Frailty predicts all-cause and cause-specific mortality among older adults in Austria: 8-year mortality follow-up of the Austrian Health Interview Survey (ATHIS 2014).

BACKGROUND: The frailty index (FI) is an established predictor of all-cause mortality among older adults, but less is known with regard to cause-specific mortality, and whether the predictive power of the FI varies between men and women and by socio-economic position. METHODS: We assessed all-cause and cause-specific mortality during 8 years of follow-up (median = 7 years) among the population-representative sample of older adults (65 + , n = 2,561) from the European Health Interview Survey in Austria (ATHIS 2014). A FI at baseline was constructed from 41 health deficits. Official cause of death information from Statistics Austria was linked with the survey data by the Austrian Micro Data Center (AMDC). Next to all-cause mortality, we differentiated between mortality from cardiovascular diseases (CVD), cancer, and other causes. Cox proportional hazard models adjusted for socio-demographic variables and causes of death as competing risks were used to assess mortality prediction. RESULTS: Among the participants, 43.5% were robust (FI < 0.10), 37.7% pre-frail (FI = 0.10-0.21), and 18.7% were frail (FI > 0.21). 405 (15.8%) participants died during follow-up. Among the deceased, 148 (36.5%) died from CVD, 127 (31.4%) died from cancer, and 130 (32.1%) died from other causes of death. The FI predicted all-cause (hazard ratio, HR = 1.33 per 0.1 FI and HR = 2.4 for frail compared to robust older adults) and cause-specific mortality risk (HRCVD = 1.25/2.46, HRcancer = 1.19/1.47, HRother = 1.49/3.59). Area under the curve (AUC) values were acceptable for CVD mortality (0.78) and other causes of death (0.74), and poor for cancer mortality (0.64). CONCLUSIONS: The FI predicts all-cause and cause-specific mortality (CVD, other causes) well, which points to its relevance as a potential screening tool for risk stratification among community-dwelling older adults.

Lonely and depressed in older age: prospective associations and common vulnerabilities.

OBJECTIVES: Research demonstrated a close relationship between loneliness and depressive symptoms, but it remains unclear whether these constructs reciprocally influence each other or whether the association is due to common causes. This study aimed at examining how loneliness and depressive symptoms jointly unfold across time and how the relationship varies both within and between individuals. METHODS: We used survey data of N = 8472 older adults gathered in the English Longitudinal Study of Ageing, which included eight waves over a time period of up to 15 years. The relationship was analyzed using a latent curve model, allowing us to separate within-person processes from between-person differences in long-term growth. RESULTS: Results showed no prospective effects of loneliness on depressive symptoms (or vice versa) at the within-person level. Yet, within-person increases in loneliness were related to within-person increases in depressive symptoms at the same point in time. As regards the between-person effects, greater long-term growth in loneliness went along with greater long-term growth in depressive symptoms. CONCLUSION: Our findings did not support the assumption that loneliness and depressive symptoms influence each other over time, but rather suggest that the short- and long-term associations may be due to a common vulnerability to the same causes.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2056138 .

Facilitators and barriers in general practitioners' choice to work in primary care units in Austria: a qualitative study.

BACKGROUND: Recent reforms in Austria have focused on establishing team-based care within multiprofessional primary care units, to enhance amongst others, the work attractiveness of general practice. Nearly 75% of qualified general practitioners are not working as contracted physicians with the social health insurance. This study aims to explore the facilitators of and barriers to non-contracted general practitioners to work in a primary care unit. METHODS: We conducted twelve semi-structured, problem-centered interviews among purposively sampled non-contracted general practitioners. To extract categories of facilitators and barriers for working in a primary care unit, transcribed interviews were inductively coded using qualitative content analysis. Subcategories were grouped into factors (facilitators and barriers) of thematic criteria and mapped on the macro-, meso-, micro-, and individual levels. RESULTS: We identified 41 categories, including 21 facilitators and 20 barriers. Most facilitators were located at the micro-level, while most barriers were located at the macro-level. Teamwork and associated conditions made primary care units attractive as workplaces and corresponded with individual demands. In contrast, system factors tended to reduce the attractiveness of working as a general practitioner. CONCLUSIONS: Multifaceted efforts are needed to address relevant factors at all of the levels mentioned above. These need to be carried out and consistently communicated by all stakeholders. Efforts to strengthen the holistic approach in primary care, like modern remuneration and patient steering mechanisms, are essential. Financial support, consulting services as well as training on entrepreneurship, management, leadership, and team-based care may help to reduce the risk and burden of founding and running a primary care unit.

