Age and ageing最新文献

{"title":"Does concern about falling predict future falls in older adults? A systematic review and meta-analysis.","authors":"Toby Jack Ellmers, Jodi P Ventre, Ellen Freiberger, Klaus Hauer, David B Hogan, Mei Ling Lim, Lisa McGarrigle, Samuel Robert Nyman, Chris J Todd, Yuxiao Li, Kim Delbaere","doi":"10.1093/ageing/afaf089","DOIUrl":"10.1093/ageing/afaf089","url":null,"abstract":"<p><strong>Background: </strong>The 2022 World Falls Guidelines recommend assessing concerns (or 'fears') about falling in multifactorial fall risk assessments. However, the evidence base for this recommendation is limited. This review evaluated the evidence for concerns about falling as an independent predictor of future falls, applying the Bradford Hill criteria for causality.</p><p><strong>Methods: </strong>Systematic review and meta-analyses were conducted (PROSPERO registration ID: CRD42023387212). MEDLINE, CINAHL Plus, Web of Science and PsycINFO were searched for studies examining associations between baseline concerns about falling and future falls in older adults (minimum 6-month follow-up). Meta-analyses examined associations between concerns about falling and future falls. Risk of bias was assessed using an adapted Newcastle Ottawa Scale for cohort studies, and evidence certainty was rated with GRADE.</p><p><strong>Results: </strong>About 53 studies, comprising 75,076 participants, were included. Meta-analysis showed significant independent association between baseline concerns and future falls when using the Falls Efficacy Scale-International to assess concerns (full scale version, pooled OR = 1.03 [95% CI = 1.02-1.05] per 1-point increase; short scale version, pooled OR = 1.08 [95% CI = 1.05-1.11]). Significant associations were also observed when using single-item measures of concerns (pooled OR = 1.60 [95% CI = 1.36-1.89] for high vs. low concerns). In contrast, balance confidence (Activities-Specific Balance Confidence Scale) did not predict future falls (pooled OR = 0.97 [95% CI = 0.93-1.01]). Despite 26 studies rated as poor quality, associations were consistent across studies of different quality. The overall certainty of the evidence was rated as moderate.</p><p><strong>Conclusions: </strong>Baseline concern about falling is a clear predictor of future falls in older adults, supporting its inclusion in fall risk assessments. Regular assessment of concerns about falling, along with targeted interventions, could help reduce the risk of falls in older adults.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The opportunities and uncertainties of clinic visit recording for older adults.","authors":"Paul J Barr, Kerri L Cavanaugh, Meredith C Masel","doi":"10.1093/ageing/afaf079","DOIUrl":"https://doi.org/10.1093/ageing/afaf079","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gait and balance metrics comparison among different fall risk groups and principal component analysis for fall prediction in older people.","authors":"Lulu Yin, Hyeri Nam, Yaru Wei, Tianyi Feng, Feifei Li, Yushan Wang, Yu Zhang, Lin Wang","doi":"10.1093/ageing/afaf076","DOIUrl":"10.1093/ageing/afaf076","url":null,"abstract":"<p><strong>Background: </strong>Falls are a leading cause of morbidity and mortality among older adults, often linked to gait and balance impairments.</p><p><strong>Objective: </strong>To compare gait and balance metrics across fall risk levels in community-dwelling older adults and identify principal components predictive of fall risk.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>General community.</p><p><strong>Subjects: </strong>Three hundred older adults were stratified into low, moderate and high fall risk groups using the STEADI toolkit.</p><p><strong>Methods: </strong>Gait and balance metrics were compared across groups. Principal component analysis (PCA) reduced dimensionality, and binary logistic regression assessed the predictive value of components.</p><p><strong>Results: </strong>High-risk individuals showed slower cadence, shorter step length, wider step width, greater gait variability and increased centre of pressure (CoP) and centre of mass (CoM) sway. PCA identified four gait and seven balance components, explaining 71.62% and 75.88% of variance, respectively. Logistic regression revealed Gait_principal component (PC)2 (instability) (OR = 2.545, P < .001), Gait_PC3 (rhythm control) (OR = 1.659, P = .006), Balance_PC1 (CoP sway during single-leg stance) (OR = 1.628, P = .007), Balance_PC2 (CoM sway velocity variability) (OR = 1.450, P = .032) and Balance_PC4 (CoP sway during double-leg stance, eyes closed) (OR = 1.616, P = .004) as significant predictors. The model achieved 77.2% accuracy, with a sensitivity of 73.1% and a specificity of 79.4%.