Prevalence and 10‐Year Outcomes of Frailty in Older Adults in Relation to Deficit Accumulation

OBJECTIVES: To evaluate the prevalence and 10‐year outcomes of frailty in older adults in relation to deficit accumulation. DESIGN: Prospective cohort study. SETTING: The National Population Health Survey of Canada, with frailty estimated at baseline (1994/95) and mortality follow‐up to 2004/05. PARTICIPANTS: Community‐dwelling older adults (N=2,740, 60.8% women) aged 65 to 102 from 10 Canadian provinces. During the 10‐year follow‐up, 1,208 died. MEASUREMENTS: Self‐reported health information was used to construct a frailty index (Frailty Index) as a proportion of deficits accumulated in individuals. The main outcome measure was mortality. RESULTS: The prevalence of frailty increased with age in men and women (correlation coefficient=0.955–0.994, P<.001). The Frailty Index estimated that 622 (22.7%, 95% confidence interval (CI)=21.0–24.4%) of the sample was frail. Frailty was more common in women (25.3%, 95% CI=23.2–27.5%) than in men (18.6%, 95% CI=15.9–21.3%). For those aged 85 and older, the Frailty Index identified 39.1% (95% CI=31.3–46.9%) of men as frail, compared with 45.1% (95% CI=39.7–50.5%) of women. Frailty significantly increased the risk of death, with an age‐ and sex‐adjusted hazard ratio for the Frailty Index of 1.57 (95% CI=1.41–1.74). CONCLUSION: The prevalence of frailty increases with age and at any age lessens survival. The Frailty Index approach readily identifies frail people at risk of death, presumably because of its use of multiple health deficits in multidimensional domains.     

Does physical activity protect older persons with frailty and cognitive impairment from excess all-cause mortality?

ObjectivesThe main aim of this study was to examine how physical activity in combination with physical frailty and cognitive impairment affects risk of mortality in older adults.Study DesignA national sample of community-dwelling Taiwanese aged 65 years or older (n=2678) was followed for 5 years.Main outcome measuresFrailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale. The Mini-Mental State Examination was used to assess cognitive impairment. Information on self-reported physical activity was collected at baseline. The study cohort was followed until the date of death or the end of the study period (31 December 2018). Deaths were confirmed by the computerized data files of the National Register of Deaths.ResultsA total of 417 deaths were recorded after 12415.2 person-years of follow-up. After adjustment for other factors, compared with active participants who were physically robust with normal cognition, inactive participants who were with either frail/pre-frail or cognitively impaired had hazard ratios for mortality of 2.65 (95% CI=[1.88-3.74]) and 3.09 (95% CI=[2.08-4.59]), respectively. Inactive participants with coexisting frailty/pre-frailty and cognitive impairment had the highest hazard ratio for mortality of 3.85 (95% CI=[2.73-5.45]). Being active was associated with a mortality reduction of 31%, 38%, and 42% in physically robust participants with normal cognition, those who were frail/pre-frail only, and those with cognitive impairment only, respectively.ConclusionsHaving a physically active life style has beneficial effects on survival in older persons with either frailty/pre-frailty or cognitive impairment.     

Combined effects of frailty status and cognitive impairment on health-related quality of life among community dwelling older adults

ObjectivesThe aim of the present study was to investigate the combined association of frailty/pre-frailty and cognitive impairment with health related quality of life (HRQOL) among community dwelling older adults.MethodsData came from a cross-sectional study of community-dwelling older adults aged 65 years or older, who participated in the 2013 National Health Interview Survey in Taiwan. Frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale proposed by the International Association of Nutrition and Aging. The Mini-Mental State Examination was used to assess cognitive function. HRQOL was measured using the European Quality of Life-5 Dimensions questionnaire (EQ-5D) that assesses three levels of functioning for the dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Poisson regression models were performed to estimate prevalence ratios (PR) and 95 % Confidence Intervals (95 % CI) for health problems in all EQ-5D domains.ResultsIn this study, 11.0 % of participants aged 65 years and older had co-occurring frailty/pre-frailty and cognitive impairment. After adjustment for other factors, compared with participants who were physically robust with normal cognition, participants with co-occurring frailty/pre-frailty and cognitive impairment had PRs of 10.38 (95 % CI 7.56–14.26), 9.66 (95 % CI 6.03–15.48), 9.37 (95 % CI 6.92–12.68), 3.04 (95 % CI 2.53–3.64), and 5.63 (95 % CI 3.83–8.28) for reporting problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, respectively.ConclusionsThere is a high prevalence of co-occurrence of frailty/pre-frailty and cognitive impairment in older adults, and this co-occurrence was strongly associated with self-reported health problems across all EQ-5D domains.     

