Comparison between Frailty Index of Deficit Accumulation and Phenotypic Model to Predict Risk of Falls: Data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton Cohort

Abstract Background frailty is a public health priority now that the global population is ageing at a rapid rate. A scientifically sound tool to measure frailty and generate population-based reference values is a starting point. Objective in this report, our objectives were to operationalize frailty as deficit accumulation using a standard frailty index (FI), describe levels of frailty in Canadians ≥45 years old and provide national normative data. Design this is a secondary analysis of the Canadian Longitudinal Study on Aging (CLSA) baseline data. Setting/participants about 51,338 individuals (weighted to represent 13,232,651 Canadians), aged 45–85 years, from the tracking and comprehensive cohorts of CLSA. Methods after screening all available variables in the pooled dataset, 52 items were selected to construct an FI. Descriptive statistics for the FI and normative data derived from quantile regressions were developed. Results the average age of the participants was 60.3 years (95% confidence interval [CI]: 60.2–60.5), and 51.5% were female (95% CI: 50.8–52.2). The mean FI score was 0.07 (95% CI: 0.07–0.08) with a standard deviation of 0.06. Frailty was higher among females and with increasing age, and scores >0.2 were present in 4.2% of the sample. National normative data were identified for each year of age for males and females. Conclusions the standardized frailty tool and the population-based normative frailty values can help inform discussions about frailty, setting a new bar in the field. Such information can be used by clinicians, researchers, stakeholders and the general public to understand frailty, especially its relationship with age and sex.

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Associations between life-course frailty and later-life heart size and function in the 1946 NSHD British birth cohort-an epidemiological study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2835 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C.C Topriceanu ◽

J.C Moon ◽

R Hardy ◽

A.D Hughes ◽

N Chaturvedi ◽

...

Keyword(s):

Life Course ◽

Birth Cohort ◽

Frailty Index ◽

Later Life ◽

Left Ventricular ◽

Step Change ◽

Deficit Accumulation ◽

Heart Size ◽

And Function ◽

The Life Course

Abstract Background Cardiovascular diseases are an important component of the multi-morbidity syndrome which is associated with negative health outcomes resulting in a major societal economic burden. An objective way to assess multi-morbidity is to calculate a frailty index based on medical deficit accumulation. Late-life frailty has been validated to predict mortality, but little is known about the association between life-course frailty and cardiovascular health in later-life. Purpose To study the association between life-course frailty and later-life heart size and function using data from the world's longest running birth cohort with continuous follow-up. Methods A 45-deficit frailty index (FI) was calculated at 4 age-intervals across the life-course (0 to 16 years old, 19 to 44 years old, 45 to 54 years old and 60 to 64 years old) in participants from the UK 1946 Medical Research Council (MRC) National Survey of Heath and Development (NSHD) birth cohort. The life-course frailty indices (FI0_16, FI19_44, FI45_54 and FI60_64) reflect the cumulative medical deficits at the corresponding age-intervals. They were used to derive FImean and FIsum reflecting overall-life frailty. The step change in deficit accumulation between age-intervals was also calculated (FI2-1, FI3-1, FI4-1, FI3-2, FI4-2, FI4-3). Echocardiographic data at 60–64 years provided: E/e' ratio, ejection fraction (EF), myocardial contraction fraction index (MCFi) and left ventricular mass index (LVmassi). Generalized linear mixed models with gamma distribution and log link assessed the association between FIs and echo parameters after adjustment for sex, socio-economic position and body mass index. Results 1.805 NSHD participants were included (834 male). Accumulation of a single deficit had a significant impact (p<0.0001 to p<0.049) on LVmassi and MCFi in all the life-course FIs and overall FIs. LVmassi increased by 0.89% to 1.42% for the life-course FIs and by 0.36%/1.82% for FIsum and FImean respectively. MCFi decreased by 0.62% to 1.02% for the life-course FIs and by 0.33%/ 1.04%. for FIsum and FImean respectively. One accumulated deficit translated into higher multiplicative odds (13.2 for FI60-64, 2.1 for FI4-1, 75.4 for FI4-2 and 78.5 for FI4-3) of elevated filling pressure (defined as E/e' ratio >13, p<0.0.005 to p<0.02).A unit increase in frailty decreased LV EF (%) by 11%/12% for FI45-54 and FI60-64 respectively, by 10% to 12% for FI2-1, FI3-1, FI4-1 and FI4-2, and 4%/15% for FIsum and FImean respectively (p<0.0014 to p<0.044). Conclusion Frailty during the life-course, overall life-frailty and the step change in deficit accumulation is associated with later-life cardiac dysfunction. Frailty strain appears to have its greatest impact on pathological myocardial hypertrophy (high LVmassi and low MCFi) potentially paving the way to later-life systolic or diastolic dysfunction in susceptible individuals. Funding Acknowledgement Type of funding source: None

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Poor appetite and long-term risk of falls among middle-aged and older adults: A longitudinal study

European Journal of Public Health ◽

10.1093/eurpub/cky214.011 ◽

2018 ◽

Vol 28 (suppl_4) ◽

Author(s):

YC Lin ◽

YH Chang

Keyword(s):