Frailty in the oldest old: is the current level or the rate of change more predictive of mortality?

BACKGROUND: It is unclear whether frailty index (FI) change captures mortality risk better than and independently of the current FI level, i.e. whether a regular FI assessment among older adults provides additional insights for mortality risk stratification or not. METHODS: We used data from the LASA 75-PLUS-study, which monitored health among 508 older adults (75+) between 2016 and 2019 every 9 months. Joint models for longitudinal and time-to-event data were used to assess the impact of both current FI and within-person FI change during the last year on mortality risk. RESULTS: Twenty percent of the participants died during 4.5 years of follow-up. Adding within-person FI change to the current FI model improved model fit and it showed that FI increases during the last year were associated with an increase in mortality risk. Consequently, the effect of the current FI decreased considerably and became statistically non-significant. CONCLUSIONS: The rate of FI change was more important than the current FI level for short-term mortality prediction among the oldest old, which highlights the benefits of regular frailty assessments.

The impact of COVID-19 restriction measures on loneliness among older adults in Austria.

BACKGROUND: To halt the spread of COVID-19, Austria implemented a 7-week 'lockdown' in March/April 2020. We assess whether the ensuing reduction in social contacts led to increased loneliness among older adults (60+). METHODS: Three analyses were conducted: (i) a comparison between pre-pandemic (SHARE: 2013-17) and pandemic (May 2020) levels of loneliness (UCLA-3 scale), (ii) an assessment of the cross-sectional correlation between being affected by COVID-19 restriction measures and loneliness (May 2020) and (iii) a longitudinal analysis of weekly changes (March-June 2020) in loneliness (Corona panel). RESULTS: We found (i) increased loneliness in 2020 compared with previous years, (ii) a moderate positive association between the number of restriction measures older adults were affected from and their loneliness and (iii) that loneliness was higher during 'lockdown' compared to the subsequent re-opening phase, particularly among those who live alone. CONCLUSIONS: We found evidence that COVID-19 restriction measures in Austria have indeed resulted in increased levels of loneliness among older adults. However, these effects seem to be short-lived, and thus no strong negative consequences for older adults' mental health are expected. Nonetheless, the effects on loneliness, and subsequent mental health issues, could be both more long-lasting and severe if future restriction measures are enacted repeatedly and/or over longer time periods.

[Survey of Relatives' Perspective on Dying In The Hospital: A Comparison Between Departments of Internal Medicine and Palliative Care In Styria (Austria)]. / Angehörigenbefragung zum Sterben im Krankenhaus: Ein Vergleich zwischen Abteilungen für innere Medizin und Palliativstationen in der Steiermark (Österreich).

BACKGROUND: Currently, 49% of deaths in Austria occur in a hospital which makes in-patient quality of care as well as quality of death and dying a highly relevant topic. In this article, we compare the quality of care and death and dying in departments of internal medicine and palliative care in hospitals from the perspective of relatives. METHODS: In a pilot study, 210 relatives of patients who died on 4 departments of internal medicine and 2 departments of palliative care in the state of Styria (Austria) were interviewed in 2015-2017 by means of a postal survey with regard to communication by hospital personnel, quality of care, and time of dying. RESULTS: Compared to the departments of internal medicine, the 2 departments of palliative care were perceived to provide better quality of care and better service with regard to the time of death and dying, that is, timely communication of critical health deterioration of the patient, enabling relatives' attendance at the time of death, preparing relatives, and the quality of death of the patient. CONCLUSION: Against the background of the large proportion of individuals who die in hospitals in Austria, this exploratory study showed that relatives perceived both better quality of care and better quality of death and dying in the assessed departments of palliative care compared to the departments of internal medicine. Thus, a more comprehensive and systematic evaluation of the potential added value of palliative care teams in Austrian hospitals is recommended.

Fluctuations in frailty among older adults.