Frailty prevalence using Frailty Index,associated factors and level of agreement among frailty tools in a cohort of Japanese older adults

Frailty prevalence defined by the deficit accumulation model (Frailty Index) has limited exploration in a Japanese population. The objective of this paper is to investigate the prevalence of frailty by Frailty Index among a cohort of healthy Japanese older adults, define risk factors associated with pre-frailty and frailty status and evaluate Frailty Index's agreement with Frailty Phenotype and Kihon checklist.MethodsData from 673 participants of the 2014 wave of the Nagoya Longitudinal Study - Healthy Elderly were used. Annual assessments include investigation of mood, memory, health status, nutrition, physical performance and oral health. The Frailty Index was compared to Frailty Phenotype and Kihon Checklist, and factors associated to Frailty Index were investigated through univariate and multivariate logistic regression.ResultsFrailty prevalence was 13.5% (n = 91) by Frailty Index, 1.5% (n = 10) by Frailty Phenotype and 4% (n = 27) by Kihon Checklist. Although the correlations between the three scales were moderate to high, the agreement between the scales was poor. In terms of risk factors, age, polypharmacy and physical activity level were associated with being pre-frail and frail. Having a higher waist circumference was associated with being pre-frail, and lower handgrip strength and lower walking speed were associated with being frail.ConclusionsThe Frailty Index showed similar metrics and agreement comparable to findings of previous studies, and was able to identify a higher number of individuals who were pre-frail and frail. Age, polypharmacy, physical activity, waking speed and waist circumference were associated with pre-frailty and frailty by frailty index.     

National prevalence of frailty in the older Japanese population: Findings from a nationally representative survey

BackgroundJapan has the largest aging population in the world, thus, a focus on frailty is important in clinical geriatric practice. Using a nationally representative sample, this study provided national estimates of the prevalence of frailty among community-dwelling older Japanese people. We also examined variations in the prevalence by sociodemographic characteristics, health conditions, and geographical regions.MethodsData came from the National Survey of the Japanese Elderly in 2012. The data were collected using a home visit and face-to-face interviews with trained interviewers. The sample consisted of 2206 adults aged ≥65 years. We used the widely accepted definition of physical frailty phenotype and calculated weighted estimates of the prevalence of frailty.ResultsOverall estimated prevalence was 8.7 % (7.5 %–9.9 %) for frail, 40.8 % (38.7 %–42.9 %) for prefrail, and 50.5 % (48.4 %–52.6 %) for robust. Frailty was more prevalent in older groups, women, and those with lower socioeconomic status, which was measured by education and household income. Frail people tended to have worse health. We also observed a regional variation: frailty prevalence tended to be higher in eastern than western Japan.ConclusionsThis study provides important evidence on the prevalence of frailty in older Japanese people and found substantial disparities by sociodemographic characteristics, health conditions, and geographical regions.     

Interaction between frailty and nutritional status on mortality and long-term hospitalization in older Koreans: A retrospective analysis of data from the 2008 Survey on Health and Welfare Status of the Elderly in Korea