Older Adults ◽

Longitudinal Study ◽

Middle Aged ◽

Poor Appetite ◽

Risk Of Falls

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444Frailty status and all-cause mortality in the community-dwelling individuals: An umbrella review

International Journal of Epidemiology ◽

10.1093/ije/dyab168.190 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

A R M Saifuddin Ekram ◽

Joanne Ryan ◽

Carlene Britt ◽

Sara Espinoza ◽

Robyn Woods

Keyword(s):

Systematic Reviews ◽

Critical Appraisal ◽

Frailty Index ◽

Community Dwelling ◽

Umbrella Review ◽

Deficit Accumulation ◽

Frailty Phenotype ◽

Essential Information ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Frailty is increasingly recognised for its association with adverse health outcomes, including mortality. However, various measures are used to assess frailty, and the strength of association could vary depending on the specific definition used. This umbrella review aims to map which frailty scale can best predict the relationship between frailty and all-cause mortality among community-dwelling older people. Methods A protocol was registered at PROSPERO, and it was conducted following the PRISMA statement. MEDLINE, Embase, PubMed, Cochrane Database of Systematic Reviews, Joanna Briggs Institute (JBI) EBP database, and Web of Science database was searched. Methodological quality was assessed using the JBI critical appraisal checklist and online AMSTAR-2 critical appraisal checklist. For eligible studies, essential information was extracted and synthesized qualitatively. Results Five systematic reviews were included, with a total of 434,115 participants. Three systematic reviews focused on single frailty scales; one evaluated Fried's physical frailty phenotype and its modifications; another focused on the deficit accumulation frailty index. The third evaluated the FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale. The two other systematic reviews determined the association between frailty and mortality using different frailty scales. All of the systematic reviews found that frailty was significantly associated with all-cause mortality. Conclusion This umbrella review demonstrates that frailty is a significant predictor of all-cause mortality, irrespective of the specific frailty scale. Key messages Frailty is associated with an increased risk of all-cause mortality in community-dwelling individuals signifying the importance of assessment in the primary healthcare setting.

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Frailty in Caregivers and Its Relationship with Psychological Stress and Resilience: A Cross-Sectional Study Based on the Deficit Accumulation Model

Journal of Frailty & Aging ◽

10.14283/jfa.2021.29 ◽

2021 ◽

pp. 1-8

Author(s):

M. F.S. Bersani ◽

F.S. Bersani ◽

F. Sciancalepore ◽

M. Salzillo ◽

M. Cesari ◽

...

Keyword(s):

Psychological Stress ◽

Frailty Index ◽

Cross Sectional Study ◽

Sectional Study ◽

Deficit Accumulation ◽

Cross Sectional ◽

Accumulation Model ◽

Emotional Strain ◽

Relationship Of ◽

The Relationship

Background: Studies increasingly suggest that chronic exposure to psychological stress can lead to health deterioration and accelerated ageing, thus possibly contributing to the development of frailty. Recent approaches based on the deficit accumulation model measure frailty on a continuous grading through the “Frailty Index” (FI), i.e. a macroscopic indicator of biological senescence and functional status. OBJECTIVES: The study aimed at testing the relationship of FI with caregiving, psychological stress, and psychological resilience. DESIGN: Cross-sectional study, with case-control and correlational analyses. PARTICIPANTS: Caregivers of patients with dementia (n=64), i.e. individuals a priori considered to be exposed to prolonged psychosocial stressors, and matched controls (n=64) were enrolled. MEASUREMENTS: The two groups were compared using a 38-item FI condensing biological, clinical, and functional assessments. Within caregivers, the association of FI with Perceived Stress Scale (PSS) and Brief Resilience Scale (BRS) was tested. RESULTS: Caregivers had higher FI than controls (F=8.308, p=0.005). FI was associated directly with PSS (r=0.660, p<0.001) and inversely with BRS (r=-0.637, p<0.001). Findings remained significant after adjusting for certain confounding variables, after excluding from the FI the conditions directly related to psychological stress, and when the analyses were performed separately among participants older and younger than 65 years. CONCLUSIONS: The results provide insight on the relationship of frailty with caregiving, psychological stress, and resilience, with potential implications for the clinical management of individuals exposed to chronic emotional strain.

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83 A Deficit Accumulation Frailty Index Predicts Mortality in Older South Africans: Findings from the HAALSI Study

Age and Ageing ◽

10.1093/ageing/afz192.01 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i27-i27

Author(s):

F J Barker ◽

J I Davies ◽

F X Gomez-Olive ◽

K Kahn ◽

F E Matthews ◽

...

