Transitions in Frailty and 4-Year Mortality Risk in Taiwan Longitudinal Study on Aging

ObjectivesTo explore the associations of (1) the frailty phenotype or frailty index transition with cause-specific mortality, and (2) different combinations of transition in frailty phenotype and frailty index with all-cause mortality.DesignRetrospective cohort study.Setting and ParticipantsData from 3529 respondents aged >50 years who completed the 1999 and 2003 surveys of the Taiwan Longitudinal Study on Aging were analyzed.MethodsCox regression and subdistribution hazard models were constructed to investigate frailty phenotype or frailty index transitions (by categories of frailty phenotype, absolute and percentage changes in frailty index, and combined categories of the 2 measurements) and subsequent 4-year all-cause and cause-specific mortality, respectively.ResultsAmong the frailty phenotype transition groups, the improved frailty group had overall mortality risk comparable to that of the maintained robustness/prefrailty group [hazard ratio (HR): 0.9; 95% CI: 0.7–1.2] and lower risk of mortality due to organ failure (HR: 0.4; 95% CI: 0.2–0.8; P = .015), whereas the worsened frailty group had the highest risk of all-cause mortality and death from infection, malignancy, cardiometabolic/cerebrovascular diseases, and other causes (HR: 1.8–3.7; all P < .03). The rapidly increased frailty index group had significantly higher all-cause and every cause-specific mortality than the decreased frailty index group (HR: 1.8–7.7; all P < .05). When frailty phenotype and frailty index transition groups were combined, participants with worsened frailty/rapidly increased frailty index had increased risk under the same frailty index/frailty phenotype transition condition, particularly for large changes in each factor (HR: 1.5–2.2; P < .01 for worsened frailty; 1.7–4.5, P < .03 for rapidly increased frailty index).Conclusions and ImplicationsWe found that considering both frailty phenotype and frailty index provided best mortality prediction. These associations were independent of baseline frailty status and comorbidities. Nevertheless, even capturing transitions in frailty phenotype or frailty index only can provide good mortality prediction, which supported adopting these approaches in different clinical settings.     

Frailty Predicts New and Persistent Depressive Symptoms Among Community-Dwelling Older Adults: Findings From Singapore Longitudinal Aging Study

ObjectiveThis study aimed to examine the cross-sectional and longitudinal relationships between physical frailty at baseline and depressive symptoms at baseline and at follow-up.DesignFour-year prospective study.SettingCommunities in the South East Region of Singapore.ParticipantsWe analyzed data of 1827 older Chinese adults aged 55 and above in the Singapore Longitudinal Aging Study-I.MeasurementsThe frailty phenotype (based on Fried criteria) was determined at baseline, depressive symptoms (Geriatric Depression Scale ≥5) at baseline and follow-ups at 2 and 4 years.ResultsThe mean age of the population was 65.9 (standard deviation 7.26). At baseline, 11.4% (n = 209) had depressive symptoms, 32.4% (n = 591) were prefrail and 2.5% (n = 46) were frail. In cross-sectional analysis of baseline data, the adjusted odds ratios (OR)s and 95% confidence intervals controlling for demographic, comorbidities, and other confounders were 1.69 (1.23–2.33) for prefrailty and 2.36 (1.08–5.15) for frailty, (P for linear trend <.001). In longitudinal data analyses, prospective associations among all participants were: prefrail: OR = 1.86 (1.08–3.20); frail: OR = 3.09 (1.12–8.50); (P for linear trend = .009). Among participants free of depressive symptoms at baseline, similar prospective associations were found: prefrail OR = 2.26 (1.12–4.57); frail: OR = 3.75 (1.07–13.16); (P for linear trend = .009).ConclusionThese data support a significant role of frailty as a predictor of depression in a relatively younger old Chinese population. Further observational and interventional studies should explore short-term dynamic and bidirectional associations and the effects of frailty reversal on depression risk.     

Nutritional Status and Frailty in Community-Dwelling Older Korean Adults: The Korean Frailty and Aging Cohort Study

Objectives

To examine the association between nutritional status and frailty in older adults.

Design

Cross-sectional study.

Setting

Community-dwelling older adults were recruited from 10 study sites in South Korea.