ObjectivesAlthough it is well known that nutritional deficiency influences frailty, and both nutritional status and frailty are closely related to mortality and morbidity in older people, there are no studies concerning this interaction. In this study, we evaluated whether the interaction of frailty and nutritional deficiency is additive and/or multiplicative.MethodsWe analyzed data from 8907 individuals (≥65 years old) who took part in the 2008 Survey on Health and Welfare Status of the Elderly in Korea. We used the Cardiovascular Health Study (CHS) frailty index and the DETERMINE checklist for assessment of frailty and nutritional status, respectively. We conducted Cox regression analysis for the outcomes ‘mortality’ and ‘mortality and long-term hospitalization risk.’ResultsIn the multivariate analysis for main effect model on ‘mortality’, the hazard ratios (HRs) of frail, high nutritional risk were 2.63 (95% CI 1.76–3.93), 1.04 (95% CI 0.78–1.38), respectively, and on ‘mortality and long-term hospitalization risk’ those values were 2.56 (95% CI 1.72–3.80), 1.18 (95% CI 0.88–1.58), respectively. In interaction effect model, multiplicative interaction existed between frailty and nutritional status (p < 0.001). Participants with frail X high nutritional risk had much higher HRs for ‘mortality’ (4.14, 95% CI 2.43–7.07) and ‘mortality and long-term hospitalization risk’ (4.60, 95% CI 2.74–7.72).ConclusionWe found that frailty and nutritional status have a multiplicative effect on adverse outcomes in community-dwelling older adults. Nutritional status assessment in older people is important because nutritional supplementation can potentially improve both nutritional status and frailty.     

Hemoglobin,Frailty, and Long-term Cardiovascular Events in Community-Dwelling Older Men Aged ≥ 70 Years

BackgroundAnemia is associated with increased risk of all-cause mortality in older populations. However, the relationship between hemoglobin and major adverse cardiovascular events (MACE), and whether this is modulated by frailty, is unclear.MethodsCHAMP (Concord Health and Ageing in Men Project) is a prospective study of community-dwelling men aged ≥ 70 years. The relationship between hemoglobin and 7-year MACE was analysed by means of Cox regression. The Youden index was used to determine the optimal hemoglobin cutoff point in predicting MACE. Frailty was assessed with the use of the Fried criteria.ResultsThe cohort comprised 1604 men (mean ± SD age 76.9 ± 5.5 years). Decreasing hemoglobin was associated with increased comorbidity, frailty, and MACE (P < 0.001), with 140 g/L the optimal cutoff point for predicting MACE. Hemoglobin, age, and frailty independently predicted MACE (all P < 0.001). Each 10 g/L decrement in hemoglobin level was associated with increased risk of MACE (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.06-1.20; P < 0.001), all-cause mortality (HR 1.20, 95% CI 1.12-1.29; P < 0.001), cardiovascular mortality (HR 1.07, 95% CI 1.01-1.14; P = 0.025), myocardial infarction (HR 1.17, 95% CI 1.09-1.25; P < 0.001), and heart failure (HR 1.17, 95% CI 1.09-1.25; P < 0.001). When stratified into hemoglobin quintiles, men in the lowest 2 quintiles (Hb 133-140 g/L and < 132g/L, respectively) were at increased risk of MACE, cardiovascular mortality, myocardial infarction, and heart failure (all P < 0.05). This relationship for MACE was independent from frailty status, with the test for interaction between frailty and hemoglobin not reaching significance (P = 0.24).ConclusionsLow hemoglobin was associated with increased MACE in community-dwelling older men independently from frailty. A hemoglobin cutoff point of 140 g/L, a level that is above contemporary definitions of anemia, predicted long-term MACE.     

Discrimination ability of comorbidity,frailty, and subjective health to predict mortality in community-dwelling older people: Population based prospective cohort study

ObjectiveTo investigate the added value of comorbidity, frailty, and subjective health to mortality predictions in community-dwelling older people and whether it changes with increasing age.Participants36,751 community-dwelling subjects aged 50–100 from the longitudinal Survey of Health, Ageing, and Retirement in Europe.MethodsMortality risk associated with Comorbidity Index, Frailty Index, Frailty Phenotype, and subjective health was analysed using Cox regression. The extent to which health indicators modified individual mortality risk predictions was examined and the added ability to discriminate mortality risks was assessed.Main outcome measuresThree-year mortality risks, hazard ratios, change in individual mortality risks, three-year area under the receiver operating characteristic curve (AUC).ResultsThree-year mortality risks increased 41-folds within an age span of 50 years. Hazard ratios per change in health indicator became less significant with increasing age (p-value < 0·001). AUC for three-year mortality prediction based on age and sex was 76·9% (95% CI 75·5% to 78·3%). Information on health indicators modified individual three-year mortality risk predictions up to 30%, both upwards and downwards, each adding < 2% discriminative power. The added discrimination ability of all health indicators gradually declined from an extra 4% at age 50–59 to < 1% in the oldest old. Trends were similar for one-year mortality and not different between sexes, levels of education, and household income.ConclusionCalendar age encompasses most of the discrimination ability to predict mortality. The added value of comorbidity, frailty, and subjective health to mortality predictions decreases with increasing age.     