</p><p><strong>Conclusions: </strong>Gait instability, rhythm control and increased postural sway are key predictors of fall risk. Integrating gait and balance metrics enhances fall risk stratification, supporting clinical decision-making.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex and education differences in trajectories of physiological ageing: longitudinal analysis of a prospective English cohort study.","authors":"Mikaela Bloomberg, Andrew Steptoe","doi":"10.1093/ageing/afaf067","DOIUrl":"10.1093/ageing/afaf067","url":null,"abstract":"<p><strong>Background: </strong>Physiological age (PA) derived from clinical indicators including blood-based biomarkers and tests of physiological function can be compared with chronological age to examine disparities in health between older adults of the same age. Though education interacts with sex to lead to inequalities in healthy ageing, their combined influence on longitudinally measured PA has not been explored. We derived PA based on longitudinally measured clinical indicators and examined how sex and education interact to inform PA trajectories.</p><p><strong>Methods: </strong>Three waves of clinical indicators (2004/05-2012/13) drawn from the English Longitudinal Study of Ageing (ages 50-100 years) were used to estimate PA, which was internally validated by confirming associations with incident chronic conditions, functional limitations and memory impairment after adjustment for chronological age and sex. Joint models were used to construct PA trajectories in 8891 English Longitudinal Study of Ageing participants to examine sex and educational disparities in PA.</p><p><strong>Findings: </strong>Amongst the least educated participants, there were negligible sex differences in PA until age 60 (sex difference [men-women] age 50 = -0.6 years [95% confidence interval = -2.2 to 0.6]; age 60 = 0.4 [-0.6 to 1.4]); at age 70, women were 1.5 years (0.7-2.2) older than men. Amongst the most educated participants, women were 3.8 years (1.6-6.0) younger than men at age 50 and 2.7 years (0.4-5.0) younger at age 60, with a nonsignificant sex difference at age 70.</p><p><strong>Interpretation: </strong>Higher education provides a larger midlife buffer to physiological ageing for women than men. Policies to promote gender equity in higher education may contribute to improving women's health across a range of ageing-related outcomes.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise effects on intrinsic capacity in acutely hospitalised older adults: a pooled analysis of two randomised controlled trials.","authors":"Pedro L Valenzuela, Mikel Izquierdo, Nicolás Martinez-Velilla, Fabricio Zambom-Ferraresi, Eduardo Lusa Cadore, Robinson Ramírez-Vélez, Mikel L Sáez de Asteasu","doi":"10.1093/ageing/afaf082","DOIUrl":"https://doi.org/10.1093/ageing/afaf082","url":null,"abstract":"<p><strong>Background: </strong>Hospitalisation often results in adverse effects in older adults, particularly an increased risk of functional and cognitive decline. Although in-hospital exercise interventions have shown benefits, their impact on intrinsic capacity (IC) remains unknown.</p><p><strong>Objective: </strong>To assess the effects of multicomponent exercise training on IC in acutely hospitalised older adults.</p><p><strong>Design: </strong>Pooled analysis of two randomised clinical trials.</p><p><strong>Setting: </strong>Three Acute Care for Elders units.</p><p><strong>Subjects: </strong>Hospitalised older adults (≥75 years).</p><p><strong>Methods: </strong>The control group received standard care, whereas the exercise group participated in an in-hospital multicomponent exercise program. The primary outcome was IC assessed using a composite score (0-100) across five domains: vitality (handgrip strength), cognition (Mini-Mental State Examination), psychological health (Yesavage Geriatric Depression Scale), locomotion (Short Physical Performance Battery) and sensory function (self-reported vision and hearing). Adverse outcomes were evaluated 1 year after discharge, including emergency visits, hospital re-admission and mortality.