human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background A frailty paradigm would be useful in primary care to identify older people at risk , but appropriate metrics at that level are lacking . We created and vali date d a simple instrument for frailty screening in Europeans aged ≥50 . Our study is based on the first wave of the Survey of Health , Ageing and Retirement in Europe ( SHARE , http://www.share-project.org ) , a large population -based survey conducted in 2004 - 2005 in twelve European countries . Methods Subjects : SHARE Wave 1 respondents ( 17,304 females and 13,811 males ) . Measures : five SHARE variables approximating Fried 's frailty definition . Analyses ( for each gender ) : 1 ) estimation of a discreet factor ( DFactor ) model based on the frailty variables using LatentGOLD ® . A single DFactor with three ordered levels or latent classes ( i.e. non-frail , pre-frail and frail ) was modelled ; 2 ) the latent classes were characterised against a biopsychosocial range of Wave 1 variables ; 3 ) the prospect i ve mortality risk ( unadjusted and age-adjusted ) for each frailty class was established on those subjects with known mortality status at Wave 2 ( 2007 - 2008 ) ( 11,384 females and 9,163 males ) ; 4 ) two web-based calculators were created for easy retrieval of a subject 's frailty class given any five measurements . Results Females : the DFactor model included 15,578 cases ( st and ard R2 = 0.61 ) . All five frailty indicators discriminated well ( p < 0.001 ) between the three classes : non-frail ( N = 10,420 ; 66.9 % ) , pre-frail ( N = 4,025 ; 25.8 % ) , and frail ( N = 1,133 ; 7.3 % ) . Relative to the non-frail class , the age-adjusted Odds Ratio ( with 95 % Confidence Interval ) for mortality at Wave 2 was 2.1 ( 1.4 - 3.0 ) in the pre-frail and 4.8 ( 3.1 - 7.4 ) in the frail . Males : 12,783 cases ( st and ard R2 = 0.61 , all frailty indicators had p < 0.001 ) : non-frail ( N = 10,517 ; 82.3 % ) , pre-frail ( N = 1,871 ; 14.6 % ) , and frail ( N = 395 ; 3.1 % ) ; age-adjusted OR ( 95 % CI ) for mortality : 3.0 ( 2.3 - 4.0 ) in the pre-frail , 6.9 ( 4.7 - 10.2 ) in the frail . Conclusions The SHARE Frailty Instrument has sufficient construct and predictive validity , and is readily and freely accessible via web calculators . To our knowledge , SHARE-FI represents the first European research effort towards a common frailty language at the community level Background Frail older people are at high risk of developing adverse outcomes , such as disability , mortality , hospitalization , and institutionalization . Previous research suggests that the Tilburg Frailty Indicator ( TFI ) is a valid and reliable instrument for measuring frailty . The aim of this study was to adapt and to test the reliability of the Polish version of the TFI . Method A st and ard guideline was used for translation and cultural adaptation of the English version of the TFI into Polish . The study included 100 Polish patients ( mean age 68.2±6.5 years ) , among them 42 men and 58 women .  Cronbach ’s alpha was used for analysis of the internal consistency of the TFI . Results The mean total TFI score was 6.7±3.1 . Forty patients scored ≥5 , which corresponded to being frail . Cronbach ’s alpha reliability coefficients of the instrument ranged from 0.68 to 0.72 and item-total correlation ranged from 0.12 to 0.52 . Conclusion The TFI is valid and reproducible for assessment of frailty syndrome among a Polish population . The Polish adaptation of the TFI proved a useful and fast tool for assessing frailty The easy-to-apply SOF criteria for frailty were recently vali date d in studies conducted in the U.S. only . In order to determine the ability of the SOF criteria to predict adverse health outcomes at a one-year follow-up in a sample of older out patients in Italy we carried out a prospect i ve cohort study on 265 community-dwelling out patients aged 65 + ( mean age 81.5 years ) consecutively referred to a geriatric clinic . At baseline participants underwent a comprehensive geriatric assessment ( CGA ) including evaluation of their frailty