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Revisiting the hypothesis of syndromic frailty: a cross-sectional study of the structural validity of the frailty phenotype

  • Béland, François1, 2, 3
  • Julien, Dominic1
  • Wolfson, Christina4
  • Bergman, Howard5
  • Gaudreau, Pierrette6, 7
  • Galand, Claude1
  • Fletcher, John1
  • Zunzunegui, Maria-Victoria8
  • Shatenstein, Bryna9, 10
  • Kergoat, Marie-Jeanne10
  • Morais, José A.11
  • Fülöp, Tamàs12
  • 1 Groupe de recherche Solidage, Lady Davis Institute, Jewish General Hospital, 3755 Chemin-de-la-Côte-Ste-Catherine, Montréal, Québec, H3T 1E2, Canada , Québec (Canada)
  • 2 École de santé publique, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, Québec, H3C 3J7, Canada , Québec (Canada)
  • 3 Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, Québec, H3C 3J7, Canada , Québec (Canada)
  • 4 Faculty of Medicine, McGill University, 1020 Avenue des-Pins-Ouest, Montréal, Québec, H3A 1A2, Canada , Québec (Canada)
  • 5 McGill University, 5858, chemin de la Côte-des-Neiges, Suite 300, Montreal, Québec, H3S 1Z1, Canada , Québec (Canada)
  • 6 Faculté de Médecine, Université de Montréal, C.P. 6128, Pavillon R, Salle R05-436, Montréal, Québec, H2X 0A9, Canada , Québec (Canada)
  • 7 Centre de recherche du Centre hospitalier de l’Université de Montréal, 900 rue St-Denis, R Pavillon, Room R05-436, Montréal, Québec, H2X 0A9, Canada , Québec (Canada)
  • 8 École de santé publique, Université de Montréal, C.P. 6128, Succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada , Québec (Canada)
  • 9 Université de Montréal, C.P. 6128, succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada , Québec (Canada)
  • 10 CIUSSS du Centre-sud-de-l’Île-de-Montréal, Montréal, QC H3W 1W5, 4565, Chemin-de-la Reine-Marie, Montréal, Québec, H3W 1W5, Canada , Québec (Canada)
  • 11 MUHC-Montreal General Hospital, Room E-16.124.1, 1650 Avenue Cedar, Montréal, Québec, H3G 1A4, Canada , Québec (Canada)
  • 12 Université de Sherbrooke, 375, rue Argyll, Sherbrooke, Québec, J1H 3H5, Canada , Québec (Canada)
Published Article
BMC Geriatrics
BioMed Central
Publication Date
Oct 27, 2020
DOI: 10.1186/s12877-020-01839-7
Springer Nature


BackgroundFried’s Phenotype Model of Frailty (PMF) postulates that frailty is a syndrome. Features of a syndrome are a heterogeneous population that can be split into at least two classes, those presenting and those not presenting the syndrome. Syndromes are characterized by a specific mixture of signs and symptoms which increase in prevalence, from less to more severe classes. So far, the null hypothesis of homogeneity – signs and symptoms of frailty cannot identify at least two classes – has been tested using Latent Class Analysis (LCA) on the five dichotomized components of PMF (unintentional weight loss, exhaustion, weakness, slowness, and low physical activity). The aim of this study is to investigate further the construct validity of frailty as a syndrome using the extension offered by Factor Mixture Models (FMM).MethodsLCA on dichotomized scores and FMM on continuous scores were conducted to test homogeneity on the five PMF components in a sample of 1643 community-dwelling older adults living in Québec, Canada (FRéLE).ResultsWith dichotomized LCA, three frailty classes were found: robust, prefrail and frail, and the hypothesis of homogeneity was rejected. However, in FMM, frailty was better represented as a continuous variable than as latent heterogeneous classes. Thus, the PMF measurement model of frailty did not meet the features of a syndrome in this study.ConclusionUsing the FRéLE cohort, the PMF measurement model validity is questioned. Valid measurement of a syndrome depends on an understanding of its etiological factors and pathophysiological processes, and on a modelling of how the measured components are linked to these processes. Without these features, assessing frailty in a clinical setting may not improve patient health. Research on frailty should address these issues before promoting its use in clinical settings.

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