The relationship between atrial fibrillation and frailty in community-dwelling older adults

Objectives(1) To compare the frailty status between community-dwelling older adults with and without atrial fibrillation (AF) in Taiwan and (2) to test the hypothesis that AF is associated with frailty in community-dwelling older adults.MethodsWe conducted a cross-sectional study in several communities in Taipei. AF was confirmed by electrocardiogram recordings or medical diagnosis. Frailty status was assessed using both the Cardiovascular Health Study (CHS) frailty phenotype and Edmonton Frail Scale (EFS).ResultsA total of 207 community-dwelling older adults voluntarily participated in this study, and 38 had AF. There was a significantly higher percentage of frailer (prefrail and frailty) older adults in the AF group (69 % vs. 36 %, p < 0.001) according to CHS phenotype, but no significant difference was detected by EFS criteria (92 % vs. 92 %, p = 0.966). The AF group showed significantly lower grip strength in men (26.8 ± 8.3 vs. 33.0 ± 6.9 kg, p = 0.006), walking speed (1.1 ± 0.3 vs. 1.2 ± 0.3 m/s, p = 0.003), and Timed Up and Go performance (8.8 ± 2.4 vs. 7.0 ± 1.9 s, p < 0.001) than the control group. The multiple logistic regression model showed that AF was an independent factor associated with frailer community-dwelling older adults after adjusted for covariates (odds ratio, 3.02; 95 % confidence interval, 1.32–6.89, p = 0.009).ConclusionCommunity-dwelling older adults with AF showed a significantly higher percentage of frailer individuals and lower physical function than those without AF. Furthermore, AF was an independent predictor of frailer community-dwelling older adults.     

Sex differences in the prevalence and prognostic impact of physical frailty and sarcopenia among older patients with heart failure

Background and aimsFrailty and sarcopenia are common and confer poor prognosis in elderly patients with heart failure; however, gender differences in its prevalence or prognostic impact remain unclear.Methods and resultsWe included 1332 patients aged ≥65 years, who were hospitalized for heart failure. Frailty and sarcopenia were defined using the Fried phenotype model and Asian Working Group for Sarcopenia criteria, respectively. Gender differences in frailty and sarcopenia, and interactions between sex and prognostic impact of frailty/sarcopenia on 1-year mortality were evaluated. Overall, 53.9% men and 61.0% women and 23.7% men and 14.0% women had frailty and sarcopenia, respectively. Although sarcopenia was more prevalent in men, no gender differences existed in frailty after adjusting for age. On Kaplan–Meier analysis, frailty and sarcopenia were significantly associated with 1-year mortality in both sexes. On Cox proportional hazard analysis, frailty was associated with 1-year mortality only in men, after adjusting for confounding factors (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.19–3.16; P = 0.008 for men; HR, 1.63; 95% CI, 0.84–3.13; P = 0.147 for women); sarcopenia was an independent prognostic factor in both sexes (HR, 1.93; 95% CI, 1.13–3.31; P = 0.017 for men; HR, 3.18; 95% CI, 1.59–5.64; P = 0.001 for women). There were no interactions between sex and prognostic impact of frailty/sarcopenia (P = 0.806 for frailty; P = 0.254 for sarcopenia).ConclusionsFrailty and sarcopenia negatively affect older patients with heart failure from both sexes.Clinical trialsThis study was registered at the University Hospital Information Network (UMIN-CTR, unique identifier: UMIN000023929) before the first patient was enrolled.     