status according to the SOF criteria . At a one-year follow-up , between June and December 2010 , we investigated nursing home placement and death in all participants as well as any fall , any admission to the emergency department ( ED ) , any hospitalization and a greater disability among the subset of subjects still living at home . One year after the visit 231 subjects were still living at home ( 87.2 % ) , 9 had been placed in a nursing home ( 3.4 % ) and 25 had died ( 9.4 % ) . Frailty was associated with a greater risk of falls ( odds ratio [ OR ] 2.01 , 95 % confidence interval [ CI ] 1.05 - 3.83 , p=0.035 ) , hospitalization ( OR 2.08 , 95 % CI 1.02 - 4.24 , p=0.045 ) and death ( OR 3.07 , 95 % 1.02 - 4.24 , p=0.045 ) after correction for demographic characteristics , comorbidity including dementia and depression , socioeconomic position and severe disability . Thus , in an older outpatient population in Italy the frailty syndrome diagnosed according to the SOF criteria was an independent predictor of several adverse health outcomes BACKGROUND A st and ard phenotype of frailty was associated with an increased risk of adverse outcomes including mortality in a recent study of older adults . However , the predictive validity of this phenotype for fracture outcomes and across risk subgroups is uncertain . METHODS To determine whether a st and ard frailty phenotype was independently associated with risk of adverse health outcomes in older women and to evaluate the consistency of associations across risk subgroups defined by age and body mass index ( BMI ) , we ascertained frailty status in a cohort of 6724 women > or=69 years and followed them prospect ively for incident falls , fractures , and mortality . Frailty was defined by the presence of three or more of the following criteria : unintentional weight loss , weakness , self-reported poor energy , slow walking speed , and low physical activity . Incident recurrent falls were defined as at least two falls during the subsequent year . Incident fractures ( confirmed with x-ray reports ) , including hip fractures , and deaths were ascertained during an average of 9 years of follow-up . RESULTS After controlling for multiple confounders such as age , health status , medical conditions , functional status , depressive symptoms , cognitive function , and bone mineral density , frail women were subsequently at increased risk of recurrent falls ( multivariate odds ratio=1.38 , 95 % confidence interval [ CI ] , 1.02 - 1.88 ) , hip fracture ( multivariate hazards ratio [MHR]=1.40 , 95 % CI , 1.03 - 1.90 ) , any nonspine fracture ( MHR=1.25 , 95 % CI , 1.05 - 1.49 ) , and death ( MHR=1.82 , 95 % CI , 1.56 - 2.13 ) . The associations between frailty and these outcomes persisted among women > or=80 years . In addition , associations between frailty and an increased risk of falls , fracture , and mortality were consistently observed across categories of BMI , including BMI > or=30 kg/m2 . CONCLUSION Frailty is an independent predictor of adverse health outcomes in older women , including very elderly women and older obese women BACKGROUND Frailty , as defined by the index derived from the Cardiovascular Health Study ( CHS index ) , predicts risk of adverse outcomes in older adults . Use of this index , however , is impractical in clinical practice . METHODS We conducted a prospect i ve cohort study in 6701 women 69 years or older to compare the predictive validity of a simple frailty index with the components of weight loss , inability to rise from a chair 5 times without using arms , and reduced energy level ( Study of Osteoporotic Fractures [ SOF index ] ) with that of the CHS index with the components of unintentional weight loss , poor grip strength , reduced energy level , slow walking speed , and low level of physical activity . Women were classified as robust , of intermediate status , or frail using each index . Falls were reported every 4 months for 1 year . Disability ( > or = 1 new impairment in performing instrumental activities of daily living ) was ascertained at 4(1/2 ) years , and fractures