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PREVALENCE OF FRAILTY IN A SPANISH ELDERLY POPULATION: THE FRAILTY AND DEPENDENCE IN ALBACETE STUDY

2011; Wiley; Volume: 59; Issue: 7 Linguagem: Inglês

10.1111/j.1532-5415.2011.03463.x

1532-5415

Pedro Abizanda, Pedro Manuel Sánchez‐Jurado, Luis Romero, Gema Paterna, Esther Martínez‐Sánchez, Pilar Atienzar‐Núñez,

Aging, Health, and Disability

To the Editor: Different studies have found the prevalence of frailty to be between 4% and 16.3%.1-6 In Spain, a few cohort studies have attempted to determine the prevalence of this syndrome,4-6 although they did not use the original Fried criteria cut-off points. In view of this, it was decided to construct the Frailty and Dependence in Albacete (FRADEA) cohort,7 which would enable the following questions to be answered: What is the prevalence of frailty in Spanish elderly people? Is it similar to that of cohorts in other countries? Are the Fried criteria valid in Spain, or should they be adapted? What sociodemographic, functional, cognitive, affective, and health factors are associated with frailty among the older adults in Spain?8, 9 The rationale, design and methodology of the FRADEA cohort have been explained in detail elsewhere.7 From a population of 18,137 persons aged 70 and older, 1,172 were randomly selected, of whom 993 (84.7%) agreed to participate. Original Fried frailty criteria and cutoff points were used to determine frailty status.1 Study covariates included age, sex, place of residence, and disability (Barthel and Lawton indexes; participants were considered to be independent in basic activities of daily living (ADLs) with a maximum score on the Barthel Index), ambulation (Holden Functional Ambulation Classification), need for walking assistance (walker, cane, or wheel chair), cognitive impairment (Mini-Mental State Examination (MMSE) score <24), risk of depression (Yesavage Geriatric Depression Scale score ≥5), high comorbidity (Charlson index ≥3), drugs usually consumed, and adverse outcomes in the prior 6 months. Of the 993 participants, Fried frailty criteria were present as follows: exhaustion, n=911 (91.7%); low physical activity, n=860 (86.6%); slow walking speed, n=819 (82.5%); weight loss, n=935 (94.2%); and weakness, n=801 (80.7%). Three or more criteria were present in 866 (87.2%) to determine the number of frail, prefrail, and nonfrail participants. Table 1 shows the prevalence of frailty in the full sample and in community-dwelling, community-dwelling with no ADL disability, and institutionalized subgroups. Figure 1 shows the interrelationship between frailty, ADL disability, and high comorbidity. Characteristics, frailty status, and adverse events of the sample. The weighted prevalence of frailty in the population aged 70 and older in Albacete was 16.3% (95% confidence interval (CI)=14.0–18.6%), and that of prefrailty was 48.8% (95% CI=45.7–51.9%). The prevalence of frailty was 15.2% (95% CI=12.7–17.7%) in the community-dwelling participants, 7.1% (95% CI=5.1–9.1%) in the community-dwelling participants independent in ADLs, and 23.1% (95% CI=17.4–28.8%) in the institutionalized participants. Eleven (1.1%) of the cohort participants met five frailty criteria, 50 (5%) met four, 107 (10.8%) met three, 185 (18.6%) met two, and 338 (34.0%) met one. Applying Fried's original cutoff points, the number of participants who met the different frailty criteria were 223 (22.5%) for exhaustion, 178 (17.9%) for low physical activity, 302 (30.4%) for slow walking speed, 135 (13.6%) for weight loss, and 446 (44.9%) for weakness, although the cutoff points calculated from the FRADEA cohort original values were for grip strength (men <38 and women <12 kg), energy expenditure (men <630 and women <490 kcal/wk), and walking speed (men<0.63 and women <0.40 m/s). Frailty was more frequent in older participants, women, and institutionalized participants. Frail participants had higher comorbidity, basic and instrumental ADL disability, and drug consumption than prefrail and nonfrail participants. Frail participants also had poorer ambulation, with a greater need for walking aids and slower walking speed. Last, frail participants had lower scores on the MMSE and higher scores on the Yesavage scale (Table 1). The covariates independently associated with frailty were aged 80 and older (OR=2.1, 95% CI 1.3–3.4), female sex (OR=2.6, 95% CI 1.5–2.4), ADL disability (OR=7.9, 95% CI 4.7–13.2), high comorbidity (OR=2.1, 95% CI 1.2–4.0), risk of depression (OR=1.7, 95% CI 1.1–2.6), and cognitive impairment (OR=1.6, 95% CI 1.0–2.7), adjusted for institutionalization. In the 6 months before the baseline visit, frail participants more frequently had adverse events than those who were prefrail or nonfrail (Table 1). Frail participants were at a greater risk of falls (OR=1.2, 95% CI 0.6–2.5), had used emergency services (OR=1.2, 95% CI 0.7–2.0), or had been hospitalized in the prior 6 months (OR=2.2, 95% CI 1.1–4.3), adjusted for age, sex, institutionalization, high comorbidity, disability, cognitive impairment, and risk of depression. The prevalence of frailty in Albacete's older population is slightly higher than that of previous studies and is associated with age, female sex, disability, comorbidity, depression risk, and previous adverse events. This project was financed by a grant from the FISCAM foundation (PI2006/42). The authors would like to thank Ramona Campos for her invaluable collaboration. Conflict of Interest: None. Author Contributions: Pedro Abizanda: principal investigator. Pedro M. Sánchez-Jurado: manuscript preparation. Luis Romero: design and methods. Gema Paterna: statistics. Esther Martínez-Sánchez and Pilar Atienzar-Núñez: data collection and management. Sponsor's Role: The sponsor had no role in the study.