BACKGROUND: frailty fluctuations, that is, within-person up and down deviations from individual long-term frailty index trajectories represent a hitherto both conceptually and empirically untapped facet of frailty among older adults. OBJECTIVE: to assess the size of frailty fluctuations in old age and their association with frailty levels, frailty growth as well as sex and socio-economic position. METHODS: a total of 18,704 biannual observations from 4,514 community-dwelling older adults (65+) in 10 European countries over 12 years from the Survey of Health, Ageing and Retirement in Europe (SHARE) were analysed. A frailty index was constructed based on 50 items. Long-term frailty trajectories and fluctuations were modelled simultaneously using Bayesian mixed-effects location-scale regression models. RESULTS: frailty index fluctuations were non-negligible among older adults, amounting to 0.04/0.05 FI or 2.0/2.5 health deficits on average. 30% of fluctuations were between 0.04 and 0.1 FI (2 and 5 health deficits) and 8% were larger than 0.1 FI (5 health deficits). Fluctuations increased with age and frailty levels, and were higher among women, those with low socio-economic position (education) and individuals who died during follow-up. CONCLUSIONS: frailty index fluctuations refer to instabilities in an older person's health status and represent a hitherto untapped but relevant aspect of vulnerability in old age. Future analysis of frailty fluctuations should be based on a larger number of repeated observations with shorter time intervals.

[The Impact of Migration Background on Health: Results of the Austrian Health Interview Survey (ATHIS 2014)]. / Die Bedeutung des Migrationshintergrunds für die Gesundheit. Ergebnisse der österreichischen Gesundheitsbefragung (ATHIS 2014).

OBJECTIVES: Previous research has shown migrants to have a poorer health status than those without a migration background in many respects. So far, it is not completely clear whether the poorer health results of migrants are mainly the cause of their socioeconomic status (SES), which on average is lower than the SES of people without a migration background. The present study explores the question whether the fact of having a migration background has an impact on health, even though SES and health-related behavior are taken into account. METHODS: Based on data from the current Austrian Health Interview Survey (ATHIS 2014) multiple linear regression models, adjusted for age and stratified by gender, were conducted. The dependent variables were physical quality of life, psychological quality ofZ life, self-perceived health, body-mass-index (BMI), headaches/musculoskeletal pain, and diabetes/cardiovascular diseases (n=15,748). RESULTS: We found differences in health between men and women with migration background and men and women without migration background. After adjusting for age, SES and health-related behavior, almost all of the revealed differences got smaller. The strongest link between migrant status and health status was detected for migrants from countries with a lower Inequality-adjusted Human Development Index (IHDI) in comparison to Austria. CONCLUSION: The results lead to the conclusion that although SES and health-related behavior do not fully explain health differences between people with migration background and those without, they can explain the differences to a large extent. However, for the health status of migrants who stem from countries with a lower standard of living and a weaker distributive justice in comparison to Austria, further factors might play a role. With respect to this group of migrants, differences in health compared to non-migrants are not solely attributable to SES and health-related behavior.

Nursing professionals' attitudes toward use of physical restraints in Styrian nursing homes Austria.

BACKGROUND: Given that nursing staff play a critical role in the decision regarding use of physical restraints, research has examined nursing professionals' attitudes toward this practice. AIM: Since nursing professionals' views on physical restraint use have not yet been examined in Austria to date, we aimed to explore nursing professionals' attitudes concerning use of physical restraints in nursing homes of Styria (Austria). METHOD: Data were collected from a convenience sample of nursing professionals (N = 355) within 19 Styrian nursing homes, based on a cross-sectional study design. Attitudes toward the practice of restraint use were assessed by means of the Maastricht Attitude Questionnaire in the German version. RESULTS: The overall results showed rather positive attitudes toward the use of physical restraints, yet the findings regarding the sub-dimensions of the questionnaire were mixed. Although nursing professionals tended to deny "good reasons" for using physical restraints, they evaluated the consequences of physical restraint use rather positive and considered restraint use as an appropriate health care practice. Nursing professionals' views regarding the consequences of using specific physical restraints further showed that belts were considered as the most restricting and discomforting devices. CONCLUSIONS: Overall, Austrian nursing professionals seemed to hold more positive attitudes toward the use of physical restraints than counterparts in other Western European countries. Future nationwide large-scale surveys will be needed to confirm our findings.

Does Sample Attrition Affect the Assessment of Frailty Trajectories Among Older Adults? A Joint Model Approach.

