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

doi:10.1016/j.jamda.2013.12.002

Journal of the American Medical Directors Association

Volume 15, Issue 4, April 2014, Pages 281-286

https://doi.org/10.1016/j.jamda.2013.12.002 Get rights and content

Abstract

Background

Frailty 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.

Methods

We 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.

Results

At 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.

Conclusion

Women 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.

Section snippets

Materials and Methods

Between 2001 and 2003, 4000 older men and women aged 65 years or older were recruited by public notices and talks held in social centers for the aged and in public housing estates in Hong Kong. The cohort consisted of equal numbers of men and women, and equal numbers of individuals aged 65 to 69 years, 70 to 74 years, and 75 years and older. These individuals were invited to attend a health check, which included a structured questionnaire and a physical assessment. Participants were excluded if

Statistical Analysis

The change in frailty status between the baseline and follow-up visits was used as the outcome. The number and proportions of participants in the robust, prefrail, and frail categories at both visits were reported according to gender. The numbers of those in each frailty category who had remained stable, improved, or declined after 2 years with respect to their frailty status were also listed. Comparison of the gender, age, and baseline frailty status of those who did or did not return for the

Results

A total of 1519 men (87.0% of 1745 at baseline) and 1499 women (89.1% of 1682 at baseline) attended both visits with complete frailty data. Table 1 compares the characteristics of participants who did or did not return (either deceased or defaulted) for the follow-up visit. Those who did not return for the follow-up were older, had lower MMSE scores, had more hospitalizations after the baseline visit, and were more likely to be frail at baseline. Men who did not return for the follow-up visit

Discussion

This is the first study to report frailty transitions among Asian individuals. We found that a quarter of prefrail men and women recovered into the robust state after 2 years, with only 11% of men and 7% women of progressing into frailty. The large proportion of prefrail persons remaining stable within a period of 2 years suggested that there may be a window during which interventions can be applied to reduce the decline rate or to improve the recovery rate.

Men and women in our cohort had

Limitation

Our cohort was not randomly selected, but it was likely a representative sample of community-living independent older people, as evidenced by comparable prevalence of frailty when compared with other cohorts.1, 9 Hospitalizations may be a result of frailty rather than a cause of the decline in frailty state. As we did not study the details of the individual hospitalizations, it was also uncertain whether they could be preventable. Our data might have an underrepresentation of the most frail, as

Conclusion

Women 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 in frailty status. Older age, previous cancer, hospitalizations, lung diseases, and stroke were risk factors for worsening in robust individuals, and higher socioeconomic status was protective.

References (29)

R.E. Hubbard et al.
Frailty in older women
Maturitas
(2011)
C.Y. Chen et al.
The prevalence of subjective frailty and factors associated with frailty in Taiwan
Arch Gerontol Geriatr
(2010)
N. Ahmed et al.
Frailty: An emerging geriatric syndrome
Am J Med
(2007)
C. DeCarli
Mild cognitive impairment: Prevalence, prognosis, aetiology, and treatment
Lancet Neurol
(2003)
M.F. Folstein et al.
Mini-mental state. A practical method for grading the cognitive state of patients for the clinician
J Psychiatr Res
(1975)
R.A. Washburn et al.
The Physical Activity Scale for the Elderly (PASE): Development and evaluation
J Clin Epidemiol
(1993)
J.A. Yesavage et al.
Development and validation of a geriatric depression screening scale: A preliminary report
J Psychiatr Res
(1982)
T.K. Malmstrom et al.
Frailty and cognition: Linking two common syndromes in older persons
J Nutr Health Aging
(2013)
T.W. Auyeung et al.
Physical frailty predicts future cognitive decline—a four-year prospective study in 2737 cognitively normal older adults
J Nutr Health Aging
(2011)
J. Lee et al.
Physical frailty in older adults is associated with metabolic and atherosclerotic risk factors and cognitive impairment independent of muscle mass
J Nutr Health Aging
(2011)

L.P. Fried et al.

Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: Evidence for a phenotype

J Gerontol A Biol Sci Med Sci

(2001)

J.E. Morley et al.

