Definition of frailty in older men according to questionnaire data (RAND-36/SF-36): The Helsinki Businessmen study

To explore the association of frailty according to questionnaire data (modified Fried criteria) with important endpoints in older men. Prospective cohort study (the Helsinki Businessmen Study) in Finland. In 1974, clinically healthy men (born 1919-1934, n=1815) of similar socioeconomic status were identified. After a 26-year follow-up in 2000 (mean age 73 years), disease prevalence, mobility-disability, and frailty status (80.9% of survivors, n=1125) were appraised using a postal questionnaire including RAND-36. Four criteria were used for definition: 1) > 5% weight loss from midlife, or body mass index (BMI) < 21 kg/m(2); 2) reported physical inactivity; 3) low vitality (RAND-36); 4) physical weakness (RAND-36). Responders with 3-4, 1-2, and zero criteria were classified as frail (n=108), prefrail (n=567), and nonfrail (n=450), respectively. Eight-year mortality was assessed from registers, and in 2007, survivors were re-assessed with questionnaires. Nonfrail as referent and adjusted for age, BMI and smoking, both prefrail (HR 2.26; 95% CI, 1.57-3.26), and frail status (4.09; 95% CI, 2.60-6.44) were significant predictors of mortality. Nonfrailty predicted better survival independently of the frailty components, diseases, and disability, and also predicted faster walking speed and less disability 7 years later. Frailty, and also prefrailty, as defined using questionnaire data (RAND-36) independently predicted important endpoints in older men.