and deaths were ascertained during 9 years of follow-up . Area under the curve ( AUC ) statistics from receiver operating characteristic curve analysis and -2 log likelihood statistics were compared for models containing the CHS index vs the SOF index . RESULTS Increasing evidence of frailty as defined by either the CHS index or the SOF index was similarly associated with an increased risk of adverse outcomes . Frail women had a higher age-adjusted risk of recurrent falls ( odds ratio , 2.4 ) , disability ( odds ratio , 2.2 - 2.8 ) , nonspine fracture ( hazard ratio , 1.4 - 1.5 ) , hip fracture ( hazard ratio , 1.7 - 1.8 ) , and death ( hazard ratio , 2.4 - 2.7 ) ( P < .001 for all models ) . The AUC comparisons revealed no differences between models with the CHS index vs the SOF index in discriminating falls ( AUC = 0.61 for both models ; P = .66 ) , disability ( AUC = 0.64 ; P = .23 ) , nonspine fracture ( AUC = 0.55 ; P = .80 ) , hip fracture ( AUC = 0.63 ; P = .64 ) , or death ( AUC = 0.72 ; P = .10 ) . Results were similar when -2 log likelihood statistics were compared . CONCLUSION The simple SOF index predicts risk of falls , disability , fracture , and death as well as the more complex CHS index and may provide a useful definition of frailty to identify older women at risk of adverse health outcomes in clinical practice OBJECTIVES To define frailty using simple indicators ; to identify risk factors for frailty as targets for prevention ; and to investigate the predictive validity of this frailty classification for death , hospitalization , hip fracture , and activity of daily living ( ADL ) disability . DESIGN Prospect i ve study , the Women 's Health Initiative Observational Study . SETTING Forty U.S. clinical centers . PARTICIPANTS Forty thous and six hundred fifty-seven women aged 65 to 79 at baseline . MEASUREMENTS Components of frailty included self-reported muscle weakness/impaired walking , exhaustion , low physical activity , and unintended weight loss between baseline and 3 years of follow-up . Death , hip fractures , ADL disability , and hospitalizations were ascertained during an average of 5.9 years of follow-up . RESULTS Baseline frailty was classified in 16.3 % of participants , and incident frailty at 3-years was 14.8 % . Older age , chronic conditions , smoking , and depressive symptom score were positively associated with incident frailty , whereas income , moderate alcohol use , living alone , and self-reported health were inversely associated . Being underweight , overweight , or obese all carried significantly higher risk of frailty than normal weight . Baseline frailty independently predicted risk of death ( hazard ratio (HR)=1.71 , 95 % confidence interval (CI)=1.48 - 1.97 ) , hip fracture ( HR=1.57 , 95 % CI=1.11 - 2.20 ) , ADL disability ( odds ratio (OR)=3.15 , 95 % CI=2.47 - 4.02 ) , and hospitalizations ( OR=1.95 , 95 % CI=1.72 - 2.22 ) after adjustment for demographic characteristics , health behaviors , disability , and comorbid conditions . CONCLUSION These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women . Underweight , obesity , smoking , and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention OBJECTIVES To compare 3 methods of describing the frailty of older adults in nursing homes . DESIGN Secondary analysis of a prospect i ve cohort study . SETTING Canadian long-term care institutions . PARTICIPANTS Institutionalized older adults in the second clinical examination cohort of the Canadian Study of Health and Aging ( CSHA-2 ; n = 728 ) . MEASURES Frailty was measured using the Cardiovascular Health Survey definition ( Frail-CHS ) ; the CSHA- Clinical Frailty Scale ( CSHA-CFS ) and a frailty index ( FI ) . RESULTS The sample was very elderly ( 87.7 + /- 6.7 years ) , disabled ( 83 % ) , and showed a high level of mobility impairment ( 83 % ) . Each frailty measure correlated moderately well with each other (  
    Output:
    
agent
Conclusions The TFI has the most robust evidence of reliability and validity and has been the most extensively examined in terms of psychometric properties .