BACKGROUND: Frailty constitutes an important risk factor for adverse outcomes among older adults. In longitudinal studies on frailty, selective sample attrition may threaten the validity of results. OBJECTIVE: To assess the impact of sample attrition on frailty index trajectories and gaps related to socio-economic status (education) therein among older adults in Europe. METHODS: A total of 64,143 observations from 21,044 respondents (50+) from the Survey of Health, Ageing and Retirement in Europe across 12 years of follow-up (2004-2015) and subject to substantial sample attrition (59%) were analysed. We compared results of a standard linear mixed model assuming missing at random (MAR) sample attrition with a joint model assuming missing not at random sample attrition. RESULTS: Estimated frailty trajectories of both the mixed and joint models were identical up to an age of 80 years, above which modest underestimation occurred when a standard linear mixed model was used rather than a joint model. The latter effect was larger for men than women. Substantial education-based inequality in frailty continued throughout old age in both the mixed and joint models. CONCLUSION: Linear mixed models assuming MAR sample attrition provided good estimates of frailty trajectories up until high age. Thus, the validity of existing studies estimating frailty trajectories based on standard linear mixed models seems not threatened by substantial sample attrition.

Responses to textual and pictorial cigarette pack health warnings: findings from an exploratory cross-sectional survey study in Austria.

BACKGROUND: Packaging and labelling tobacco products has emerged as an effective policy to reduce the global health burden of tobacco use. The main purpose of this study was to explore Austrian smokers' and ex-smokers' responses to both the textual and pictorial cigarette pack health warnings (CPHWs) recently implemented. METHODS: We analysed self-reported data (N=500) from an Austrian cross-sectional survey that was conducted after the implementation of the new pictorial CPHWs in 2016. RESULTS: The results showed only weak effects of the CPHWs on the decision to quit or reduce smoking, and the level of impact of the CPHWs remained limited particularly because of smokers denying the ill-effects of tobacco use. CONCLUSIONS: Although the CPHWs seem to have the potential to promote a change in smoking behaviour, the warnings reached only a rather small group of smokers, while the majority of smokers appeared to remain unaffected by this intervention. Public health policies are challenged to increase the salience of CPHWs and to overcome smokers' denial of detrimental health effects.

Impact of migration background on health of children and adolescents in Austria. Results of the Austrian Health Survey 2014.

OBJECTIVE: The present study examines the question as to whether the wellbeing of children and adolescents in Austria and the use of vaccination are influenced by migration background. METHODS: The data was extracted from the Austrian Health Survey 2014 (ATHIS 2014). It contains health-related information of 5,277 children and adolescents aged 0 to 17 years. The analysis was based on logistic regression models. RESULTS: To stem from a migration background had no influence on the assessment of health or the assessment of complaints. Regarding vaccination, the results showed that the children of study participants born in non-EU foreign countries had twice the chance of being vaccinated as the children of Austria-born parents. No difference existed between the children of Austria-born parents and the children of parents born in non-EU countries. CONCLUSIONS: The analysis suggests that children and adolescents with a migration background in Austria are not worse off in terms of their physical wellbeing and vaccination status than children without a migration background. Some thought should, however, be given to the fact that the notion of migration background refers to a heterogenic population. To analyse the risks and chances of children and adolescents from different migrant backgrounds, a more differentiated survey of their migrant background and social situation and a more differentiated survey of health parameters will be required.

Attitudes towards end-of-life decisions in case of long-term care dependency: a survey among the older population in Austria.

BACKGROUND: Research on attitudes towards end-of-life decisions (ELDs) contextually most often refers to the very end of life, that is, to situations of terminally ill patients or severe pain, but it is rarely applied to the broader context of long-term care dependency in old age. METHODS: In a representative survey among older Austrians (50+, n=968), respondents were asked about their approval of assisted suicide and euthanasia (EUT) when requested by an older, severely care-dependent person. The influence of sociodemographics, care-related experiences and expectations, religiosity, trust, locus of control and concerns regarding constrictions of old age on the approval of both these ELDs was assessed through logistic regression analyses. RESULTS: 42% and 34% of the respondents approved assisted suicide and EUT, respectively, in case of care dependency. Non-religious individuals, less trusting respondents and those concerned about constrictions associated with old age were more likely to approve both these ELDs. CONCLUSIONS: Widespread concerns regarding long-term care dependency in old age should be addressed in information campaigns, and public discourse about ELDs should pay more attention to situations of long-term care dependency.

Explaining the impact of poverty on old-age frailty in Europe: material, psychosocial and behavioural factors.

