Use of the frailty index in evaluating the prognosis of older people in Beijing: A cohort study with an 8-year follow-up

Abstract Background Knowledge is scarce on how needs for home help and special housing evolve among older people who begin to receive support from municipal social care. The purpose of this study was to describe baseline distributions and transitions over time between levels of dependency among older persons after being granted social care in a Swedish municipality. Methods Based on a longitudinal cohort study in a Swedish municipality, data was collected retrospectively from municipal records. All persons 65 years or older who received their first decision on social care during 2010 (n = 415) were categorized as being in mild, moderate, severe, or total dependency, and were observed until the end of 2013. Baseline distributions and transitions over time were described descriptively and analysed with survival analysis, with the Kaplan-Meier estimator, over the entire follow-up period. To test potential differences in relation to gender, we used the Cox-Proportional hazards model. Results Baseline distributions between mild, moderate, severe, and total dependency were 53, 16, 24, and 7.7%. During the first year, between 40 and 63% remained at their initial level of dependency. Among those with mild and moderate levels of dependency at baseline, a large proportion declined towards increasing levels of dependency over time; around 40% had increased their dependency level 1 year from baseline and at the end of the follow-up, 75% had increased their dependency level or died. Conclusions Older people in Sweden being allocated home help are at high risk for decline towards higher levels of dependency, especially those at mild or moderate dependency levels at baseline. Taken together, it is important that municipalities make use of existing knowledge so that they implement cost-effective preventative interventions for older people at an early stage before a decline toward increasing levels of dependency.

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P2524Extent and outcomes of frailty in older people with atrial fibrillation: a nationwide study using primary care data

European Heart Journal ◽

10.1093/eurheartj/ehz748.0853 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Wilkinson ◽

O Todd ◽

M Yadegarfar ◽

A Clegg ◽

C P Gale ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Older People ◽

Proportional Hazards ◽

Frailty Index ◽

Community Setting ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

All Cause Mortality

Abstract Background The prevalence of atrial fibrillation (AF) in older people is increasing, as is frailty. Frailty describes an increased vulnerability to adverse outcomes, whereby the balance of risk and benefit associated with an intervention may be more nuanced. However, there are limited data from a community setting on the prevalence of AF and frailty in older people. It is important to understand the burden of AF and frailty, and the associated impact on mortality and stroke disease in order to inform shared decision making with patients, and also inform guidelines for this increasing group of older people. Purpose To estimate the prevalence of AF and the burden of frailty in patients with AF, in a large primary care dataset. To report stroke and mortality by frailty group. Methods We used electronic health records of 537,051 patients in England aged 65 years or older on 31/12/2015, with follow-up for all-cause mortality and ischaemic or unclassified stroke to 11/04/2017. Patients with a history of AF were identified using Clinical Terms Version 3 (CTV-3) codes. Frailty was identified up to the point of study entry using the electronic frailty index (eFI, the proportion of deficits out of 36 possible deficits), and categorised into robust (0–0.12), mild (>0.12–0.24), moderate (>0.24–0.36) or severe (>0.36) frailty. Median CHA2DS2-VASc and ATRIA scores for patients with frailty were compared with the robust group using Mann-Whitney. The association between frailty status, all-cause mortality and stroke was calculated using Cox proportional hazards models, adjusted for age and sex. Results Of the cohort, 61,177 patients (11.4%) had AF. Of those with AF, 27,987 (45.8%) were female, and 54,734 (89.5%) had frailty. 6,443 (10.5%) were classified as robust; 20,352 (33.3%) mildly frail; 20,315 (33.2%) moderately frail; and 14,067 (23.0%) severely frail. The median number of eFI-defined deficits among patients with AF was 9 (interquartile range [IQR] 6–12). Median stroke and bleeding scores were higher in those with frailty compared with the robust group (CHA2DS2-VASc 4 [IQR 3–5] v 2 [2–3], p≤0.001; ATRIA 4 [2–6] v 1 [0–2], p≤0.001). During 73,338 patient-years of follow-up, there were 6,805 (11.1%) deaths and 945 (1.54%) strokes. Compared with the robust group, all-cause mortality and stroke were higher with increasing frailty. Mortality: mild frailty hazard ratio 1.53 (95% confidence interval 1.29–1.80); moderate frailty 2.50 (2.13–2.94); severe frailty 4.26 (3.63–5.01). Stroke: mild frailty 1.36 (0.99–1.85); moderate frailty 1.67 (1.23–2.28); severe 1.99 (1.45–2.73). Kaplan-Meier survival curves by frailty Conclusion The prevalence of AF among those aged over 65 years in primary care in England is high, the majority of whom are frail. Increasing severity of frailty was associated with higher mortality and stroke rates. The extent to which the judicious use of oral anticoagulation may improve clinical outcomes for patients with AF and frailty is currently unknown. Acknowledgement/Funding CPG: Bayer, BMS, AstraZeneca, Novartis Vifor Pharma, Menerini