</p><p><strong>Results: </strong>A total of 570 patients (age 87.3 ± 4.8 years) were enrolled during acute hospitalisation [median duration 8 (interquartile range = 3) days] and randomised to the exercise (n = 288) or control group (n = 282). The exercise intervention significantly improved IC compared to the control group [7.74 points, 95% confidence interval (CI) 6.45-9.03, P < .001], with benefits observed in all IC domains. IC score at discharge was inversely associated with mortality risk during follow-up (OR = 0.98 per each increase in IC score at discharge, 95% CI = 0.96, 0.99, P = .010), although no association was found with emergency visits (P = .866) or re-admissions (P = .567).</p><p><strong>Conclusions: </strong>In-hospital exercise is an effective strategy to enhance IC in hospitalised older adults. Additionally, the IC score at discharge was inversely related to the mortality risk within 1 year of discharge.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New horizons in personality disorders-from neglect to necessity in geriatric care.","authors":"Richard C Oude Voshaar, Silvia D M van Dijk","doi":"10.1093/ageing/afaf066","DOIUrl":"https://doi.org/10.1093/ageing/afaf066","url":null,"abstract":"<p><p>Personality disorders, characterised by enduring and maladaptive patterns of behaviour, cognition and emotional regulation, affect 1 in 10 older adults. Personality disorders are frequently encountered in geriatric care considering their association with multimorbidity and increased health care utilisation. Patients with personality disorders often receive inadequate somatic health care due to (i) difficulties in expressing their actual symptoms and needs, (ii) challenging interactions with professionals, and (iii) non-compliance with medical treatment and lifestyle advice. Acknowledging personality disorders in geriatric care may improve treatment outcomes of somatic diseases. Since empirical evidence on personality diagnosis and treatment in older adults is scarce, we summarise future endeavours. First, the development of age-inclusive diagnostic tools should be prioritised to ensure comparability across age groups and facilitate longitudinal research over the lifespan. Second, evidence-based treatment approaches should be tailored to older people. Insight-oriented psychotherapies remain effective in later life considering sufficient level of introspection. Supportive and mediative therapies may better suit those with significant cognitive or physical impairments. Geriatric care models should be ideal for managing the complex needs of these patients when a consistent approach can be assured within the geriatric team as well as within the network considering the high level of interdisciplinary exchange needed. Third, considering the dynamic nature of personality disorders older adults should not be excluded from studies using novel technologies for real-time monitoring and personalised care. By addressing these gaps, the field can improve somatic treatment outcomes and uphold the dignity and well-being of older adults with personality disorders.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating reliable and clinically significant changes in health outcomes of a mindfulness-based cognitive defusion training program among older adults with mild cognitive impairment: a randomized controlled trial.","authors":"Yinxia Ren, Bei Wu, Chenxi Ge, Lulu Shi, Chen Zhang, Mengna Zhu, Dan Zhao, Lina Wang","doi":"10.1093/ageing/afaf069","DOIUrl":"10.1093/ageing/afaf069","url":null,"abstract":"<p><strong>Background: </strong>Recognizing perceived stress as a modifiable risk factor, mindfulness-based programs show promise for stress mitigation in older adults with mild cognitive impairment (MCI).</p><p><strong>Objective: </strong>To assess the efficacy of a mindfulness-based contextual cognitive defusion training (M-bCCDT) program on perceived stress and other health outcomes, and to examine the reliable and clinically significance of these improvements at individual-level among older adults with MCI.</p><p><strong>Design: </strong>A two-arm, assessor-blinded randomized controlled trial.</p><p><strong>Settings and participants: </strong>102 community-dwelling older adults with MCI.