Background: Previous research found poverty to be associated with adverse health outcomes among older adults but the factors that translate low economic resources into poor physical health are not well understood. The goal of this analysis was to assess the impact of material, psychosocial, and behavioural factors as well as education in explaining the poverty-health link. Methods: In total, 28 360 observations from 11 390 community-dwelling respondents (65+) in the Survey of Health, Ageing and Retirement in Europe (2004-13, 10 countries) were analysed. Multilevel growth curve models were used to assess the impact of combined income and asset poverty risk on old-age frailty (frailty index) and associated pathway variables. Results: In total, 61.8% of the variation of poverty risk on frailty level was explained by direct and indirect effects. Results stress the role of material and particularly psychosocial factors such as perceived control and social isolation, whereas the role of health behaviour was negligible. Conclusion: We suggest to strengthen social policy and public health efforts in order to fight poverty and its deleterious health effects from early age on as well as to broaden the scope of interventions with regard to psychosocial factors.

Attitudes towards assisted suicide and euthanasia among care-dependent older adults (50+) in Austria: the role of socio-demographics, religiosity, physical illness, psychological distress, and social isolation.

BACKGROUND: Care-dependency constitutes an important issue with regard to the approval of end-of-life decisions, yet attitudes towards assisted suicide and euthanasia are understudied among care-dependent older adults. We assessed attitudes towards assisted suicide and euthanasia and tested empirical correlates, including socio-demographics, religiosity, physical illness, psychological distress and social isolation. METHODS: A nationwide cross-sectional survey among older care allowance recipients (50+) in private households in Austria was conducted in 2016. In computer-assisted personal interviews, 493 respondents were asked whether or not they approved of the availability of assisted suicide and euthanasia in case of long-term care dependency and whether or not they would consider using assisted suicide or euthanasia for themselves. Multiple logistic regression analysis was used to assess the impact of potential determinants of attitudes towards assisted suicide and euthanasia. RESULTS: About a quarter (24.8-26.0%) of the sampled care-dependent older adults approved of the availability of assisted suicide and euthanasia respectively indicated the will to (hypothetically) make use of assisted suicide or euthanasia. Attitudes towards assisted suicide were most favourable among care-dependent older adults living in urban areas, those who did not trust physicians, those who reported active suicide ideation, and individuals with a strong fear of dying. With regard to euthanasia, living alone, religiosity and fear of dying were the central determinants of acceptance. CONCLUSIONS: Positive attitudes towards and will to (hypothetically) use assisted suicide and euthanasia were expressed by a substantial minority of care-dependent older adults in Austria and are driven by current psychological suffering and fear of the process of dying in the (near) future. Community-based psychosocial care should be expanded to address psychological distress and fears about end-of-life issues among care-dependent older adults.

Educational inequality as a predictor of rising back pain prevalence in Austria-sex differences.

BACKGROUND: Back pain (BP) represents a widespread public health problem in Europe. The morbidity depends on several indicators, which must be investigated to discover risk groups. The examination of trends in socioeconomic developments should ensure a better understanding of the complex link between socioeconomic-status and BP. Therefore, the role of social inequalities for BP has been investigated among Austrian subpopulations over a 24-year period. METHODS: Self-reported data from nationally representative health surveys (1983-2007) were analyzed and adjusted for self-report bias (N=121 486). Absolute changes (ACs) and aetiologic fractions (AF) were calculated to measure trends. To quantify the extent of social inequality, the relative index of inequality was computed based on educational levels. RESULTS: The prevalence of BP nearly doubled between 1983 and 2007. When investigating educational groups, subjects with low educational level were most prevalent. Obese persons generally showed higher rates of BP than non-obese subjects. Continuously rising trends across the different educational groups were more evident in men. The AC was highest in obese men with high education (+32.9%). Education-related inequalities for BP were more evident in men than women. CONCLUSION: Educational level is an important social indicator for BP. A gradient for low to high educational level in the trends of BP prevalence was clearly identified and stable only among men. We presume that the association 'education' and 'physical workload leading to BP' is more relevant for men than for women. The implementation of effective approaches to BP, in combination with target group-specific interventions focusing on educational status, is recommended.

Determinants of acceptance of end-of-life interventions: a comparison between withdrawing life-prolonging treatment and euthanasia in Austria.

BACKGROUND: End-of-life decisions remain a hotly debated issue in many European countries and the acceptance in the general population can act as an important anchor point in these discussions. Previous studies on determinants of the acceptance of end-of-life interventions in the general population have not systematically assessed whether determinants differ between withdrawal of life-prolonging treatment (WLPT) and euthanasia (EUT). METHODS: A large, representative survey of the Austrian adult population conducted in 2014 (n = 1,971) included items on WLPT and EUT. We constructed the following categorical outcome: (1) rejection of both WLPT and EUT, (2) approval of WLPT but rejection of EUT, and (3) approval of both WLPT and EUT. The influence of socio-demographics, personal experiences, and religious and socio-cultural orientations on the three levels of approval were assessed via multinomial logistic regression analysis. RESULTS: Higher education and stronger socio-cultural liberal orientations increased the likelihood of approving both WLPT and EUT; personal experience with end-of-life care increased only the likelihood of approval of WLPT; and religiosity decreased approval of EUT only. CONCLUSION: This study found evidence for both shared (education, liberalism) and different (religiosity, care experiences) determinants for the acceptance of WLPT and EUT.

