Portal de Periódicos da CAPES

Frailty in elderly Japanese

1999; Elsevier BV; Volume: 353; Issue: 9162 Linguagem: Inglês

10.1016/s0140-6736(05)75972-9

1474-547X

Kozo Matsubayashi, Kiyohito Okumiya, Yasushi Osaki, Michiko Fujisawa, Yoshinori Doi,

Nutrition and Health in Aging

Kenneth Rockwood and colleagues (Jan 16, p 205)1Rockwood K Stadnyk K MacKnight C et al.A brief clinical instrument to classify frailty in elderly people.Lancet. 1999; 353: 205-206Summary Full Text Full Text PDF PubMed Scopus (704) Google Scholar present a brief instrument to classify frailty in community-dwelling elderly people in Canada relating to prediction of death and institutionalisation, and emphasise the importance of bladder incontinence. Since 1991 we have conducted an annual assessment of the activities of daily living (ADL) dependency of elderly people aged at least 65 years living in a rural Japanese town, Kahoku.2Matsubayashi K Okumiya K Wada T et al.Secular improvement in self-care independence of old people living in community in Kahoku, Japan.Lancet. 1996; 347: 60Summary Full Text PDF PubMed Scopus (54) Google Scholar We investigated the relative risk of functional abilities of seven ADL items for subsequent death, from Aug 1, 1991 to Dec 31, 1998. The study population consisted of 1488 elderly Japanese people aged at least 65 years in 1991 living in the community (642 men, 846 women, mean age 76 years [SD 5], which included 91% of all Kahoku residents of this age-group. We assessed seven items of ADL (walking, ascending and descending stairs, feeding, dressing, toileting, and bathing), noting the help required, on a 4-point scale: 3, completely independent; 2, need some help; 1, need much help; 0, completely dependent. Seven ADL scores were summed up to a total score (0–21). We classified participants into three groups by ADL dependency: high-grade ADL group (total ADL score 21), medium-grade ADL group (total score 14–20), and low-grade ADL group (total score <14). During the study, 315 people died. We analysed age and sex-adjusted relative risks of dependency in each ADL item (score <2 vs 3) and of two groups graded by total ADL score (medium and low-grade ADL groups compared with high-grade ADL group) for subsequent death with the Cox proportional hazards model. The table shows age and sex-adjusted relative risks and 95% CIs of each ADL item, and medium and low grade ADL groups compared with the high ADL group. The highest relative risk in seven ADL items was walking followed by feeding, toileting &c.TableAge and sex-adjusted relative risk of each ADL dependency and total ADL grade for subsequent deathRelative risk (95% CI)Age1·13 (1·11-1·15)Sex (male)1·69 (1·36-2·11)Each ADL item (ADL score <2 vs 3)Walking3·42 (2·27-5·14)Ascending and descending stairs2·62 (1·90-3·61)Feeding3·16 (1·91-5·23)Dressing2·66 (1·76-4·03)Toileting2·97 (1·86-4·75)Bathing2·51 (1·75-3·59)Grooming2·32 (1·52-3·54)Groups graded by total ADL scoreHigh grade (score 21)1·0Medium grade (score 14-20)1·89 (1·42-2·52)Low grade (score <14)3·10 (2·04-4·7) Open table in a new tab ADL dependency in community-dwelling elderly people graded by total ADL score was significantly associated with subsequent death in dose-response relation in our Japanese data as Rockwood and colleagues report.1Rockwood K Stadnyk K MacKnight C et al.A brief clinical instrument to classify frailty in elderly people.Lancet. 1999; 353: 205-206Summary Full Text Full Text PDF PubMed Scopus (704) Google Scholar Although bladder incontinence was an important risk for death,1Rockwood K Stadnyk K MacKnight C et al.A brief clinical instrument to classify frailty in elderly people.Lancet. 1999; 353: 205-206Summary Full Text Full Text PDF PubMed Scopus (704) Google Scholar our data show that dependency of toileting was the third risk for death after walking and feeding. Because Rockwood1Rockwood K Stadnyk K MacKnight C et al.A brief clinical instrument to classify frailty in elderly people.Lancet. 1999; 353: 205-206Summary Full Text Full Text PDF PubMed Scopus (704) Google Scholar does not report the difference between those who were independent and those who had only bladder incontinence, the geriatric status scale,3Hogan DB Fox RA A prospective controlled trial of geriatric consultation teams in an acute-care hospital.Age Aging. 1990; 19: 107-113Crossref PubMed Scopus (84) Google Scholar which focuses on acute-care hospitalised patients, should be modified to apply to community-dwelling elderly. ADL dependency (total ADL dependency including walking) is significantly associated with death in community-dwelling elderly people.