However , there is insufficient evidence at present to determine the best tool for use in research and clinical practice .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background A frailty paradigm would be useful in primary care to identify older people at risk , but appropriate metrics at that level are lacking . We created and vali date d a simple instrument for frailty screening in Europeans aged ≥50 . Our study is based on the first wave of the Survey of Health , Ageing and Retirement in Europe ( SHARE , http://www.share-project.org ) , a large population -based survey conducted in 2004 - 2005 in twelve European countries . Methods Subjects : SHARE Wave 1 respondents ( 17,304 females and 13,811 males ) . Measures : five SHARE variables approximating Fried 's frailty definition . Analyses ( for each gender ) : 1 ) estimation of a discreet factor ( DFactor ) model based on the frailty variables using LatentGOLD ® . A single DFactor with three ordered levels or latent classes ( i.e. non-frail , pre-frail and frail ) was modelled ; 2 ) the latent classes were characterised against a biopsychosocial range of Wave 1 variables ; 3 ) the prospect i ve mortality risk ( unadjusted and age-adjusted ) for each frailty class was established on those subjects with known mortality status at Wave 2 ( 2007 - 2008 ) ( 11,384 females and 9,163 males ) ; 4 ) two web-based calculators were created for easy retrieval of a subject 's frailty class given any five measurements . Results Females : the DFactor model included 15,578 cases ( st and ard R2 = 0.61 ) . All five frailty indicators discriminated well ( p < 0.001 ) between the three classes : non-frail ( N = 10,420 ; 66.9 % ) , pre-frail ( N = 4,025 ; 25.8 % ) , and frail ( N = 1,133 ; 7.3 % ) . Relative to the non-frail class , the age-adjusted Odds Ratio ( with 95 % Confidence Interval ) for mortality at Wave 2 was 2.1 ( 1.4 - 3.0 ) in the pre-frail and 4.8 ( 3.1 - 7.4 ) in the frail . Males : 12,783 cases ( st and ard R2 = 0.61 , all frailty indicators had p < 0.001 ) : non-frail ( N = 10,517 ; 82.3 % ) , pre-frail ( N = 1,871 ; 14.6 % ) , and frail ( N = 395 ; 3.1 % ) ; age-adjusted OR ( 95 % CI ) for mortality : 3.0 ( 2.3 - 4.0 ) in the pre-frail , 6.9 ( 4.7 - 10.2 ) in the frail . Conclusions The SHARE Frailty Instrument has sufficient construct and predictive validity , and is readily and freely accessible via web calculators . To our knowledge , SHARE-FI represents the first European research effort towards a common frailty language at the community level Background Frail older people are at high risk of developing adverse outcomes , such as disability , mortality , hospitalization , and institutionalization . Previous research suggests that the Tilburg Frailty Indicator ( TFI ) is a valid and reliable instrument for measuring frailty . The aim of this study was to adapt and to test the reliability of the Polish version of the TFI . Method A st and ard guideline was used for translation and cultural adaptation of the English version of the TFI into Polish . The study included 100 Polish patients ( mean age 68.2±6.5 years ) , among them 42 men and 58 women .  Cronbach ’s alpha was used for analysis of the internal consistency of the TFI . Results The mean total TFI score was 6.7±3.1 . Forty patients scored ≥5 , which corresponded to being frail . Cronbach ’s alpha reliability coefficients of the instrument ranged from 0.68 to 0.72 and item-total correlation ranged from 0.12 to 0.52 . Conclusion The TFI is valid and reproducible for assessment of frailty syndrome among a Polish population . The Polish adaptation of the TFI proved a useful and fast tool for assessing frailty The easy-to-apply SOF criteria for frailty were recently vali date d in studies conducted in the U.S. only . In order to determine the ability of the SOF criteria to predict adverse health outcomes at a one-year follow-up in a sample of older out patients in Italy we carried out a prospect i ve cohort study on 265 community-dwelling out patients aged 65 + ( mean age 81.5 years ) consecutively referred to a