The impact of multidimensional frailty on dependency in activities of daily living and the moderating effects of protective factors

BackgroundDependency in activities of daily living (ADL) might be caused by multidimensional frailty. Prevention is important as ADL dependency might threaten the ability to age in place. Therefore, this study aimed to assess whether protective factors, derived from a systematic literature review, moderate the relationship between multidimensional frailty and ADL dependency, and whether this differs across age groups.MethodsA longitudinal study with a follow–up after 24 months was conducted among 1027 community-dwelling people aged ≥65 years. Multidimensional frailty was measured with the Tilburg Frailty Indicator, and ADL dependency with the ADL subscale from the Groningen Activity Restriction Scale. Other measures included socio-demographic characteristics and seven protective factors against ADL dependency, such as physical activity and non-smoking. Logistic regression analyses with interaction terms were conducted.ResultsFrail older people had a twofold risk of developing ADL dependency after 24 months in comparison to non-frail older people (OR = 2.12, 95% CI = 1.45–3.00). The selected protective factors against ADL dependency did not significantly moderate this relationship. Nonetheless, higher levels of physical activity decreased the risk of becoming ADL dependent (OR = 0.67, 95% CI = 0.46–0.98), as well as having sufficient financial resources (OR = 0.49, 95% CI = 0.35–0.71).ConclusionMultidimensional frail older people have a higher risk of developing ADL dependency. The studied protective factors against ADL dependency did not significantly moderate this relationship.     

Frailty and Bleeding in Older Adults Undergoing TAVR or SAVR: Insights From the FRAILTY-AVR Study

ObjectivesThe aim of this study was to examine the value of frailty to predict in-hospital major bleeding and determine its impact on mid-term mortality following transcatheter (TAVR) or surgical (SAVR) aortic valve replacement.BackgroundBleeding complications are harbingers of mortality and major morbidity in patients undergoing TAVR or SAVR. Despite the high prevalence of frailty in this population, little is known about its effects on bleeding risk.MethodsA post hoc analysis was performed of the multinational FRAILTY-AVR (Frailty Aortic Valve Replacement) cohort study, which prospectively enrolled older adults ≥70 years of age undergoing TAVR or SAVR. Trained researchers assessed frailty using a questionnaire and physical performance battery pre-procedure and ascertained clinical data from the electronic health record. The primary endpoint was major or life-threatening bleeding during the index hospitalization, and the secondary endpoint was units of packed red blood cells transfused.ResultsThe cohort consisted of 1,195 patients with a mean age of 81.3 ± 6.0 years. The incidence of life-threatening bleeding, major bleeding with a clinically apparent source, and major bleeding without a clinically apparent source was, respectively, 3%, 6%, and 9% in the TAVR group and 8%, 10%, and 31% in the SAVR group. Frailty measured using the Essential Frailty Toolset was an independent predictor of major bleeding and packed red blood cell transfusions in both groups. Major bleeding was associated with a 3-fold increase in 1-year mortality following TAVR (odds ratio: 3.40; 95% confidence interval: 2.22 to 5.21) and SAVR (odds ratio: 2.79; 95% confidence interval: 1.25 to 6.21).ConclusionsFrailty is associated with post-procedural major bleeding in older adults undergoing TAVR and SAVR, which is in turn associated with a higher risk for mid-term mortality.     

Respiratory muscle strength for discriminating frailty in community-dwelling elderly: a cross-sectional study

