Réjean Hébert

BACKGROUND: Frailty and fitness are important attributes of older persons, but population samples of their prevalence, attributes, and outcomes are limited. METHODS: The authors report data from the community-dwelling sample (n = 9008) of the Canadian Study of Health and Aging, a representative, 5-year prospective cohort study. Fitness and frailty were determined by self-reported exercise and function level and testing of cognition. RESULTS: Among the community-dwelling elderly population, 171 per 1000 were very fit and 12 per 1000 were very frail. Frailty increased with age, so that by age 85 years and older, 44 per 1000 were very frail. The risk for adverse health outcomes increased markedly with frailty: Compared with older adults who exercise, those who were moderately or severely frail had a relative risk for institutionalization of 8.6 (95% confidence interval, 4.9 to 15.2) and for death of 7.3 (95% confidence interval, 4.7 to 11.4). These risks persist after adjustments for age, sex, comorbid conditions, and poor self-rated health. At all ages, men reported higher levels of exercise and less frailty compared with women. Decreased fitness and increased frailty were also associated with poor self-ratings of health (42% in the most frail vs 7% in the most fit), more comorbid illnesses (6 vs 3), and more social isolation (34% vs 29%). CONCLUSIONS: Fitness and frailty form a continuum and predict survival. Exercise influences survival, even in old age. Relative fitness and frailty can be determined quickly in a clinical setting, are potentially useful markers of the risk for adverse health outcomes, and add value to traditional medical assessments that focus on diagnoses.

ABSTRACT Zarit Burden Interview (ZBI) is the most widely used instrument for assessing the burden experienced by the caregivers of persons with dementia. As part of the Canadian Study of Health and Aging, the 22-item ZBI was administered to a representative sample of 312 informal caregivers of community-dwelling subjects with dementia. The mean score was 22.4 out of 88 (sd: 16.2) and the median score was 18.5, which is far lower than those reported in previous studies using this instrument with convenience samples. There was no significant difference in the burden score according to the age, gender, living arrangement, marital status or employment status of the caregiver. The ZBI score was more strongly correlated to the depressive mood of the caregivers (r = 0.59) and the behaviour problems of the care recipients (r = 0.64) than their cognitive (r = 0.32) and functional (r = 0.31) status. Following a factor analysis, a 12-item short version of the instrument is proposed with two factors: personal strain (3 items) and role strain (9 items).

The Functional Autonomy Measurement System (SMAF) is an instrument developed for the measurement of the needs of the elderly and the handicapped. Its elaboration was based on the World Health Organization's classification of impairments, disabilities and handicaps. A functional autonomy rating scale, using a four-level measurement scale, quantifies a subject's performance on 29 functions in five sectors of activity: activities of daily living, mobility, communication, mental functions and instrumental activities of daily living. For each function, the evaluator must also estimate available resources to compensate for any identified disability in order to estimate the handicap. The disability and handicap profile obtained is the basis for the prescription of home care or the allocation of chronic care beds. An inter-observer study concluded that the scale is reliable for evaluators from different professions in the community as well as in institutional settings. The instrument is rapid to administer (on average 42 min) and the reliability is not influenced by training. A study of concurrent validity has shown a strong correlation between the disability index obtained by the SMAF and the amount of required nursing-care time. This instrument can be used for clinical purposes and in epidemiological and evaluative research.