Frailty: Emergence and consequences in women aged 65 and older in the Women's Health Initiative observational study

Nancy Fugate Woods, Andrea Z. LaCroix, Shelly L. Gray, Aaron Aragaki, Barbara B. Cochrane, Robert L. Brunner, Kamal Masaki, Anne Murray, Anne B. Newman

Research output: Contribution to journalArticlepeer-review

826 Scopus citations


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: Prospective study, the Women's Health Initiative Observational Study. SETTING: Forty U.S. clinical centers. PARTICIPANTS: Forty thousand 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.

Original languageEnglish (US)
Pages (from-to)1321-1330
Number of pages10
JournalJournal of the American Geriatrics Society
Issue number8
StatePublished - Aug 2005


  • Activities of daily living
  • Disability
  • Ethnicity
  • Frailty
  • Postmenopausal women
  • Women's Health Initiative


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