Participants

1473 volunteers aged 70–84 years without severe cognitive impairment and who participated in the Korean Frailty and Aging Cohort Study (KFACS) conducted in 2016.

Measurements

Nutritional status was measured using the Mini Nutritional Assessment Short Form (MNA-SF). Frailty was assessed with the Fried’s frailty index. The relationship between nutritional status and frailty was examined using the multinomial regression analysis, adjusting for covariates.

Results

Of the respondents 14.3% had poor nutrition (0.8% with malnutrition, 13.5% at risk of malnutrition). There were 10.7% who were frail, with 48.5% being prefrail, and 40.8% robust. Poor nutrition was related to a significantly increased risk of being prefrail (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.09–2.32) and frail (OR: 3.30, 95% CI: 1.96–5.54).

Conclusion

Poor nutritional status is strongly associated with frailty in older adults. More research to understand the interdependency between nutritional status and frailty may lead to better management of the two geriatric conditions.

     

Alcohol Consumption and Risk of Incident Frailty: The English Longitudinal Study of Aging

BackgroundAlcohol consumption is a common modifiable lifestyle factor. Alcohol may be a risk factor for frailty, however, there is limited evidence in the literature.ObjectiveThe objectives of this study were to examine the association of alcohol consumption with the risk of incident frailty.MethodsThis is a prospective panel study of 2544 community-dwelling people aged 60 years and older in England. Frailty status defined by frailty phenotype criteria was measured at baseline and 4 years later. Participants free of frailty at baseline were divided into 5 groups based on quantity of self-reported alcohol consumption per week with cut-points at 0, 7, 14, and 21 UK units per week. Adjusted odds ratios (OR) were calculated for incident frailty according to the alcohol consumption using logistic regression models.ResultsCompared with the low consumption group (>0 and ≤7 units per week), incident frailty risk over 4 years was significantly higher among nondrinkers [OR 1.71, 95% confidence interval (CI) 1.12‒2.60, P value = .01], after controlling for sociodemographic confounders. In a supplementary analysis this became nonsignificant after further adjustment for baseline health status. Heavy drinkers (>21 units per week) had a significantly lower incident frailty risk (unadjusted OR 0.45, 95% CI 0.27‒0.75, P < .01), which became nonsignificant on adjustment for sociodemographic factors (OR 0.64, 95% CI 0.37‒1.13, P = .12).Conclusions/ImplicationsWe found that nondrinkers were more likely than those with low alcohol consumption to develop frailty, but this appeared to be explained by poorer baseline health status. No evidence was found for an association between high levels of alcohol consumption and becoming frail. Future studies with information on life-course history of alcohol use, especially for those classified as nondrinkers in old age, are warranted.     

Reversible Cognitive Frailty,Dementia, and All-Cause Mortality. The Italian Longitudinal Study on Aging

Objectives

Cognitive frailty, a condition describing the simultaneous presence of physical frailty and mild cognitive impairment, has been recently defined by an international consensus group. We estimated the predictive role of a “reversible” cognitive frailty model on incident dementia, its subtypes, and all-cause mortality in nondemented older individuals. We verified if vascular risk factors or depressive symptoms could modify this predictive role.

Inequalities in Frailty Among Older Turkish and Moroccan Immigrants and Native Dutch: Data from the Longitudinal Aging Study Amsterdam

Very few studies have investigated frailty among older immigrants in Europe. The aim of the current study was to investigate inequalities in frailty in young-olds related to gender, educational level and country of origin, as well as intersections between these characteristics. Cross-sectional data were used from older Turkish and Moroccan immigrants (n?=?466) and native Dutch (n?=?1,020), all aged 55–65 years and participating in the Longitudinal Aging Study Amsterdam. Frailty was assessed with a 30-item frailty index, based on the deficit accumulation approach. Frailty was higher among women, lower educated, and people with a migration background. Of all groups considered, frailty levels were the highest among Turkish immigrants. No statistically significant interaction effects between gender, educational level and country of origin were found. When targeting frailty interventions, special attention should be devoted to older immigrants, as they are the most vulnerable group with the highest frailty levels.

