Background: Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established. 

Methods: To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality. 

Results: Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline). 

Conclusions: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.

https://www.sharp.com/services/hospice/upload/phenotype5-13.pdf

Frailty in Older Adults Evidence for a Phenotype

Despite the concern that has been expressed about potential method biases, and the pervasiveness of research settings with the potential to produce them, there is disagreement about whether they really are a problem for researchers in the behavioral sciences. Therefore, the purpose of this review is to explore the current state of knowledge about method biases. First, we explore the meaning of the terms “method” and “method bias” and then we examine whether method biases influence all measures equally. Next, we review the evidence of the effects that method biases have on individual measures and on the covariation between different constructs. Following this, we evaluate the procedural and statistical remedies that have been used to control method biases and provide recommendations for minimizing method bias.

Sources of Method Bias in Social Science Research and Recommendations on How to Control It

because observed behavior is the result of interactions between environmental factors and genes during the extended period of development. Therefore, to better understand expert and exceptional performance, we must require that the account specify the different environmental factors that could selectively promote and facilitate the achievement of such performance. In addition, recent research on expert performance and expertise (Chi, Glaser, & Farr, 1988; Ericsson & Smith, 1991a) has shown that important characteristics of experts' superior performance are acquired through experience and that the effect of practice on performance is larger than earlier believed possible. For this reason, an account of exceptional performance must specify the environmental circumstances, such as the duration and structure of activities, and necessary minimal biological attributes that lead to the acquisition of such characteristics and a corresponding level of performance. An account that explains how a majority of individuals can attain a given level of expert performance might seem inherently unable to explain the exceptional performance of only a small number of individuals. However, if such an empirical account could be empirically supported, then the extreme characteristics of experts could be viewed as having been acquired through learning and adaptation, and studies of expert performance could provide unique insights into the possibilities and limits of change in cognitive capacities and bodily functions. In this article we propose a theoretical framework that explains expert performance in terms of acquired characteristics resulting from extended deliberate practice and that limits the role of innate (inherited) characteristics to general levels of activity and emotionality. We provide empirical support from two new studies and from already published evidence on expert performance in many different domains.

/pdf/the-role-of-deliberate-practice-in-the-acquisition-of-expert-3j9768t5su.pdf

The role of deliberate practice in the acquisition of expert performance.

Recent studies of eye movements in reading and other information processing tasks, such as music reading, typing, visual search, and scene perception, are reviewed. The major emphasis of the review is on reading as a specific example of cognitive processing. Basic topics discussed with respect to reading are (a) the characteristics of eye movements, (b) the perceptual span, (c) integration of information across saccades, (d) eye movement control, and (e) individual differences (including dyslexia). Similar topics are discussed with respect to the other tasks examined. The basic theme of the review is that eye movement data reflect moment-to-moment cognitive processes in the various tasks examined. Theoretical and practical considerations concerning the use of eye movement data are also discussed.

/pdf/eye-movements-in-reading-and-information-processing-20-years-3z5ay8hdwc.pdf

Eye movements in reading and information processing: 20 years of research.

A theory is proposed to account for some of the age-related differences reported in measures of Type A or fluid cognition. The central hypothesis in the theory is that increased age in adulthood is associated with a decrease in the speed with which many processing operations can be executed and that this reduction in speed leads to impairments in cognitive functioning because of what are termed the limited time mechanism and the simultaneity mechanism. That is, cognitive performance is degraded when processing is slow because relevant operations cannot be successfully executed (limited time) and because the products of early processing may no longer be available when later processing is complete (simultaneity). Several types of evidence, such as the discovery of considerable shared age-related variance across various measures of speed and large attenuation of the age-related influences on cognitive measures after statistical control of measures of speed, are consistent with this theory.

http://www.anitacrawley.net/Resources/Articles/salthouse%20The%20Processing%20Speed%20Theory%20of%20Adult%20Age%20Differences%20in%20Cognition.pdf

The processing-speed theory of adult age differences in cognition.

To investigate possible gender differences in the patterns of age-cognition relations, a meta-analysis was conducted on the data from 25 studies (5,201 participants) by the second author and his collaborators. Gender and age differences consistent with prior reports were found, but there were few measures on which the age × gender interactions were significant. Although the majority of neuroimaging studies investigating gender differences in age-related atrophy and functional decline report greater age-related differences in males, the only significant interactions on the cognitive measures in this study (on measures of speed and reasoning) were in the direction of lesser age-related declines for males than for females.

/pdf/is-age-kinder-to-females-than-to-males-45tk1ehgho.pdf

Is age kinder to females than to males

There is currently little consensus regarding what must be explained by theories of cognitive aging. In the present article, four empirical generalizations that seem to imply certain constraints in theorizing are identified. These generalizations, and their possible implications or constraints, are that (1) age-related differences are found in a wide range of cognitive variables, implying that either a large number of specific factors or a small number of general factors must be contributing to the age-related differences; (2) the age-related influences on different cognitive variables are not independent, and unique age-related influences appear to be few in number and small in magnitude, implying that some fairly general factors need to be postulated to account for the shared age-related influences; (3) only a small proportion of distinct age-related variance occurs late in practice and at long presentation durations, implying that adequate explanations must include factors operating when the individuals are just beginning to perform the task and when the stimuli can first be registered; and (4) measures of how quickly very simple cognitive tasks can be performed share considerable age-related variance with many cognitive variables, implying that factors related to simple processing efficiency need to be incorporated into the explanations.

/pdf/constraints-on-theories-of-cognitive-aging-1omvv2euom.pdf

Constraints on theories of cognitive aging.

Age-related effects on cognition between 20 and 50 years of age

Datafrom a recent project involving 362 adults ranging from 20 to 79 years of age were reanalyzed to examine the eJfects of statistical control of self-assessed health status on the age trends in several measures of cognitive functioning. The major result was that the age trends were virtually identical with, and without, control ofthe healthstatus variable. Implications of the views that the lack of health influences was d.ue lo a narrow range of health status or to insensitive assessment of health status were discussed. fT is sometimes suggested that age-related effects on mear sures of coenitive functioning are no[ due to intrinsic maturational pio..rr", or to diffJrential patterns of experience at diff'erent phases of life, but instead are attributable to a variety of pathological diseases. This is clearly a plausible argument because the incidence of many diseases does increase with age, and at least some of those diseases have been documented to be associated with lower levels of cognitive functioning. Unfortunately, however, the role of health variables in the relations between age and cognitive measures has seldom been systematically investigated. The analyses described in the present report represent one attempt to determine whether there are significant relations among age, self-assessed health status, and measures of cognitive functioning, and whether an age-related decrease in health status might account for some of the observed agerelated differences in cognitive functioning. Health status ofresearch participants in the current pro1ect

Age, Self-Assessed Health Status, and Cognition

At least four distinct explanations can be proposed to account for patterns of spared and impaired performance in which the age-related effects on some variables are weaker than those on other variables. These are: (a) some variables lack sufficient reliability to exhibit relations with other variables; (b) the variables differ in their dependence on what many of the variables have in common; (c) variables with little or no age differences reflect a qualitatively different form of cognition than variables with moderate to large age differences; and (d) variables with little or no age differences have independent positive age-related influences that offset the negative age-related effects shared with other cognitive variables. These interpretations were examined with three different variables hypothesized to reflect implicit learning obtained from a sample of 183 adults ranging from 18 to 87 years of age. Only an implicit learning measure derived from a sequential reaction time task had acceptable reliabil...

A framework for analyzing and interpreting differential aging patterns: Application to three measures of implicit learning

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