ObjectivesTo compare obtained and predicted inspiratory and expiratory muscle strength between frail, pre-frail, and non-frail older people; to examine the association between inspiratory and expiratory muscle strength and frailty in older people; and to determine cut-off points for inspiratory and expiratory muscle strength for discriminating frailty in older people.MethodsA cross-sectional study was conducted with 379 community-dwelling older adults. Frailty was assessed using Fried’s phenotype, while inspiratory and expiratory muscle strength were measured with maximum inspiratory and maximum expiratory pressures. Inferential analyses were performed using paired Student t-tests, one-way analysis of variance (ANOVA) tests, and a multinomial logistic regression model. ROC curves were constructed to establish cut-off points of maximum inspiratory and expiratory pressures for discriminating frailty and pre-frailty.ResultsFrail and pre-frail participants presented significantly lower mean inspiratory and expiratory pressures compared to non-frail participants; values were significantly lower than predicted. Inspiratory and expiratory muscle strength were inversely associated with frailty and pre-frailty. Cut-off points ≥-50cmH₂O and ≤60cmH₂O for maximum inspiratory and expiratory pressures, respectively, were established as optimal discriminators of frailty. The cut-off point ≤65cmH₂O for maximum expiratory pressure was established as a discriminant for the presence of pre-frailty.ConclusionsInspiratory and expiratory muscle strength were lower in frail than in pre-frail older adults, and lower in pre-frail than in non-frail peers. Frailty and pre-frailty were inversely associated with inspiratory and expiratory muscle strength. Cut-off points for inspiratory and expiratory muscle strength may be useful in clinical practice for discriminating frailty and pre-frailty in older adults.     

Psychometric analysis of the Arabic (Saudi) Tilburg Frailty Indicator among Saudi community-dwelling older adults

BackgroundFrailty is a common geriatric syndrome that can be screened using validated questionnaires. A commonly used assessment is the Tilburg Frailty Indicator (TFI), containing fifteen self-reported questions about components of frailty, with scores ranging from zero to fifteen (higher scores representing increased frailty and a cutoff score of greater than five used to diagnose frailty). Despite its widespread use, the TFI is not commonly used in Arabic-speaking countries, and there is an overall lack of Arabic-translated questionnaires to adequately detect and measure frailty for older adults in Saudi Arabia.ObjectivesTo translate and cross-culturally adapt the Tilburg Frailty Indicator (TFI) specifically for use with the Saudi population, and to examine reliability and construct validity among adults in senior-living facilities in Saudi Arabia.MethodsA total of 84 community-dwelling older adults were enrolled (mean age = 72 ± 4.7 years). The translation and cross-cultural adaptation of the TFI from English to Arabic was performed using standardized guidelines. Test–retest reliability and internal consistency were examined in two visits, spaced one-week apart. Construct validity of the TFI against other measurements related to frailty was examined. The physical domain for TFI was validated against the Short Physical Performance Battery (SPPB), the timed Up and Go Test (TUG), and gait speed (as part of the SPPB). The psychological domains were validated against the Patient Health Questionnaire, and the social domains were validated against the social domain scores from the WHOQOL-BREF.ResultsThe internal consistency of the TFI with the overall KR-20 was 0.70. For the domain scores KR-20 was 0.68 for the physical, 0.57 for the psychological, and 0.42 for the social. The KR-20 after deletion of each item correlations ranged from 0.66 to 0.72. For the test-retest reliability with one-week interval, the ICC was 0.86 (95 % CI = 0.67–0.94). The Arabic TFI showed statistically significant association with other measurements related to frailty.ConclusionThis study found that the translated Arabic (Saudi) TFI is a valid and reliable instrument in assessing the frailty among Saudi community-dwelling older adults. Our results suggest that the use of this Arabic-translated TFI for clinical screening of frailty in any primary health setting may aid continued understanding for the validity of this instrument and help provide a quantitative diagnostic tool for the prevention and treatment of frailty.     

Bidirectional relationship between insomnia and frailty in older adults: A 2-year longitudinal study

BackgroundMost previous studies that examined the association of insomnia with frailty used cross-sectional designs. The temporal relationship between these factors is therefore largely unknown. This study aimed to examine the bidirectional relationship between insomnia and frailty by sex.MethodsA 2-year longitudinal study involving all community-dwelling older adults living in a rural area in Japan (n = 3844). Validated measures of insomnia and frailty were employed. Insomnia was assessed using the Athens insomnia scale, and frailty using the Kihon checklist. We performed a cross-lagged panel model, adjusted for age, sex, years of education, employment status, self-rated health, complications (hypertension, diabetes, stroke, or osteoarthritis), BMI, physical activity, alcohol consumption, and smoking status, and assessed differences by sex.ResultsPoor sleep predicted the onset and worsening of frailty during follow up (standardized coefficient [95% confidence interval]: 0.076 [0.045, 0.107]). Frailty also predicted severe insomnia symptoms (0.074 [0.044, 0.104]). However, the temporal association between these conditions varied by sex. In older men, the effect of frailty on insomnia was stronger than that of insomnia on frailty. However, in women, the impact of insomnia on frailty was stronger than that of frailty on insomnia.ConclusionsThe primary potential cause of the association between insomnia and frailty may vary by sex, being frailty in men and insomnia in women. Sex-specific interventions to improve sleep quality and duration, and maintain functional abilities in daily life may contribute to the prevention and management of both frailty and insomnia in older adults.     