     

Dietary Patterns and Frailty in Older Korean Adults: Results from the Korean Frailty and Aging Cohort Study

There are few studies on dietary patterns and frailty in Asians, and the results are controversial. Therefore, this study examined the association between dietary patterns and frailty in older Korean adults using the Korean Frailty and Aging Cohort Study (KFACS). The sample consisted of 511 subjects, aged 70–84 years, community-dwelling older people from the KFACS. Dietary data were obtained from the baseline study (2016–2017) using two nonconsecutive 24-h dietary recalls, and dietary patterns were extracted using reduced rank regression. Frailty was measured by a modified version of the Fried Frailty Phenotype (FFP) in both the baseline (2016) and the first follow-up study (2018). A logistic regression analysis was used to examine the association between dietary patterns and frailty status in 2018. The “meat, fish, and vegetables” pattern was inversely associated with pre-frailty (OR = 0.41, 95% CI = 0.21–0.81, p for trend = 0.009) and exhaustion (OR = 0.41, 95% CI = 0.20–0.85, p for trend = 0.020). The “milk” pattern was not significantly associated with frailty status or the FFP components. In conclusion, a dietary pattern with a high consumption of meat, fish, and vegetables was associated with a lower likelihood of pre-frailty.     

Flavonoid intakes in the Baltimore Longitudinal Study of Aging

Major sources of flavonoids were identified, and mean intakes over several decades were reported, among 1638 participants (mean age 62.1 ± 16.0 y), of the Baltimore Longitudinal Study of Aging (BLSA). Dietary data were collected using 7-d diet records during three time periods (1980s, 1990s and 2000-present), and the USDA flavonoid, proanthocyanidin and isoflavone databases were used to estimate dietary flavonoid intakes. Dietary intake data were divided according to decade of visit. Foods were matched with appropriate foods in the USDA databases. Mixed dishes were disaggregated to individual foods and a similar procedure was followed. Total flavonoids and five sub-classes of flavonoids, including flavonols, flavones, flavanones, flavan-3-ols and anthocyanidins, were computed by summing appropriate compounds. The median intakes of flavonoids and the contributions of various foods to intakes were calculated by decade. Age and sex adjusted mean (SE) daily intakes of flavonoids increased from 250 (7.4) in the 1980s to 280 (9.9) mg in the 2000s. Top contributors of flavonoids were tea, apple/pear (and juices), citrus fruits (and juices), peaches, plums, grapes, nectarines (and juices) and chocolate. The data show an increase in the consumption of flavonoids over the three decades, which appears to be related to intake of fruit.     

Frailty and Malnutrition: Related and Distinct Syndrome Prevalence and Association among Community-Dwelling Older Adults: Singapore Longitudinal Ageing Studies

Objective

The association between frailty and malnutrition is widely noted, but the common and distinct aspects of this relationship are not well understood. We investigated the prevalence of prefrailty/frailty and malnutrition/nutritional risk; their overlapping prevalence; compared their sociodemographic, physical, and mental health risk factors; and assessed their association, independently of other risk factors.

Relationship Between Sarcopenia and Frailty in the Toledo Study of Healthy Aging: A Population Based Cross-Sectional Study

Introduction

Frailty and sarcopenia are correlates of musculoskeletal aging that represent a state of vulnerability increasing the risk of negative health outcomes. Standardized definitions are lacking for both, and sometimes both concepts are used interchangeably. However, no large study has assessed the coexistence of these 2 entities in a cohort of older community-dwelling people.

Translating Frailty Research Into Clinical Practice: Insights From the Successful Aging and Frailty Evaluation Clinic

Aging researchers have been studying frailty for decades. Experts agree that frailty is a medical syndrome marked by reduced physiologic function, which increases the risk of vulnerability and short-term mortality, particularly in the face of a stressor. Frailty has been shown to predict poor outcomes including falls, disability, major morbidity following surgery, and mortality among older adults. Despite hundreds of papers identifying frailty as a useful marker of risk, its translation into clinical practice has lagged. The Successful Aging and Frailty Evaluation (SAFE) clinic was established in 2011 specifically to implement routine and structured frailty assessment and management in a variety of referred patients. Now, more than 7 years after its inception, we offer our “in the trenches” clinical perspective on logistical challenges, the clinical utility of the frailty assessment, and future frailty needs and targets to help further the frailty translation research efforts.     