</p><p><strong>Methods: </strong>Participants were randomly allocated to either a M-bCCDT program (weekly 60-minute sessions for 8 weeks, followed by 12 weeks of unsupervised practice) or health promotion classes. Measures of perceived stress, memory function, global cognitive function, psychomotor speed and mindfulness awareness were collected at baseline (T0), 8-week (T1) and 20-week (T2). Intervention effects were assessed at a group level (Generalized Estimating Equation, GEE) and individual level (Reliable and Clinically Significant Changes, RCSC).</p><p><strong>Results: </strong>The M-bCCDT program demonstrated significant interaction effects in perceived stress compared to the wait-list control group by GEE analysis (βT1 = -3.686, 95% CI [-5.397, -1.976]; βT2 = -7.608, 95% CI [-9.387, -5.829]). Furthermore, this program also showed significant efficacy in memory function, psychomotor speed and mindfulness awareness. RCSC indicated that 30 participants (59%) in the intervention group showed statistically significant improvement in perceived stress at 8-week, with 7 (14%) clinically significant. This increased to 38 (75%) with 20 (39%) clinically significant at 20-week. Secondary outcomes also showed statistically and clinically significant improvements over time, but no improvement in global cognitive function at the individual level.</p><p><strong>Conclusions: </strong>The M-bCCDT program positively impacted perceived stress and mindfulness awareness in older adults with MCI, facilitating the improvements in memory and psychomotor speed, with these benefits sustained for 20 weeks. It offers a systematic approach for community healthcare providers in MCI stress management.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between changes in physical functions and risk of stroke: a prospective cohort study.","authors":"Yulin Xie, Yiling Lou, Shen Huang, Qingqing Jiang, Xiaohan Wang, Linlin Wang, Hengchang Wang, Furong Wang, Shiyi Cao","doi":"10.1093/ageing/afaf087","DOIUrl":"https://doi.org/10.1093/ageing/afaf087","url":null,"abstract":"<p><strong>Background: </strong>The association between changes in physical functions and stroke incidence remains uncertain.</p><p><strong>Methods: </strong>A total of 7978 participants without stroke from the China Health and Retirement Longitudinal Study (CHARLS) were recruited in 2011-2012 and followed up until 2020. We assessed annual changes in physical functions from 2011 to 2015, including absolute grip strength, relative grip strength, walking speed, chair-rising time and standing balance. The Cox proportional hazards model was applied to assess the longitudinal associations between annual changes in physical functions and stroke. Restricted cubic spline analyses were used to explore the dose-response relationships.</p><p><strong>Results: </strong>During 71 714 person-years of follow-up, 549 incident stroke cases were reported. For each 1-kg absolute grip strength increment, 0.1-unit relative grip strength increment, or 1-point standing balance test score increment, the hazard of stroke was reduced by 12% [hazard ratio (HR): 0.88; 95% confidence interval (CI): 0.84-0.93], 53% (HR: 0.47; 95% CI: 0.34-0.64), 55% (HR: 0.45; 95% CI: 0.30-0.67), respectively. We found a negative linear dose-response association of the annual change in absolute and relative grip strength with incident stroke, as well as a nonlinear association between the annual change in standing balance and incident stroke. However, neither the annual change in walking speed nor chair-rising time was related to the incident stroke.</p><p><strong>Conclusions: </strong>A greater improvement in absolute grip strength, relative grip strength or standing balance was suggested to be associated with a lower risk of stroke amongst middle-aged and older people. These objectively measured physical function changes are imperative for high-risk population classification and stroke prevention.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"24-Hour time use and cognitive performance in late adulthood: results from the Investigating Gains in Neurocognition in an Intervention Trial of Exercise (IGNITE) study.","authors":"Audrey M Collins, Maddison L Mellow, Ashleigh E Smith, Lu Wan, Neha P Gothe, Jason Fanning, John M Jakicic, Chaeryon Kang, George Grove, Haiqing Huang, Lauren E Oberlin, Jairo H Migueles, M Ilyas Kamboh, Arthur F Kramer, Charles H Hillman, Eric D Vidoni, Jeffrey M Burns, Edward McAuley, Kirk I Erickson","doi":"10.1093/ageing/afaf072","DOIUrl":"10.1093/ageing/afaf072","url":null,"abstract":"<p><strong>Objective: </strong>This cross-sectional study examined associations between 24-hour time-use composition (i.e. sleep, sedentary time, light physical activity and moderate-to-vigorous physical activity) and cognitive performance and explored whether demographic or genetic factors moderated these relationships.