Agreement between 35 published frailty scores in the general population

Gloria A. Aguayo*, Anne Françoise Donneau, Michel T. Vaillant, Anna Schritz, Oscar H. Franco, Saverio Stranges, Laurent Malisoux, Michèle Guillaume, Daniel R. Witte

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

188 Citations (Scopus)


In elderly populations, frailty is associated with higher mortality risk. Although many frailty scores (FS) have been proposed, no single score is considered the gold standard. We aimed to evaluate the agreement between a wide range of FS in the English Longitudinal Study of Ageing (ELSA). Through a literature search, we identified 35 FS that could be calculated in ELSA wave 2 (2004-2005). We examined agreement between each frailty score and the mean of 35 FS, using a modified Bland-Altman model and Cohen's kappa (κ). Missing data were imputed. Data from 5,377 participants (ages ≥60 years) were analyzed (44.7% men, 55.3% women). FS showed widely differing degrees of agreement with the mean of all scores and between each pair of scores. Frailty classification also showed a very wide range of agreement (Cohen's κ = 0.10-0.83). Agreement was highest among "accumulation of deficits"-type FS, while accuracy was highest for multidimensional FS. There is marked heterogeneity in the degree to which various FS estimate frailty and in the identification of particular individuals as frail. Different FS are based on different concepts of frailty, and most pairs cannot be assumed to be interchangeable. Research results based on different FS cannot be compared or pooled.

Original languageEnglish
Pages (from-to)420-434
Number of pages15
JournalAmerican Journal of Epidemiology
Issue number4
Publication statusPublished - 15 Aug 2017


  • Bland-Altman model
  • Cohen's kappa coefficient
  • accuracy
  • agreement
  • disability
  • elderly population
  • frailty scores
  • reliability


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