geriatric clinic . At baseline participants underwent a comprehensive geriatric assessment ( CGA ) including evaluation of their frailty status according to the SOF criteria . At a one-year follow-up , between June and December 2010 , we investigated nursing home placement and death in all participants as well as any fall , any admission to the emergency department ( ED ) , any hospitalization and a greater disability among the subset of subjects still living at home . One year after the visit 231 subjects were still living at home ( 87.2 % ) , 9 had been placed in a nursing home ( 3.4 % ) and 25 had died ( 9.4 % ) . Frailty was associated with a greater risk of falls ( odds ratio [ OR ] 2.01 , 95 % confidence interval [ CI ] 1.05 - 3.83 , p=0.035 ) , hospitalization ( OR 2.08 , 95 % CI 1.02 - 4.24 , p=0.045 ) and death ( OR 3.07 , 95 % 1.02 - 4.24 , p=0.045 ) after correction for demographic characteristics , comorbidity including dementia and depression , socioeconomic position and severe disability . Thus , in an older outpatient population in Italy the frailty syndrome diagnosed according to the SOF criteria was an independent predictor of several adverse health outcomes BACKGROUND A st and ard phenotype of frailty was associated with an increased risk of adverse outcomes including mortality in a recent study of older adults . However , the predictive validity of this phenotype for fracture outcomes and across risk subgroups is uncertain . METHODS To determine whether a st and ard frailty phenotype was independently associated with risk of adverse health outcomes in older women and to evaluate the consistency of associations across risk subgroups defined by age and body mass index ( BMI ) , we ascertained frailty status in a cohort of 6724 women > or=69 years and followed them prospect ively for incident falls , fractures , and mortality . Frailty was defined by the presence of three or more of the following criteria : unintentional weight loss , weakness , self-reported poor energy , slow walking speed , and low physical activity . Incident recurrent falls were defined as at least two falls during the subsequent year . Incident fractures ( confirmed with x-ray reports ) , including hip fractures , and deaths were ascertained during an average of 9 years of follow-up . RESULTS After controlling for multiple confounders such as age , health status , medical conditions , functional status , depressive symptoms , cognitive function , and bone mineral density , frail women were subsequently at increased risk of recurrent falls ( multivariate odds ratio=1.38 , 95 % confidence interval [ CI ] , 1.02 - 1.88 ) , hip fracture ( multivariate hazards ratio [MHR]=1.40 , 95 % CI , 1.03 - 1.90 ) , any nonspine fracture ( MHR=1.25 , 95 % CI , 1.05 - 1.49 ) , and death ( MHR=1.82 , 95 % CI , 1.56 - 2.13 ) . The associations between frailty and these outcomes persisted among women > or=80 years . In addition , associations between frailty and an increased risk of falls , fracture , and mortality were consistently observed across categories of BMI , including BMI > or=30 kg/m2 . CONCLUSION Frailty is an independent predictor of adverse health outcomes in older women , including very elderly women and older obese women BACKGROUND Frailty , as defined by the index derived from the Cardiovascular Health Study ( CHS index ) , predicts risk of adverse outcomes in older adults . Use of this index , however , is impractical in clinical practice . METHODS We conducted a prospect i ve cohort study in 6701 women 69 years or older to compare the predictive validity of a simple frailty index with the components of weight loss , inability to rise from a chair 5 times without using arms , and reduced energy level ( Study of Osteoporotic Fractures [ SOF index ] ) with that of the CHS index with the components of unintentional weight loss , poor grip strength , reduced energy level , slow walking speed , and low level of physical activity . Women were classified as robust , of intermediate status , or frail using each index . Falls were reported every 4 months for 