Editorial: Something about frailty

J Gerontol A Biol Sci Med Sci

(2001)

X. Song et al.

Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation

J Am Geriatr Soc

(2010)

R. Romero-Ortuno et al.

The frailty index in Europeans: Association with age and mortality

Age Ageing

(2012)

Cited by (239)

Preserved Ratio Impaired Spirometry and COPD Accelerate Frailty Progression: Evidence From a Prospective Cohort Study
2024, Chest
COPD has been found to be associated with frailty. However, longitudinal evidence for associations of COPD with frailty progression is inadequate. Furthermore, recent studies revealed a new phenotype of lung function impairment: preserved ratio impaired spirometry (PRISm) findings. Associations of PRISm findings and their transitions with frailty progression are unclear.
What are the associations of PRISm findings, transitions of PRISm findings, and COPD with frailty progression?
To analyze the associations of PRISm findings and COPD with frailty progression, 5,901 patients were included from the English Longitudinal Study of Ageing. Patients were classified into three lung function patterns of normal spirometry (NS) findings, PRISm findings, and COPD. Frailty progression was assessed by repeated measurements of the frailty index (FI) during follow-up. Among these 5,901 patients, 3,765 patients were included to analyze the associations of PRISm findings transitions with frailty progression. PRISm findings transitions were assessed based on the changes of lung function patterns after a 4-year interval. Linear mixed-effect models were used for statistical analyses.
The median follow-up periods were 9.5 years for the analyses of PRISm findings and COPD with frailty progression and 5.8 years for PRISm findings transitions with frailty progression. When compared with participants with NS findings, patients with PRISm findings and COPD demonstrated accelerated FI progression with additional annual increases of 0.301 (95% CI, 0.211-0.392; P < .001) and 0.172 (95% CI, 0.102-0.242; P < .001), respectively. Patients who transitioned from NS findings to PRISm findings also demonstrated accelerated FI progression when compared with those with stable NS findings (β = 0.242; 95% CI, 0.008-0.476; P = .042). However, no accelerated FI progression was found in patients with PRISm findings who transitioned to NS findings (β = 0.119; 95% CI, –0.181 to 0.418; P = .438).
Our findings indicate that PRISm findings and COPD are associated with accelerated frailty progression. Further studies are needed to elucidate the causality of the association of PRISm findings and COPD with frailty.
The Association Between Habitual Tea Consumption and Frailty Transition in Community-Dwelling Older Adults: A Prospective Cohort Study
2024, Journal of the American Medical Directors Association
To investigate the association between habitual tea consumption and transitions between frailty states among older adults in China.
A prospective cohort study based on the Chinese Longitudinal Healthy Longevity Study.
A total of 23,720 older adults aged ≥65 years with complete data regarding frailty status and tea consumption were recruited.
The frequency and consistency of tea consumption were introduced to evaluate levels of tea consumption. The frailty index was used to define frailty status (frail and nonfrail). Frailty transition was classified into remaining nonfrail, improvement, worsening, and remaining frail groups. Logistic regression models were applied.
The overall frailty prevalence at baseline was 19.1%, being lower among consistent daily tea drinkers (12.5%) and higher among non-tea drinkers (21.9%). Logistic regression analyses showed that the risk of frailty was significantly reduced among consistent daily tea drinkers after adjusting for all confounders [odds ratio (OR), 0.81; 95% CI, 0.67–0.98]. During the 3-year follow-up, improvement in frailty status was more common among consistent daily tea drinkers (50.9%) than non-tea drinkers (40.9%), and this trend was opposite in participants with worsened frailty status (consistent daily tea drinkers: 12.2%) vs non-tea drinkers: 19.2%). Further analysis showed that consistent daily tea drinkers were significantly associated with improvement in frailty status (OR, 3.24; 95% CI, 1.02–10.31) and remaining in a nonfrail state (OR, 1.35; 95% CI, 1.00–1.83). In addition, daily tea consumption was observed to be positively associated with remaining in a nonfrail state and inversely associated with worsened frailty status in men, but not in women.
Older people consuming tea daily tend to have an improved frailty status in the future. Men with daily tea consumption were less likely to have a worsened frailty status. Advocating for the traditional lifestyle of drinking tea could be a promising way to advance healthy aging for older adults.