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Prevalence and Prognostic Significance of Frailty in Gerontal Inpatients With Pre-clinical Heart Failure: A Subgroup Analysis of a Prospective Observational Cohort Study in China

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.607439 ◽

2020 ◽

Vol 7 ◽

Author(s):

Pei-Pei Zheng ◽

Si-Min Yao ◽

Jing Shi ◽

Yu-Hao Wan ◽

Di Guo ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Subgroup Analysis ◽

Frailty Index ◽

Observational Cohort Study ◽

Prospective Observational Cohort Study ◽

Frailty Phenotype ◽

Observational Cohort ◽

Clinical Heart Failure

Objective: To evaluate the prognostic value of frailty in gerontal pre-clinical heart failure (stage B heart failure, SBHF) inpatients.Background: The association between frailty and SBHF remains unknown.Methods: We conducted a subgroup analysis of a prospective observational cohort study on frailty. The previous study recruited 1,000 elderly inpatients who were consecutively admitted to a tertiary referral hospital in Beijing, China, from September 2018 to February 2019. The outcomes were all-cause death or readmission at 1-year follow-up. SBHF was diagnosed for asymptomatic cardiac structural or functional abnormalities. Frailty was assessed using the Comprehensive Geriatric Assessment-Frailty Index (CGA-FI).Results: Overall, 531 inpatients aged ≥65 years were deemed to have SBHF and followed up for 1 year. Of them, 34.5% exhibited frailty. During the follow-up period, all-cause death or readmission occurred in 157 (29.5%) participants. Of these participants, 36.6% (67/183) and 25.9% (90/348) belonged to the frail and non-frail groups, respectively (χ2 = 6.655, P = 0.010). Frailty, defined by the CGA-FI, rather than Fried frailty phenotype, could independently predict 1-year all-cause death or readmission (hazard ratio, 1.56; 95% confidence interval, 1.03–2.35; P = 0.034) and was more suitable for predicting all-cause death or readmission than N-terminal pro-B-type natriuretic peptide in female SBHF inpatients aged 80 years or over(AUCCGA−FI vs. AUCNT−proBNP 0.654 vs. 0.575, P = 0.017).Conclusions: Frailty is highly prevalent even among SBHF inpatients aged ≥65 years. The CGA-FI can independently predict 1-year all-cause death or readmission, rather than Fried frailty phenotype. Frailty in gerontal SBHF inpatients deserves more attention.Clinical Trial registration: ChiCTR1800017204; date of registration: 07/18/2018.

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Income and education are associated with transitions in health status among community-dwelling older people in Japan: the JAGES cohort study

Family Practice ◽

10.1093/fampra/cmz022 ◽

2019 ◽

Vol 36 (6) ◽

pp. 713-722 ◽

Cited By ~ 1

Author(s):

Takaaki Ikeda ◽

Toru Tsuboya ◽

Jun Aida ◽

Yusuke Matsuyama ◽

Shihoko Koyama ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Health Status ◽

Older People ◽

Multinomial Logistic Regression ◽

Community Dwelling ◽

Baseline Survey ◽

Older Individuals ◽

Community Dwelling Older Adults

Abstract Background Health inequalities are an emerging issue in ageing societies, but inequalities in pre-frailty, which is suffered by almost half of older people, are mostly unknown. Objective This study aimed to determine the association between the socio-economic status (SES) and changes across pre-frailty, frailty, disability and all-cause mortality. Methods We conducted a prospective cohort study across 23 Japanese municipalities between 2010 and 2013. Functionally independent community-dwelling older adults aged ≥65 years (n = 65 952) in 2010 were eligible for the study. The baseline survey was conducted from 2010 to 2012, and the self-reporting questionnaires were mailed to 126 438 community-dwelling older adults [64.8% (81 980/126 438) response rate]. The follow-up survey was conducted in 2013. Overall, 65 952 individuals were followed up [80.4% (65 952/81 980) follow-up rate]. The health status was classified into five groups: robust; pre-frailty; frailty; disability and death. We conducted three multinomial logistic regression models stratified by the initial disability status. Educational attainment and equivalized household income were separately added to the models as exposures after adjusting for covariates. Results Participants with the lowest educational level were less likely to recover from pre-frailty to robust compared with those with the highest level [odds ratio (OR) (95% confidence interval (CI)) = 0.84 (0.76–0.93)]. The participants with the lowest income level were also less likely to recover from pre-frailty to robust compared with those with the highest level [OR (95% CI) = 0.80 (0.69–0.91)]. Conclusions Older individuals with a lower SES were less likely to recover from a pre-frailty status.

