Pulmonary function was assessed by the ratio of the forced expiratory volume in 1

second (FEV1) to the forced vital capacity (FVC). Values of FEV1/FVC below 0.7 indicate chronic airflow obstruction. Visual impairment was defined as having corrected binocular vision worse than 20/40, as used in other studies. 35Hearing impairment was assessed using self-report and the standard whisper test. Functional dependency was assessed by self-reported difficulty and requiring help on 1 or more IADL or basic ADL activities, previously validated for use in the local population. 36 and 37Hospitalization was determined by the participants’ self-reports of new hospitalizations for any chronic medical conditions over the previous year. Quality of life was measured using the Medical Outcomes Study SF12-PCS of quality of life. 28 All social-demographic, health, biochemical, and other characteristics

buy Trametinib of the participants were dichotomized and described using proportions. Bivariate associations of potential risk indicator variables with frailty defined by the CHS Frailty scale were analyzed based on the Cochran-Mantel-Haenszel test. ADL disability, IADL disability, falls, and hospitalization were not included as candidate risk predictor variables in the selection models. Stepwise buy EPZ015666 logistic regression (P < .05 for entry and P < .05 for retention in the model) was performed to select significant independent predictors of frailty. All variables were entered as candidate predictor variables in the initial regression model. The strengths of associations were estimated by odds ratio (OR) and 95% confidence interval (CI). A summary risk score for frailty was derived from the β coefficients

associated with the significant predictor variables RAS p21 protein activator 1 in the final selection model for frailty. We assigned a risk score for each variable based on its coefficient value, standardized with the lowest value, which was assigned a value of 1, and rounded to the nearest integer. The summary risk score for an individual was obtained by summing the weighted scores of each of the risk factors. Validation of the FRI on the external validation sample was performed by analyzing the association of the FRI score as a continuous variable with the observed proportions of prefrailty and frailty in multinomial logistic regression models, and estimating the OR (95% CI) of prefrailty and frailty associated with each unit of FRI score in the baseline sample, together with receiver operating characteristics (ROC) analyses. In the prospective follow-up data, longitudinal associations of the FRI with adverse health outcomes (IADL-ADL disability, hospitalization, lowest quintile of SF12-PCS) at the 2-year follow-up were analyzed. The ability of the FRI to predict adverse health outcomes was compared with the CHS Frailty scale and the FRAIL scale.