</p><p><strong>Methods: </strong>This analysis included baseline data from cognitively unimpaired older adults (n = 648) enrolled in the Investigating Gains in Neurocognition in an Intervention Trial of Exercise study. Time use was measured using wrist-worn triaxial accelerometers. Cognitive domains were determined using a confirmatory factor analysis from a comprehensive neuropsychological battery. Linear regression models tested associations between time-use composition and cognitive factors, adjusting for age, sex, education, body mass index, apolipoprotein E4 (APOE4) allele carriage and study site. Interaction terms evaluated moderation of time use by age, sex, education and APOE4 status. We also examined the theoretical impact of reallocating time between time-use behaviours on cognitive performance using compositional isotemporal substitution methods.</p><p><strong>Results: </strong>Time-use composition was associated with processing speed (F = 5.16, P = .002), working memory (F = 4.81, P = .003) and executive function/attentional control (F = 7.09, P < .001) but not episodic memory (F = 2.28, P = .078) or visuospatial function (F = 2.26, P = .081). Post hoc isotemporal substitution analyses found that significant associations were driven by time spent in moderate-to-vigorous physical activity (MVPA), with lesser amounts of MVPA associated with poorer cognitive performance. There was no evidence of moderation by any tested factors.</p><p><strong>Conclusions: </strong>Increasing or decreasing MVPA, at the expense of time spent in sleep, sedentary behaviour or light physical activity, may be related to individual variation in processing speed, executive function/attentional control and working memory in older adulthood.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and external validation of the electronic frailty index 2 using routine primary care electronic health record data.","authors":"Kate Best, Farag Shuweihdi, Juan Carlos Bazo Alvarez, Samuel Relton, Christina Avgerinou, Danielle Nimmons, Irene Petersen, Maria Pujades-Rodriguez, Simon Paul Conroy, Kate Walters, Robert M West, Andrew Clegg","doi":"10.1093/ageing/afaf077","DOIUrl":"10.1093/ageing/afaf077","url":null,"abstract":"<p><strong>Background: </strong>The electronic frailty index (eFI) is nationally implemented into UK primary care electronic health record systems to support routine identification of frailty. The original eFI has some limitations such as equal weighting of deficit variables, lack of time constraints on variables known to resolve and definition of frailty category cut-points. We have developed and externally validated the eFI2 prediction model to predict the composite risk of home care package; hospital admission for fall/fracture; care home admission; or mortality within one year, addressing the limitations of the original eFI.</p><p><strong>Methods: </strong>Linked primary, secondary and social care data from two independent retrospective cohorts of adults aged ≥65 in 2018 was used; the population of Bradford using the Connected Bradford dataset (development cohort, 78 760 patients) and the population of Wales, from the Secure Anonymised Information Linkage databank (external validation cohort, 660 417 patients). Candidate predictors included the original eFI variables, supplemented with variables informed by literature reviews and clinical expertise. The composite outcome was modelled using Cox regression.</p><p><strong>Results: </strong>In internal validation the model had excellent discrimination (C-index = 0.803, Nagelkerke's R2 = 0.0971) with good calibration (Calibration slope = 1.00). In external validation, the model had good discrimination (C-index = 0.723, Nagelkerke's R2 = 0.064), with some evidence of miscalibration (Calibration slope = 1.104).</p><p><strong>Conclusions: </strong>The eFI2 demonstrates robust prediction for key frailty-related outcomes, improving on the original eFI. Our use of novel methodology to develop and validate the eFI2 will advance the field of frailty-related research internationally, setting a new methodological standard.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}