Transitions in Frailty States Among Community-Living Older Adults and Their Associated Factors

BackgroundFrailty renders older individuals more prone to adverse health outcomes. Little has been reported about the transitions between the different frailty states. We attempted to examine the rate of these transitions and their associated factors.MethodsWe recruited 3018 Chinese community-living adults 65 years or older. Frailty status was classified according to the Fried criteria in 2 visits 2 years apart. Demographic data, medical conditions, hospitalizations, and cognition were recorded. Rates of transitions and associated factors were studied.ResultsAt baseline, 850 (48.7%) men and 884 (52.6%) women were prefrail. Among these, 23.4% men and 26.6% women improved after 2 years; 11.1% of men and 6.6% of women worsened. More men than women (P < .001) deteriorated into frailty. Hospitalizations, older age, previous stroke, lower cognition, and osteoarthritis were risk factors for decline among prefrail participants. Having diabetes was associated with 50% lower chance of improvement in women. Among the robust, older age and previous cancer, hospitalizations, chronic lung diseases, and stroke were risk factors for worsening. Higher socioeconomic status was protective. Previous stroke reduced the chance of improvement by 78% in frail men. Only younger age was associated with improvement in frail women.ConclusionWomen were less likely to decline in frailty status than men. Hospitalizations, older age, previous stroke, lower cognitive function, diabetes, and osteoarthritis were associated with worsening or less improvement. Older age, previous cancer, hospitalizations, lung diseases, and stroke were risk factors for worsening in the robust and higher socioeconomic status was protective.     

The Relationship Between the Dietary Inflammatory Index and Incident Frailty: A Longitudinal Cohort Study

Objective

Inflammation is key risk factor for several conditions in the elderly. However, the relationship between inflammation and frailty is still unclear. We investigated whether higher dietary inflammatory index (DII) scores were associated with higher incidence of frailty in a cohort of North Americans.

Transitions Between Frailty States and Its Predictors in a Cohort of Community-Dwelling Spaniards

ObjectivesStudy the frequency and determinants of frailty transitions in a community-dwelling older population.DesignPopulation-based prospective longitudinal study [The Toledo Study of Healthy Ageing (TSHA)].Setting and Participants1748 community-dwelling individuals aged >65 years living in Toledo, a Spanish province.MethodsFrailty was measured with the Fried phenotype. Logistic models were used to assess the associations of sociodemographic, clinical, life-habits, functional, physical performance, and analytical variables with frailty transitions (losing robustness, transitioning from prefrailty to robustness, and from prefrailty to frailty) over a median of 5.2 years.ResultsMean age on enrolment was 75 years, and 55.8% were females. At baseline, 10.3% were frail and 43.1% prefrail. At follow-up, 35.8% of the frail individuals recovered to a prefrail and 15.1% to a robust state. In addition, 43.7% of the prefrail participants became robust, but 14.5% developed frailty. Of those robust at baseline, 32.9% became prefrail and 4.2% frail. In multivariate logistic models, chair-stands had a predictive role in all transitions studied: linearly in keeping robustness and with a floor effect (5 stands) in transitions from prefrailty to robustness and (inversely) from prefrailty to frailty. More depressive symptoms were associated with unfavorable transitions. Not declaring the amount of alcohol drunk and low grip strength were associated with loss of robustness. Hearing and cognitive impairment, low physical activity and smoking with transitioning from prefrailty to frailty. Autonomy for instrumental activities of daily living and uricemia were associated with transitions between robustness and prefrailty in both directions. Increasing body mass index in the range of moderate to severe obesity hampered regaining robustness.Conclusions and ImplicationsSpontaneous improvement of frailty measured with the Fried phenotype is frequent, mainly to prefrailty. Most of the variables associated with transitions are modifiable and suggest research topics and interventions to reduce frailty in clinical and social care settings.     

Association Between Potentially Inappropriate Medications and Frailty in the Early Old Age: A Longitudinal Study in the GAZEL Cohort

Objectives

High-risk prescribing can have deleterious effects on the health of older people. This study aimed to assess the role of inappropriate prescribing on changes in frailty status over 3 years of follow-up.