, and mortality from wave 3 (1998-99) through wave 8 (2012-13). RESULTS: The original and modified frailty phenotype measures had a strong correlation (r =.89; P <.000) and agreement (κ =.84; 95% confidence interval [CI] =.81-.86; weighted κ =.86; 95% CI =.84-.88; bootstrap κ =.84; 95% CI =.81-.86; bootstrap-weighted κ =.86; 95% CI =.84-.88 with 1000 bootstrapping samples). Four outcome models showed similar risk predictions for both frailty measures, with the exception of physician visits for frail participants. CONCLUSION: “Limitations in walking half a mile” can be used as a substitute criterion for “low physical activity” in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H-EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community-dwelling older Mexican Americans.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - Jan 1 2019

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Phenotype
Confidence Intervals
Independent Living
Exercise
Hispanic Americans
Walking
Epidemiologic Studies
Physicians
Proportional Hazards Models
Population
Weight Loss
Linear Models
Hospitalization
Cross-Sectional Studies
Odds Ratio
Mortality

Keywords

  • frail older adults
  • Mexican Americans
  • minority health

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

@article{39af643f65984993b36ca50133030168,
title = "Validation of the Modified Frailty Phenotype Measure in Older Mexican Americans",
abstract = "OBJECTIVES: Develop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE) and related studies. DESIGN: Expert-based panel evaluation of content validity, cross-sectional analysis of construct validity, and longitudinal analysis of criterion validity for a modified version of the frailty phenotype measure. SETTING: Five southwestern states. PARTICIPANTS: A total of 1833 community-dwelling Mexican Americans aged 67 years or older. MEASUREMENTS: Frailty was assessed using the frailty phenotype measure (weight loss, weakness, exhaustion, slowness, and low physical activity) and a modified frailty phenotype measure (replacing “low physical activity” with “limitations in walking half a mile”). Each individual was classified as non-frail, pre-frail, or frail based on both frailty measures (original vs modified). Expert panel consensus was used to examine content validity. Spearman correlation, κ, weighted κ, and bootstrapping κ examined construct validity (n = 1833). Generalized linear mixed models, odds ratios, Cox proportional regression models, hazard ratios, and C statistics were used to analyze criterion validity (n = 1446) across four outcomes: hospitalization, physician visits, disability, and mortality from wave 3 (1998-99) through wave 8 (2012-13). RESULTS: The original and modified frailty phenotype measures had a strong correlation (r =.89; P <.000) and agreement (κ =.84; 95{\%} confidence interval [CI] =.81-.86; weighted κ =.86; 95{\%} CI =.84-.88; bootstrap κ =.84; 95{\%} CI =.81-.86; bootstrap-weighted κ =.86; 95{\%} CI =.84-.88 with 1000 bootstrapping samples). Four outcome models showed similar risk predictions for both frailty measures, with the exception of physician visits for frail participants. CONCLUSION: “Limitations in walking half a mile” can be used as a substitute criterion for “low physical activity” in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H-EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community-dwelling older Mexican Americans.",
keywords = "frail older adults, Mexican Americans, minority health",
author = "Chih-ying Li and {Al Snih al snih}, Soham and Chen, {Nai Wei} and Kyriakos Markides and Jaspreet Sodhi and Kenneth Ottenbacher",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/jgs.16104",
language = "English (US)",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Validation of the Modified Frailty Phenotype Measure in Older Mexican Americans

AU - Li, Chih-ying

AU - Al Snih al snih, Soham

AU - Chen, Nai Wei

AU - Markides, Kyriakos

AU - Sodhi, Jaspreet

AU - Ottenbacher, Kenneth

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVES: Develop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE) and related studies. DESIGN: Expert-based panel evaluation of content validity, cross-sectional analysis of construct validity, and longitudinal analysis of criterion validity for a modified version of the frailty phenotype measure. SETTING: Five southwestern states. PARTICIPANTS: A total of 1833 community-dwelling Mexican Americans aged 67 years or older. MEASUREMENTS: Frailty was assessed using the frailty phenotype measure (weight loss, weakness, exhaustion, slowness, and low physical activity) and a modified frailty phenotype measure (replacing “low physical activity” with “limitations in walking half a mile”). Each individual was classified as non-frail, pre-frail, or frail based on both frailty measures (original vs modified). Expert panel consensus was used to examine content validity. Spearman correlation, κ, weighted κ, and bootstrapping κ examined construct validity (n = 1833). Generalized linear mixed models, odds ratios, Cox proportional regression models, hazard ratios, and C statistics were used to analyze criterion validity (n = 1446) across four outcomes: hospitalization, physician visits, disability, and mortality from wave 3 (1998-99) through wave 8 (2012-13). RESULTS: The original and modified frailty phenotype measures had a strong correlation (r =.89; P <.000) and agreement (κ =.84; 95% confidence interval [CI] =.81-.86; weighted κ =.86; 95% CI =.84-.88; bootstrap κ =.84; 95% CI =.81-.86; bootstrap-weighted κ =.86; 95% CI =.84-.88 with 1000 bootstrapping samples). Four outcome models showed similar risk predictions for both frailty measures, with the exception of physician visits for frail participants. CONCLUSION: “Limitations in walking half a mile” can be used as a substitute criterion for “low physical activity” in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H-EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community-dwelling older Mexican Americans.

AB - OBJECTIVES: Develop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE) and related studies. DESIGN: Expert-based panel evaluation of content validity, cross-sectional analysis of construct validity, and longitudinal analysis of criterion validity for a modified version of the frailty phenotype measure. SETTING: Five southwestern states. PARTICIPANTS: A total of 1833 community-dwelling Mexican Americans aged 67 years or older. MEASUREMENTS: Frailty was assessed using the frailty phenotype measure (weight loss, weakness, exhaustion, slowness, and low physical activity) and a modified frailty phenotype measure (replacing “low physical activity” with “limitations in walking half a mile”). Each individual was classified as non-frail, pre-frail, or frail based on both frailty measures (original vs modified). Expert panel consensus was used to examine content validity. Spearman correlation, κ, weighted κ, and bootstrapping κ examined construct validity (n = 1833). Generalized linear mixed models, odds ratios, Cox proportional regression models, hazard ratios, and C statistics were used to analyze criterion validity (n = 1446) across four outcomes: hospitalization, physician visits, disability, and mortality from wave 3 (1998-99) through wave 8 (2012-13). RESULTS: The original and modified frailty phenotype measures had a strong correlation (r =.89; P <.000) and agreement (κ =.84; 95% confidence interval [CI] =.81-.86; weighted κ =.86; 95% CI =.84-.88; bootstrap κ =.84; 95% CI =.81-.86; bootstrap-weighted κ =.86; 95% CI =.84-.88 with 1000 bootstrapping samples). Four outcome models showed similar risk predictions for both frailty measures, with the exception of physician visits for frail participants. CONCLUSION: “Limitations in walking half a mile” can be used as a substitute criterion for “low physical activity” in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H-EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community-dwelling older Mexican Americans.

KW - frail older adults

KW - Mexican Americans

KW - minority health

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U2 - 10.1111/jgs.16104

DO - 10.1111/jgs.16104

M3 - Article

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

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