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328 - Depression as a disorder of accelerated ageing

International Psychogeriatrics ◽

10.1017/s1041610220002288 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 87-87

Keyword(s):

Cohort Study ◽

Depressive Disorder ◽

Excess Mortality ◽

Frailty Index ◽

Population Based ◽

Accelerated Ageing ◽

List Type ◽

Biological Ageing ◽

Dsm Iv

Presenting author:Prof.dr. Richard C. Oude Voshaar, University of Groningen, The Netherlands ([email protected])Co-author:Prof.dr. Ivan Aprahamian, Faculty of Medicine of Jundiaí, Brazil ([email protected])Depressive disorder has been conceptualised as a disorder of accelerated ageing. Furthermore, meta - analyses have shown that depression associated with excess mortality, although most studies can be criticised for insufficient confounder control. These characteristics of depression resemble the characteristics of biomedical frailty. Biomedical frailty can be assessed with the frailty index (FI) based on the deficit accumulation model. This model postulates that the proportion of at least 30 ageing-related health deficits reflects biological age on top of chronological age. The characteristics of the FI are independent of the specific health deficits included, as long as health deficits from different physiological systems are included. The FI is the most accurate frailty model for predicting mortality, the ultimate outcome of increasing frailty states. Because of its continuous nature, the FI is sensitive to change which enables us to study trajectories of frailty.The objective of the present lecture is 1) to show that depressive disorder associated with accelerated biological ageing as indexed by the frailty index, 2) that depressive disorder is a risk factor for excess mortality, and 3) to show that this latter explanation is largely explain by biomedical frailty.The Netherlands Study of Depression in Older persons (NESDO) is a clinical cohort of 378 depressed patients according to DSM-IV criteria and 132 non-depressed controls who have been followed up for six-year. The data of this cohort study enabled us to construct a frailty index based on 41 non-depression related health deficits. Linear mixed models showed that the frailty index had a significantly steeper increase over six years among depressed patients compared to their non-depressed counterparts.Subsequently, we constructed a frailty index based on 64 health deficits in the LifeLines cohort study, a three-generation population-based study including 167,000 persons. In this population-based cohort, we replicated our finding that the presence of a depressive disorder according to DSM-IV criteria, but also anxiety disorders, were associated with an accelerated increase of the frailty index over a 5-year follow-up. Furthermore, Cox-regression showed that the presence of a depressive disorder or any anxiety disorder was also associated with excess mortality over a 10-year follow-up. These effects remained significant when adjusted for socio-demographic characteristics, lifestyle variables and multimorbidity, but disappeared when adjusted for the frailty index.We conclude that depressive disorder can indeed be conceptualised as a disorder of accelerated biological ageing, as indexed by the frailty index. Moreover, biomedical frailty may be an explanatory factor for excess mortality found to be associated with affective disorders. Therefore, biomedical frailty seems a promising marker for risk stratification in geriatric psychiatry.

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Course of frailty stratified by physical and mental multimorbidity patterns: a 5-year follow-up of 92,640 participants of the LifeLines cohort study

BMC Medicine ◽

10.1186/s12916-021-01904-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

R. C. Oude Voshaar ◽

H. W. Jeuring ◽

M. K. Borges ◽

R. H. S. van den Brink ◽

R. M. Marijnissen ◽

...