Short-term dynamics of loneliness and depressive symptoms: Gender differences in older adults.

BACKGROUND: Previous research examining the relationship between loneliness and depressive symptoms often treated these constructs as static traits rather than dynamic states. The current study focused on the short-term, prospective link between loneliness and depressive symptoms, while also analyzing potential gender differences. METHODS: We modeled panel data from seven bi-weekly assessments gathered in the FRequent health Assessment In Later life (FRAIL70+) study. At baseline, the sample size amounted to N = 426 community-dwelling older adults aged 70 years or older in Austria. The relationship between loneliness and depressive symptoms was analyzed using a latent change score modeling framework. RESULTS: As regards depressive symptoms, women showed higher initial levels and more change across the three months than men. Loneliness did not considerably change across time for both sexes. Moreover, greater levels of loneliness at a given point in time were associated with an accelerated increase in depressive symptoms two weeks later in women but not in men. CONCLUSION: Loneliness appeared to be a potential determinant of future increases in depressive symptoms. The varying effects observed between men and women suggest potential gender differences in short-term fluctuations of depressive symptoms and their underlying mechanisms.

Terminal Decline in Physical Function in Older Adults.

BACKGROUND: It is currently unclear whether (and when) physical function exhibits a terminal decline phase, that is, a substantial acceleration of decline in the very last years before death. METHODS: 702 deceased adults aged 70 years and older from the Yale PEP Study provided 4 133 measurements of physical function (Short Physical Performance Battery, SPPB) up to 20 years before death. In addition, continuous gait and chair rise subtest scores (in seconds) were assessed. Generalized mixed regression models with random change points were used to estimate the onset and the steepness of terminal decline in physical function. RESULTS: Decline accelerated in the last years of life in all 3 measures of physical function. The onset of terminal decline occurred 1 year before death for the SPPB, and at 2.5 and 2.6 years before death for chair rise and gait speed test scores, respectively. Terminal declines in physical function were 6-8 times steeper than pre-terminal declines. Relative to those whose condition leading to death was frailty, participants who died from dementia and cancer had an up to 6 months earlier and 3 months later onset of terminal decline in SPPB, respectively. CONCLUSIONS: Terminal decline in physical function among older adults is comparable to the more established terminal decline phenomenon in cognition. Our results provide additional evidence of late-life rapid decline in physical function due to impending death.

Reliability of the Frailty Index Among Community-Dwelling Older Adults.

BACKGROUND: Consistent and reproducible estimates of the underlying true level of frailty are essential for risk stratification and monitoring of health changes. The purpose of this study is to examine the reliability of the frailty index (FI). METHODS: A total of 426 community-dwelling older adults from the FRequent health Assessment In Later life (FRAIL70+) study in Austria were interviewed biweekly up to 7 times. Two versions of the FI, one with 49 deficits (baseline), and another with 44 (follow-up) were created. Internal consistency was assessed using confirmatory factor analysis and coefficient omega. Test-retest reliability was assessed with Pearson correlation coefficients and the intraclass correlation coefficient. Measurement error was assessed with the standard error of measurement, limits of agreement, and smallest detectable change. RESULTS: Participants (64.6% women) were on average 77.2 (±5.4) years old with mean FI49 at a baseline of 0.19 (±0.14). Internal consistency (coefficient omega) was 0.81. Correlations between biweekly FI44 assessments ranged between 0.86 and 0.94 and reliability (intraclass correlation coefficient) was 0.88. The standard error of measurement was 0.05, and the smallest detectable change and upper limits of agreement were 0.13; the latter is larger than previously reported minimal clinically meaningful changes. CONCLUSIONS: Both internal consistency and reliability of the FI were good, that is, the FI differentiates well between community-dwelling older adults, which is an important requirement for risk stratification for both group-level oriented research and patient-level clinical purposes. Measurement error, however, was large, suggesting that individual health deteriorations or improvements, cannot be reliably detected for FI changes smaller than 0.13.