Prevalence of Frailty in Middle-Aged and Older Community-Dwelling Europeans Living in 10 Countries

M OST industrialized countries will need to adapt their health care systems to meet the challenges arising from population aging.This will require meaningful estimates of population health from epidemiological surveys.Functional impairments in the oldest age group have been discussed with regard to current and projected long-term care needs; however, this limits the view of the future needs of aging populations.In Europe, the large cohort of post -World War II baby boomers will reach retirement age over the next two decades.And although preventing an unfavorable evolution toward loss of autonomy in this generation is a public health priority, little is known regarding the proportion at risk for functional decline in middle age and beyond.Health indicators based on selected chronic conditions or unhealthy behaviors are diffi cult to interpret because multiple combinations of degenerative diseases result in considerable heterogeneity in the risk for functional loss and health care needs.Thus, the geriatric concept of frailty ( 1 -3 ) is of particular interest because frailty is likely to be a precursor of disability ( 4 -6 ) and may be reversible in its early stages ( 7 ).The prevalence of frailty might summarize health and the needs for prevention in middle-aged and older populations ( 8 , 9 ).A major impediment to measuring frailty in population-based surveys is the lack of an operational defi nition.However, Fried and colleagues ( 4 , 10 ) identifi ed a frailty phenotype that was predictive of adverse outcomes such as falls and fractures ( 11 , 12 ), mobility and functional declines ( 4 , 5 , 12 ), hospitalizations ( 4 ), nursing home admissions ( 5 ), and death ( 4 -6 , 11 -13 ).The prevalence of this phenotype has mainly been estimated for Northern America and scant data are available for Europe ( 14 , 15 ).The population of European countries could experience different levels of frailty due to cultural, regional, or political distinctions.The purposes of this study were to quantify the prevalence of frailty in community-dwelling middle-aged and older Europeans participating in the Survey of Health, Aging and Retirement in Europe (SHARE) in 2004, compare this prevalence among the 10 countries included in this survey, and evaluate selected population characteristics as potential explanations for international differences observed in the 65 years and older (65+) subgroup. Methods