A Harmonized Frailty Index Using Global Aging Data

Background Frailty is a common syndrome among older adults, associated with multiple adverse health outcomes. Work harmonizing frailty measurement across 25 countries and regions and different socioeconomic environments is limited. A harmonized definition is needed to assess frailty across settings to inform comparative studies of health and health care. Methods Data on adults aged 50+ from eight health and retirement surveys were analyzed: CHARLS (China), ELSA (England and Wales), ELSI (Brazil), HRS (USA), LASI (India), MHAS (Mexico), SHARE (Europe and Israel), and TILDA (Ireland). We produced 30-item deficit accumulation frailty index (FI) from shared variables. We assessed within-survey distributions and, in four surveys with available data (HRS, MHAS, SHARE, and TILDA), association with mortality. Results 184,715 participants were included; mean (SD) age was 65.1 (9.80) and 55.1% were female. Mean (SD) FI was 0.196 (0.133), and 39.2% were frail. Frailty distributions were right-skewed, with higher median FI for females than males (p < 0.0001). Kaplan-Meier analysis showed lower survival with greater frailty in studies with survival data. Hazard ratios (95% CI, p-value) for severe frailty (FI ≥ 0.4) compared with non-frailty (FI < 0.1) after adjustment for age, gender, and smoking status were 5.50 (4.89–6.19), 4.36 (3.67–5.18), 8.81 (6.44–12.05), and 3.97 (2.99–5.27) for HRS, MHAS, SHARE, and TILDA respectively, all with p < 0.0001. Conclusions This is a harmonized FI developed using data from multiple settings, with strong associations with mortality. This is a useful tool to better understand aging in a global context.