Keyword(s):

Chronic Disease ◽

Older People ◽

Chronic Diseases ◽

Heart Diseases ◽

Frailty Index ◽

Disease Clusters ◽

Specific Disease ◽

The Impact ◽

Over Time

Abstract Background The frailty index (FI) is a well-recognized measurement for risk stratification in older people. Among middle-aged and older people, we examined the prospective association between the FI and mortality as well as its course over time in relation to multimorbidity and specific disease clusters. Methods A frailty index (FI) was constructed based on either 64 (baseline only) or 35 health deficits (baseline and follow-up) among people aged ≥ 40 years who participated in LifeLines, a prospective population-based cohort living in the Northern Netherlands. Among 92,640 participants, multivariable Cox proportional hazard models were fitted to study the hazard ratio (HR) of the FI at baseline, as well as for 10 chronic disease clusters for all-cause mortality over a 10-year follow-up. Among 55,426 participants, linear regression analyses were applied to study the impact of multimorbidity and of specific chronic disease clusters (independent variables) on the change of frailty over a 5-year follow-up, adjusted for demographic and lifestyle characteristics. Results The FI predicted mortality independent of multimorbidity and specific disease clusters, with the highest impact in people with either endocrine, lung, or heart diseases. Adjusted for demographic and lifestyle characteristics, all chronic disease clusters remained independently associated with an accelerated increase of frailty over time. Conclusions Frailty may be seen as a final common pathway for premature death due to chronic diseases. Our results suggest that initiating frailty prevention at middle age, when the first chronic diseases emerge, might be relevant from a public health perspective.

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Impacts of heart disease, depression and their combination on all-cause mortality in older people: a rural community-based cohort study in China

BMJ Open ◽

10.1136/bmjopen-2020-038341 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038341

Author(s):

Weiju Zhou ◽

Alex Hopkins ◽

M Justin Zaman ◽

Xuguang (Grant) Tao ◽

Amanda Rodney ◽

...

Keyword(s):

Cohort Study ◽

Heart Disease ◽

Older People ◽

Rural Areas ◽

Cox Regression ◽

Population Based ◽

Computer Assisted ◽

All Cause Mortality ◽

The Impact

ObjectiveTo assess the impact of heart disease (HD) combined with depression on all-cause mortality in older people living in the community.DesignA population-based cohort study.ParticipantsWe examined the data of 1429 participants aged ≥60 years recruited in rural areas in Anhui province, China. Using a standard method of interview, we documented all types of HD diagnosed by doctors and used the validated Geriatric Mental Status-Automated Geriatric Examination for Computer Assisted Taxonomy algorithm to diagnose any depression for each participant at baseline in 2003. The participants were followed up for 8 years to identify vital status.MeasurementsWe sought to examine all-cause mortality rates among participants with HD only, depression only and then their combination compared with those without these diseases using multivariate adjusted Cox regression models.Results385 deaths occurred in the cohort follow-up. Participants with baseline HD (n=91) had a significantly higher mortality (64.9 per 1000 person-years) than those without HD (42.9). In comparison to those without HD and depression, multivariate adjusted HRs for mortality in the groups of participants who had HD only, depression only and both HD and depression were 1.46 (95% CI 0.98 to 2.17), 1.79 (95% CI 1.28 to 2.48) and 2.59 (95% CI 1.12 to 5.98), respectively.ConclusionOlder people with both HD and depression in China had significantly increased all-cause mortality compared with those with HD or depression only, and without either condition. Psychological interventions should be taken into consideration for older people and those with HD living in the community to improve surviving outcome.

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Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people

Aging Clinical and Experimental Research ◽

10.1007/s40520-019-01383-4 ◽

2019 ◽

Vol 32 (10) ◽

pp. 2013-2019 ◽

Cited By ~ 3

Author(s):

Marika Salminen ◽

Anna Viljanen ◽

Sini Eloranta ◽

Paula Viikari ◽

Maarit Wuorela ◽

...

Keyword(s):

Confidence Interval ◽

Older People ◽

Cox Regression ◽

Frailty Index ◽

Community Dwelling ◽

Clinical Settings ◽

Follow Up Study ◽

Community Dwelling Older People ◽

A Prospective Study

Abstract Background There is a lack of agreement about applicable instrument to screen frailty in clinical settings. Aims To analyze the association between frailty and mortality in Finnish community-dwelling older people. Methods This was a prospective study with 10- and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood’s frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used. Results Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10–12.41] in 10-year follow-up, and 6.32 [4.17–9.57] in 18-year follow-up) and FI (5.97 [4.13–8.64], and 3.95 [3.16–4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78–2.69], and 1.69 [1.46–1.96]; FI 1.81[1.25–2.62], and 1.31 [1.07–1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10- (4.41 [3.55–5.34]) and 18-year follow-ups (3.78 [3.19–4.49]). Discussion Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people. Conclusions FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.

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