Frailty in Chinese older adults with hypertension: Prevalence,associated factors,and prediction for long‐term mortality

Hypertension and frailty are associated and often coexist in older adults. Few studies have examined the association between hypertension and frailty in Chinese population. We explored the prevalence of and the factors associated with frailty as well as whether frailty could identify patients at risk of adverse outcomes among older adults with hypertension. Data were from the Beijing Longitudinal Study of Aging. A total of 1111 hypertensive participants aged ≥60 years old who completed the comprehensive geriatrics assessment were included. All participants were followed up for 8 years. The total number of deaths was 604. Frailty was assessed by the 68‐item frailty index. Stepwise forward logistic regression was used to explore the association between the associated factors and frailty in hypertensive participants. The prediction for mortality was assessed using the adjusted Cox proportional hazards model. Two hundred and eighteen older adults were determined as frail (prevalence rate: 19.6%). Frail older adults with hypertension had worse physical performance, worse psychological, and social function, as well as worse lifestyle habits, compared to nonfrail older adults with hypertension. Chair stand test failure, balance test failure, fracture, disability, depression, and physical frailty measured with modified frailty phenotype were independently associated with frailty. Frailty was associated with a higher 8‐year mortality, hazard ratio (HR) = 3.40, adjusted for age and sex, HR = 2.61. Frailty is associated with poorer physical function and higher mortality in community‐dwelling hypertensive older adults in China. These findings emphasize the importance and need for frailty intervention and prevention in older adults with hypertension.     

Neighborhood Deprivation, Individual Socioeconomic Status, and Frailty in Older Adults

OBJECTIVES: To assess how individual socioeconomic status and neighborhood deprivation affect frailty.
DESIGN: Nationally representative population-based study, the English Longitudinal Study of Aging (ELSA), analyzed cross-sectionally.
PARTICIPANTS: Four thousand eight hundred eighteen individuals aged 65 and older.
MEASUREMENTS: Outcome was a frailty index (FI), based on 58 potential deficits, with a theoretical range from 0 to 1; exposures were individual wealth and neighborhood deprivation (lack of local resources, financial and otherwise), based on a set of standard indicators.
RESULTS: The FI score varied independently according to wealth and neighborhood deprivation. The mean FI score for an individual in the highest 20% of wealth and least deprived 20% of neighborhoods was 0.09 (95% confidence interval (CI)=0.09–0.09) and for an individual in the lowest 20% of wealth and most deprived 20% of neighborhoods was 0.17 (95% CI=0.16–0.17).
CONCLUSION: Frailty in older adults is independently associated with individual and neighborhood socioeconomic factors. Older adults who are poor and live in deprived neighborhoods are most vulnerable. Policies and interventions intended to prevent or reduce frailty must take into account individual circumstances and the broader social settings in which individuals are located.     

Clinical implication of frailty assessment in older patients with atrial fibrillation

