Portal de Periódicos da CAPES

Frailty in the Oldest Old: Prevalence and Associated Factors

2013; Wiley; Volume: 61; Issue: 2 Linguagem: Inglês

10.1111/jgs.12154

1532-5415

Assumpta Ferrer, Teresa Badía, Francesç Formiga, Héctor Sanz, Maria Jesus Megido, Ramón Pujol,

Health Systems, Economic Evaluations, Quality of Life

Frailty is a multifactorial syndrome that is increasingly used as a marker of vulnerability in elderly adults; 23% of the oldest old are currently considered to be frail.1, 2 So using cross-sectional information from a community-dwelling group aged 86, the main objective of the current study was to describe frailty prevalence and the factors associated with this syndrome. The current data were compiled from the Octabaix study, a 3-year randomized clinical trial in community-dwelling individuals.3 For the present study, at the beginning of the second year, in the 273 subjects in the study at that point, data on functional status, participation in the intervention to prevent falls and malnutrition, and comorbidities were compiled. A comparative analysis was performed between individuals with and without a phenotypic definition of frailty.4 (Individuals with ≥3 of unintentional weight loss, self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity were considered frail; those with one to two criteria, prefrail; and those with 0, nonfrail.) One hundred sixty-six (60.8%) of the final sample were female, and 56 (20.5%) were frail, 148 (54.2%) were prefrail, and 69 (25.3%) were nonfrail. Table 1 shows the characteristics of the three groups. No statistically significant differences were found between the intervention and control groups in the sensitivity analysis. The model with the best fit according to the Akaike information criterion indicated that factors significantly associated with frailty were functional status (odds ratio (OR) = 4.92, 95% confidence interval (CI) = 0.54–9.53), nutritional risk (OR = 2.33, 95% CI = 1.26–4.32), number of drugs participant was taking (OR = 1.17, 95% CI = 1.09–1.26), social risk (OR = 1.13, 95% CI = 1.01–1.26), CD4 lymphocyte subset (OR = 1.03, 95% CI = 1.01–1.06), and intervention group (OR = 0.48, 95% CI = 0.29–0.80). The results of the ordinal logistic regression–adjusted model of morbidity were not statistically significant. In crude models, heart failure (OR = 1.94, 95% CI = 1.04–3.61) and anemia (OR = 1.77, 95% CI = 1.03–3.03) were found to be statistically significant. The prevalence of frailty found in the present study (20%) was higher than reported in the Cardiovascular Health Study in 73-year-olds (6.3%)4 and similar to that reported in the Canadian Study of Health and Aging in 74-year-olds (23%)1 and in the Women's Health and Aging Study (WHAS) in 78-year-olds (25%).5 In addition to the obvious influence of aging, there are other possible reasons for the difference in these rates because of the absence of a universal definition of frailty and the different characteristics (disability, cognitive impairments or not) of the cohorts selected.6 The percentage of people in the prefrail group was also high in this study (54%), almost as high as in the WHAS (59%).5 This is important because it is at this prefrail group that interventions should be targeted to minimize the incidence of injuries and frailty. In the current study, the likelihood of developing frailty in the intervention group was half the rate in the controls, although this finding should be treated with caution because of the cross-sectional design. The analysis of frailty risk revealed no sex differences in this group, unlike other studies.1 The fact that there are fewer differences between the sexes in cardiovascular mortality index and frailty rates in younger individuals may also explain these sex differences, although they are associated with reported ethnic differences (sex roles with most women with clear domestic role, little economic independence whereas men were the providers, in this age group of elderly people in Mediterranean countries).7 This study did not identify a clear association between frailty and a particular disease, although congestive heart failure and anemia were more frequent in frail subjects. Comprehensive reviews have suggested that impaired energy flow and greater oxygen consumption cause frail people to slow down and perform tasks less efficiently.8 Functional status was significantly associated with frailty in the current study; a decrease of 1 point in disability was associated with a five times greater likelihood of frailty. These findings indicate that functional status is a central factor in frailty and that disability is probably a consequence rather than a cause, as reported elsewhere9, and indicate an earlier trajectory as the result of a multidimensional frail phenotype.10 An interesting finding of the present study was the association between nutritional risk and frailty, which showed that elderly adults usually have micronutrient deficiencies or concurrent diseases.8 Social risk, another condition associated with frailty, was lower in the prefrail group than in the frail group. This probably reflects the greater difficulty involved in living alone and moving around the house or the greater likelihood of financial difficulties.1 In conclusion, the present study found a high prevalence of frailty in the oldest old. Frailty appears to be associated with decline in functional status and nutritional risk. These findings may encourage clinicians to bring forward the starting point for management of frailty as a complex syndrome in this growing age group. This work was supported by a public funding from the Fondo de Investigación Sanitaria- Instituto de Salud Carlos III, Spain (PS09/00552). Clinical Trials.gov NCT0114116. Members of the Octabaix Study: J. Almeda (Unitat de Suport a la Recerca de Costa de Ponent, IDIAP J Gol), T. Badia (ABS Martorell Urbano), A. Lobato (ABS Sant Andreu de la Barca), C. Fernández (CAP Rambla), A. Ferrer (CAP El Pla), F. Formiga (UFISS de Geriatría. Servicio de Medicina Interna, Hospital Universitari de Bellvitge), A. Gil (ABS Sant Andreu de la Barca), M.J. Megido (ABS Just Oliveras), G. Padrós (Laboratori Clínic L'Hospitalet-Cornellà), M. Sarró (CAP Florida Nord), A. Tobella (ABS Martorell Rural). Author Contributions: Ferrer wrote the manuscript and researched data. Badia wrote the manuscript and researched data. Formiga contributed to the discussion and reviewed the manuscript. Sanz conducted statistical analysis and reviewed the manuscript. Megido reviewed the manuscript. Pujol reviewed the manuscript. Sponsor's Role: No sponsors.