1 year . Disability ( > or = 1 new impairment in performing instrumental activities of daily living ) was ascertained at 4(1/2 ) years , and fractures and deaths were ascertained during 9 years of follow-up . Area under the curve ( AUC ) statistics from receiver operating characteristic curve analysis and -2 log likelihood statistics were compared for models containing the CHS index vs the SOF index . RESULTS Increasing evidence of frailty as defined by either the CHS index or the SOF index was similarly associated with an increased risk of adverse outcomes . Frail women had a higher age-adjusted risk of recurrent falls ( odds ratio , 2.4 ) , disability ( odds ratio , 2.2 - 2.8 ) , nonspine fracture ( hazard ratio , 1.4 - 1.5 ) , hip fracture ( hazard ratio , 1.7 - 1.8 ) , and death ( hazard ratio , 2.4 - 2.7 ) ( P < .001 for all models ) . The AUC comparisons revealed no differences between models with the CHS index vs the SOF index in discriminating falls ( AUC = 0.61 for both models ; P = .66 ) , disability ( AUC = 0.64 ; P = .23 ) , nonspine fracture ( AUC = 0.55 ; P = .80 ) , hip fracture ( AUC = 0.63 ; P = .64 ) , or death ( AUC = 0.72 ; P = .10 ) . Results were similar when -2 log likelihood statistics were compared . CONCLUSION The simple SOF index predicts risk of falls , disability , fracture , and death as well as the more complex CHS index and may provide a useful definition of frailty to identify older women at risk of adverse health outcomes in clinical practice OBJECTIVES To define frailty using simple indicators ; to identify risk factors for frailty as targets for prevention ; and to investigate the predictive validity of this frailty classification for death , hospitalization , hip fracture , and activity of daily living ( ADL ) disability . DESIGN Prospect i ve study , the Women 's Health Initiative Observational Study . SETTING Forty U.S. clinical centers . PARTICIPANTS Forty thous and six hundred fifty-seven women aged 65 to 79 at baseline . MEASUREMENTS Components of frailty included self-reported muscle weakness/impaired walking , exhaustion , low physical activity , and unintended weight loss between baseline and 3 years of follow-up . Death , hip fractures , ADL disability , and hospitalizations were ascertained during an average of 5.9 years of follow-up . RESULTS Baseline frailty was classified in 16.3 % of participants , and incident frailty at 3-years was 14.8 % . Older age , chronic conditions , smoking , and depressive symptom score were positively associated with incident frailty , whereas income , moderate alcohol use , living alone , and self-reported health were inversely associated . Being underweight , overweight , or obese all carried significantly higher risk of frailty than normal weight . Baseline frailty independently predicted risk of death ( hazard ratio (HR)=1.71 , 95 % confidence interval (CI)=1.48 - 1.97 ) , hip fracture ( HR=1.57 , 95 % CI=1.11 - 2.20 ) , ADL disability ( odds ratio (OR)=3.15 , 95 % CI=2.47 - 4.02 ) , and hospitalizations ( OR=1.95 , 95 % CI=1.72 - 2.22 ) after adjustment for demographic characteristics , health behaviors , disability , and comorbid conditions . CONCLUSION These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women . Underweight , obesity , smoking , and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention OBJECTIVES To compare 3 methods of describing the frailty of older adults in nursing homes . DESIGN Secondary analysis of a prospect i ve cohort study . SETTING Canadian long-term care institutions . PARTICIPANTS Institutionalized older adults in the second clinical examination cohort of the Canadian Study of Health and Aging ( CSHA-2 ; n = 728 ) . MEASURES Frailty was measured using the Cardiovascular Health Survey definition ( Frail-CHS ) ; the CSHA- Clinical Frailty Scale ( CSHA-CFS ) and a frailty index ( FI ) . RESULTS The sample was very elderly ( 87.7 + /- 6.7 years ) , disabled ( 83 % ) , and showed a high level of mobility impairment ( 83 % ) . Each frailty measure correlated moderately well with each other (  
    Output:
    