Original Study
A New Functional Classification Based on Frailty and Disability Stratifies the Risk for Mortality Among Older Adults: The FRADEA Study

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Abstract

Objectives

The aim of the current study was to investigate whether a new functional classification, based on basic (BADL) and instrumental (IADL) activities of daily living and frailty, is associated with mortality in older adults during 10 years of follow-up.

Design

Cohort study, with a follow-up of 10 years.

Setting and participants

A total of 924 participants aged 70 and older from the Frailty and Dependence in Albacete (FRADEA) study, a population-based sample of Spanish older adults.

Measures

At baseline, a new functional classification of 8 categories was constructed with limitations in BADL using the Barthel Index, limitations in IADL using the Lawton IADL Index, and the criteria of the frailty phenotype. Associations with 10-year mortality were assessed using Kaplan-Meier curves and Cox proportional hazard models.

Results

The risk of mortality gradually increased toward the less functionally independent end of the classification. The presence of mild, moderate, or severe BADL impairment was associated with mortality, in models adjusted for age, sex, comorbidity and institutionalization. The analyses also revealed that those who were BADL independent, IADL dependent and prefrail [hazard ratio (HR) = 2.27, 95% confidence interval (CI) = 1.22-4.20], and those who were BADL independent and frail (HR = 3.74, 95% CI = 1.88-7.42) had an increased risk of mortality.

Conclusions/implications

A new functional classification composed of BADL, IADL, and frailty representing the functional continuum is effective in stratifying the risk for mortality in older adults. Frailty is a high-mortality-risk state close to subjects with mild disability in BADL, needing an intensive specialized approach. Prefrailty with any impairment in IADL has an intermediate mortality risk and should be offered primary care interventions.

Section snippets

Study Population

In this longitudinal study, data from the first wave of the FRADEA study (2007-2009) and follow-up data on mortality over a period of 10 years (2007-2017) were used. FRADEA is a population-based cohort study among older adults aged 70 and older from the urban area of Albacete in Spain. Details on the methods and sampling have been published before.20 In summary, to obtain a representative sample of a Spanish urban older population, 1172 people aged 70 and older were randomly selected from

Results

Table 1 shows the characteristics of the total study sample and by 10-year all-cause mortality status. The mean age of the 924 included older adults was 79.5 years, the majority were female (60.7%), and almost a quarter of the sample was living in a nursing home (22.3%). Participants who died during 10 years of follow-up were older (82.5 years vs 76.3 years), more often institutionalized (38.5% vs 5.1%), had higher comorbidity (1.8 diseases vs 0.8 diseases), lower functional scores (Barthel and

Discussion

The main conclusion of our study is that a new functional classification composed of BADL, IADL, and frailty as 8 exclusive categories representing the functional continuum is effective in stratifying the risk for mortality in older adults, independently of age, sex, comorbidity, and institutionalization.

It is well known that disability in BADL and IADL9, 10, 11, 12 and frailty26 are health conditions independently associated with mortality. Also it is known that frailty, as a predisability

Conclusions and Implications

A new functional classification composed of BADL, IADL, and frailty, representing the functional continuum, is effective in stratifying the risk for mortality in older adults. Frailty is a higher-mortality-risk state close to subjects with mild disability in BADL, needing an intensive specialized approach. Prefrailty with any impairment in IADL has an intermediate mortality risk and should be offered primary care interventions. Our work emphasizes the need to base health care to older adults on

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    • Cited by (0)

    This work was supported by CIBERFES, Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, España; Ayuda cofinanciada por el Fondo Europeo de Desarrollo Regional FEDER Una Manera de hacer Europa. E.O. Hoogendijk is supported by an NWO/ZonMw Veni fellowship (grant number 91618067).

    The authors declare no conflicts of interest.

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