Hearing Loss and Frailty among Older Adults: The Atherosclerosis Risk in Communities Study
2023, Journal of the American Medical Directors Association
Hearing loss may contribute to frailty through cognitive and physical decline, but population-based evidence using validated measures remains scarce. We investigated the association of hearing loss with phenotypic frailty and its individual components and explored the potential protective role of hearing aid use.
Cross-sectional study of community-dwelling older adults at visit 6 (2016–2017) of the Atherosclerosis Risk in Communities (ARIC) study, a cohort study of older adults from 4 U.S. communities (Washington County, MD; Forsyth County, NC; Jackson, MS; and Minneapolis, MN).
Population-based study of 3179 participants (mean age = 79.2 years, 58.9% female).
Pure-tone audiometry at 0.5–4 kHz was used to assess unaided hearing, and the better-hearing ear's pure-tone average was categorized as follows: no [≤25 dB hearing level (HL)], mild (26–40 dB HL), and moderate or greater (>40 dB HL) hearing loss. Hearing aid use was self-reported. The Fried/physical frailty phenotype was used to categorize frailty status (robust, pre-frail, or frail). Multivariable multinomial and logistic regression models were used to study the association of hearing loss/hearing aid use with frailty status and individual frailty components, respectively.
In our sample, 40% had mild and 27% had moderate or greater hearing loss (12% and 55% reported hearing aid use, respectively). Moderate or greater hearing loss was associated with greater odds of being pre-frail [odds ratio (OR), 1.25; 95% CI, 1.01–1.57] and frail (OR, 1.62; 95% CI, 1.06–2.47) vs robust, and greater odds of having slow gait, low physical activity, and exhaustion, compared with no hearing loss. Among those with hearing loss (>25 dB HL), compared with hearing aid users, nonusers had greater odds of being frail vs robust, and having unintentional weight loss, slow gait, and low physical activity.
Hearing loss is associated with pre-frailty and frailty. Longitudinal studies are warranted to establish if hearing aid use may prevent or delay frailty onset.
Frailty phenotype in heart failure: A condition that transcends age
2023, Revista Portuguesa de Cardiologia
Studies on younger frail and pre-frail subjects suffering from heart failure (HF) are scarce, except for those focusing on the critically ill. This work aims to describe differences between younger (<65 years) and older (≥65 years) pre-frail and frail HF outpatients regarding their nutritional, functional and clinical statuses.
In this cross-sectional study, a sample of 99 HF frail and pre-frail patients (aged 24–81 years, 38.4% women, 21.2% frail, 59.6% <65 years) was recruited from an HF outpatients’ clinic in northern Portugal. Muscle mass was estimated from mid-upper arm muscle circumference. Weight status was assessed using body mass index. Hand grip strength and gait speed were measured. Medical records were reviewed. Associations between participants’ characteristics and age were calculated using binary logistic regression.
Age was associated with hand grip strength (OR=0.90), gait speed (OR=0.01) and diabetes (OR=4.95). Obesity, muscle mass or heart failure functional classes were not associated with age categories.
There is an overall lack of differentiation between younger and older HF patients with the frailty phenotype. Therefore, frailty phenotype should be assessed in all patients, regardless of age. Hand grip strength seems to be a good predictor for older age and more studies are needed to define age-specific hand grip strength cut-offs for HF populations.
Estudos em insuficientes cardíacos jovens com fragilidade e pré-fragilidade são escassos, à exceção de trabalhos focados em doentes críticos. Este trabalho tem como objetivo descrever diferenças entre pacientes externos adultos (<65 anos) e idosos (≥65 anos), com fragilidade e insuficiência cardíaca concomitantes, no respeitante ao seu estado nutricional, funcional e clínico.
Neste estudo transversal, foi recrutada de uma consulta externa de um hospital do Norte de Portugal, uma amostra de 99 insuficientes cardíacos com fragilidade e pré-fragilidade (idade 24-81 anos, 38,4% mulheres, 21,2% frágeis, 59,6% < 65 anos). A massa muscular foi estimada a partir do perímetro muscular do braço. O estado ponderal foi classificado utilizando o Índice de Massa Corporal. Foi medida a força de preensão da mão. A associação entre as características preditivas dos participantes e as categorias de idade foi calculada através de regressão logística binária.
A idade foi associada à força preensora da mão (OR=0,90), à velocidade da marcha (OR=0,01) e à diabetes (OR=4,95). A obesidade, a massa muscular ou as classes funcionais de insuficiência cardíaca não foram associadas às categorias de idade.