BackgroundWe aimed to show the frailty status in older AF patients, and to find the association between frailty and the scores of CHA₂DS₂-VASc and HAS-BLED. Ultimately, we sought to investigate the impact of frailty on cardiovascular and all-cause mortality in older AF patients.MethodsWe retrospectively evaluated 365 patients (≥65 years old) with AF, who underwent comprehensive geriatric assessment (CGA) between 2007 and 2014 in a single tertiary hospital. The CHA₂DS₂-VASc and HAS-BLED scores were calculated based on the electronic medical records and the frailty index was computed from the CGA data. The primary outcomes were cardiovascular and all-cause mortality.ResultsFrailty status was positively associated with the CHA₂DS₂-VASc score (P < 0.001) and the HAS-BLED score (P = 0.01). Patients with high CHA₂DS₂-VASc and HAS-BLED scores were more likely to be treated with anticoagulants rather than antiplatelet agents. However, frailty status was not associated with antithrombotic therapy. During the follow-up period (median [interquartile range], 22.9 [8.4–42.2] months), 141 patients (38.6%) died, of which 48 were due to cardiovascular events. CHA₂DS₂-VASc score could predict cardiovascular mortality, but not all-cause mortality. In contrast, frailty status was the independent predictor for both cardiovascular and all-cause mortality after adjusting for possible confounders (hazard ratio for all-cause mortality, 4.549; 95% CI, 2.756–7.509; P < 0.001).ConclusionFrailty assessment can be used to predict mortality in older AF patients, and provides additional prognostic value, along with the CHA₂DS₂-VASc and HAS-BLED scores.     

Low serum micronutrient concentrations predict frailty among older women living in the community

BACKGROUND: Micronutrient deficiencies are common among older adults. We hypothesized that low serum micronutrient concentrations were predictive of frailty among older disabled women living in the community. METHODS: We studied 766 women, aged 65 and older, from the Women's Health and Aging Study I, a population-based study of moderately to severely disabled community-dwelling women in Baltimore, Maryland. Serum vitamins A, D, E, B(6), and B(12), carotenoids, folate, zinc, and selenium were measured at baseline. Frailty status was determined at baseline and during annual visits for 3 years of follow-up. RESULTS: At baseline, 250 women were frail and 516 women were not frail. Of 463 nonfrail women who had at least one follow-up visit, 205 (31.9%) became frail, with an overall incidence rate of 19.1 per 100 person-years. Compared with women in the upper three quartiles, women in the lowest quartile of serum carotenoids (hazard ratio [HR] 1.39; 95% confidence interval [CI], 1.01-1.92), alpha-tocopherol (HR 1.39; 95% CI, 1.02-1.92), and 25-hydroxyvitamin D (HR 1.34; 95% CI, 0.94-1.90) had an increased risk of becoming frail. The number of nutritional deficiencies (HR 1.10; 95% CI, 1.01-1.20) was associated with an increased risk of becoming frail, after adjusting for age, smoking status, and chronic pulmonary disease. Adjusting for potential confounders, we found that women in the lowest quartile of serum carotenoids had a higher risk of becoming frail (HR 1.54; 95% CI, 1.11-2.13). CONCLUSIONS: Low serum micronutrient concentrations are an independent risk factor for frailty among disabled older women, and the risk of frailty increases with the number of micronutrient deficiencies.     

Oral Frailty Index-8 in the risk assessment of new-onset oral frailty and functional disability among community-dwelling older adults

BackgroundOral frailty is associated with the loss of oral function and increased care needs. We have previously developed an Oral Frailty Index (OFI-8) to identify older adults at risk of oral frailty. Herein, we aimed to examine whether OFI-8 scores are indicative of oral frailty or functional disability risk in community-dwelling older adults.MethodsA total of 2,011 individuals (51% women; mean age, 73.0 ± 5.5 years) participated in the 2012 baseline survey (last follow-up wave 2018). Oral frailty was assessed at each time point, based on tooth status, oral function, and other subjective measures. Functional disability was defined as long-term care certification granted during 2012–2019. The OFI-8 items were assessed at baseline.ResultsThe prevalence and incidence rates of oral frailty at baseline and 6 years were 16% and 24%, respectively. The area under the receiver operating characteristic curve of OFI-8 was 0.88 with 95% confidence interval of 0.86–0.90 for oral frailty. The OFI-8 score of ≥4 points maximized the sum of sensitivity and specificity values. The corresponding positive rate, sensitivity, specificity, positive, and negative predictive values were 30%, 80%, 80%, 43%, and 95%, respectively, for baseline oral frailty. A 1-point increase in the OFI-8 score corresponded to a 1.3-fold increase in the risk of new-onset oral frailty and 1.1-fold increase in the risk of disability.ConclusionsOFI-8 may help identify individuals at risk of oral frailty and functional disability. It may also increase the awareness of oral care and facilitate its uptake.