Table 1.

Single Item Frailty Markers

Grip Strength: The Harpenden and Jamar dynamometers are both validated clinical instruments for measurement of grip strength.

Leong et al: Grip strength was inversely associated with all-cause mortality (hazard ratio per 5 kg reduction in grip strength 1·16, 95% CI 1·13–1·20; p<0·0001), cardiovascular mortality (1·17, 1·11–1·24; p<0·0001), non-cardiovascular mortality (1·17, 1·12–1·21; p<0·0001), myocardial infarction (1·07, 1·02–1·11; p=0·002), and stroke (1·09, 1·05–1·15; p<0·0001). Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure.(4)

Syddall et al: In men, lower grip strength correlated with ten ageing markers compared to chronological age which was significantly associated with seven. In women, there were six significant relationships for grip compared to three for age. The conclusion is grip strength was associated with more markers of frailty than chronological age.(34)

Timed Up-and-Go: Robinson et al: This timed test starts with the subject standing from a chair, walking ten feet, returning to the chair, and ends after the subject sits. Timed up-and-go results are grouped: Fast≤10 sec, Intermediate=11–14 sec, Slow≥15 sec.

272 subjects (mean age of 74±6 years). Slower timed up-and-go was associated with an increased postoperative complications following colorectal (fast-13%, intermediate-29% and slow-77%; p<0.001) and cardiac (fast-11%, intermediate-26% and slow-52%; p<0.001) operations. Slower timed up-and-go was associated with increased one-year mortality following both colorectal (fast-3%, intermediate-10% and slow-31%; p=0.006) and cardiac (fast-2%, intermediate-3% and slow-12%;p=0.039) operations.(35)

Falls: Jones et al: A fall was defined as unintentionally coming to rest on the ground, floor or other lower level. Patients were considered to have had a fall if they had a history of one or more falls in the six-months preceding surgery.

There were 235 subjects with a mean age of 74±6 years. Pre-operative falls occurred in 33%. One or more postoperative complications occurred more frequently in the group with prior falls compared to the non-fallers following both colorectal (59% vs. 25%; p=0.004) and cardiac (39% vs. 15%; p=0.002) operations. These findings were independent of advancing chronologic age. Need for discharge to an institutional care facility occurred more frequently in the group that had fallen in comparison to the non-fallers in both the colorectal (52% vs. 6%; p<0.001) and cardiac (62% vs. 32%; p=0.001) groups. Similarly, 30-day readmission was higher in the group with prior falls following both colorectal (p=0.043) and cardiac (p=0.016) operations.(36)