Verificou-se uma escassez generalizada de diferenças entre doentes adultos e idosos com insuficiência cardíaca e fenótipo de fragilidade concomitantes, justificando a avaliação da fragilidade mesmo em indivíduos mais jovens. A força de preensão da mão parece ser um bom preditor para a idade, mas são necessários mais estudos para definir pontos de corte específicos para populações de insuficientes cardíacos.
Frailty knowledge level and its influencing factors among older adults in China
2023, Geriatric Nursing
Raising older adults’ frailty knowledge level and encouraging them to actively engage in the prevention and treatment of frailty is essential to promote healthy aging. This cross-sectional study investigated frailty knowledge level and its influencing factors in community-dwelling older adults in China. A total of 734 older adults were included in the analysis. About half of them misjudged their frailty state (42.50%), and 17.17% obtained frailty knowledge in the community. Those who were female, lived in rural areas, lived alone, had not attended school, had a monthly income <3,000RMB, were at risk for malnutrition, were depressed, and were socially isolated were more likely to have lower frailty knowledge level. Those with advanced age and pre-frailty or frailty stage were more knowledgeable about frailty. The group with the highest proportion of low frailty knowledge level was those who had never attended school or completed primary school and had loose friend ties (98.7%). It is crucial to develop tailored intervention to raise frailty knowledge level in older adults in China.
Progression of frailty as measured by a cumulative deficit index: A systematic review
2023, Ageing Research Reviews
Frailty is a risk factor for adverse health outcomes. There is a paucity of literature on frailty progression defined by a cumulative deficit model among community dwelling older people. The objective of this review was to synthesise evidence on these changes in health and mortality among community-dwelling older people.
Six databases (Medline, Embase, CINAHL, Cochrane, PsycInfo, Web of Science) and a clinical trials registry were searched in July 2021. The inclusion criteria were studies using a frailty index and providing information on transition between frailty states or to death in community-dwelling older people aged ≥ 50. Exclusion criteria were studies examining specific health conditions, conference abstracts and non-English studies. To standardise the follow-up period and facilitate comparison, we converted the transition probabilities to annual transition rates.
Two reviewers independently screened 5078 studies and 61 studies were included for analysis. Of these, only three used the same frailty state cut-points to facilitate cross-cohort comparison. This review found that frailty tends to increase with time, people who are frail at baseline have greater likelihood to progress in frailty and die, and the main factor that accelerates frailty progression is age. Other risk factors for progression are having chronic disease, smoking, obesity, low-income or/and low-education levels. A frailty index is an accurate predictor of adverse outcomes and death.
This systematic review demonstrated that worsening in frailty was a common frailty transition, and older people who are frail at baseline are more likely to die. A frailty index has significant power to predict adverse health outcomes. It is a useful tool for within-cohort comparison but there are challenges comparing different cohorts due to dependence of frailty progression on age and differences in how frailty index is defined and measured.

View all citing articles on Scopus

: This study was funded by The Jockey Club Charities Trust; the S.H. Ho Centre for Gerontology and Geriatrics, Faculty of Medicine, The Chinese University of Hong Kong; and the Hong Kong Research Grant Council (CUHK 4101/01M).

: The authors declare no conflicts of interest.

View full text

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

Abstract

Background

Methods

Results

Conclusion

Section snippets

Materials and Methods

Statistical Analysis

Results

Discussion

Limitation

Conclusion

Maturitas

Arch Gerontol Geriatr

Am J Med

Lancet Neurol

J Psychiatr Res

J Clin Epidemiol

J Psychiatr Res

J Nutr Health Aging

J Nutr Health Aging

J Nutr Health Aging

Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: Evidence for a phenotype

J Gerontol A Biol Sci Med Sci

Editorial: Something about frailty

J Gerontol A Biol Sci Med Sci

Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation

J Am Geriatr Soc

The frailty index in Europeans: Association with age and mortality

Age Ageing

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