Keyword(s):

South Africa ◽

Older People ◽

Frailty Index ◽

Cox Proportional Hazards ◽

Sub Saharan Africa ◽

Deficit Accumulation ◽

South Africans ◽

Risk Of Death ◽

The Mean ◽

Cumulative Deficit

Abstract Introduction Few studies have investigated frailty in older people in sub-Saharan Africa, yet such information is vital to prepare responses to rapid population ageing. We aimed to derive and test a cumulative deficit frailty index in a population of older people from rural South Africa. Methods We analysed data from the Health and Ageing in Africa: Longitudinal Studies of an INDEPTH Community (HAALSI) study, which enrolled participants aged 40 years and older nested within the Agincourt Health and Demographic Survey Site, South Africa. We created a 32-variable cumulative deficit frailty index using questionnaire (illnesses, symptoms and activities of daily living), physical performance and physiological indices, and blood test results. Each variable was dichotomised to 1 (deficit) or 0 (no deficit). The frailty index for each individual was calculated as the mean of all frailty variables. Frailty categories were defined using cut-offs from the UK electronic frailty index: 0-0.12 (non-frail), >0.12-0.24 (mild frailty), >0.24-0.36 (moderate frailty) and >0.36 (severe frailty). Cox proportional hazards models, both unadjusted and adjusted for age and sex, were fitted to test the association between frailty status and all-cause mortality. Results We analysed data from 3989 participants, mean age 61 years (SD 13); 2175 (54.5%) were female. The mean follow-up period was 17 months; 1464 (36.7%) were non-frail, 2059 (51.6%) had mild frailty, 402 (10.1%) had moderate frailty and 64 (1.6%) had severe frailty. A total of 135 (3.4%) died. Adjusted Cox models showed worse frailty category was associated with higher risk of death compared with non-frail individuals: hazard ratios 1.94 (95% CI 1.23, 3.07) for mild frailty, 3.25 (95% CI 1.86, 5.68) for moderate frailty, and 5.50 (95% CI 2.44, 12.40) for severe frailty. Conclusions Frailty measured by a cumulative deficits index is common and predicts mortality in a rural population of older South Africans.

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THE EFFECTS OF FRAILTY, POLYPHARMACY, AND COGNITION ON HEALTH OUTCOMES: A STUDY ON INTERRAI RESIDENTIAL CARE DATA

Innovation in Aging ◽

10.1093/geroni/igz038.330 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S86-S86

Author(s):

Macy Zou ◽

Ronald Kelly ◽

Betty Chinda ◽

Mckenzie Braley ◽

Tony Zhang ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Residential Care ◽

Frailty Index ◽

Interactive Effects ◽

Deficit Accumulation ◽

Emergency Visits ◽

Ongoing Research ◽

Risk Of Death ◽

Increased Risk

Abstract Frailty Index (FI), polypharmacy and cognition status are significant health concerns in older adults. We conducted this study to investigate the interplay of frailty, polypharmacy, and cognition, in determining health outcomes. InterRAI Residential Care (RAI-RC MDS2.0) data were retrieved from residential care homes in Surrey, BC, Canada. Older residents (65+ years) who had RAI-RC records between 2016 and 2018 were used in the analysis (n=976). A deficit accumulation-based FI was generated using 36 variables. Information on polypharmacy and cognition were obtained by accounting the total number of medications and the cognitive performance scale. Information on falls, emergency visits, and mortality were followed. Multivariate Cox proportional hazard models were used to examine the effects of these variables on different outcomes. The FI showed a near Gaussian distribution (median= 0.370 mean= 0.372 SD= 0.143), and increased linearly with age on a logarithm scale (R=0.75, p<0.001). Residents with cognitive impairment showed a higher level of the FI (KW= 863.3, p<0.001). A higher FI was associated with an increased risk of death (HR=15.2 p=0.006) and emergency visits (HR=2.72 p=0.048), adjusting for age, sex, medications, and education levels. Frailty, polypharmacy, and cognition levels are associated and have interactive effects on health outcomes. Ongoing research is to validate the findings with large samples in different health settings, and to understand the underlying processes of the effect. The close relationships between frailty, polypharmacy, and cognition with health outcomes call for effective integrated strategies for healthcare of older adults with multiple complex health problems.

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Polypharmacy is a risk factor for hospital admission due to a fall: evidence from the English Longitudinal Study of Ageing

BMC Public Health ◽

10.1186/s12889-020-09920-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

P. Zaninotto ◽

Y. T. Huang ◽

G. Di Gessa ◽

J. Abell ◽

C. Lassale ◽

...

Keyword(s):

Older Adults ◽

Longitudinal Study ◽

Older People ◽

Hospital Admission ◽

Prescription Drugs ◽

Hospital Admissions ◽

Competing Risk ◽

Risk Of Falls ◽

Nationally Representative ◽

English Longitudinal Study

Abstract Background Falls amongst older people are common; however, around 40% of falls could be preventable. Medications are known to increase the risk of falls in older adults. The debate about reducing the number of prescribed medications remains controversial, and more evidence is needed to understand the relationship between polypharmacy and fall-related hospital admissions. We examined the effect of polypharmacy on hospitalization due to a fall, using a large nationally representative sample of older adults. Methods Data from the English Longitudinal Study of Ageing (ELSA) were used. We included 6220 participants aged 50+ with valid data collected between 2012 and 2018.The main outcome measure was hospital admission due to a fall. Polypharmacy -the number of long-term prescription drugs- was the main exposure coded as: no medications, 1–4 medications, 5–9 medications (polypharmacy) and 10+ medications (heightened polypharmacy). Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for common confounders, including multi-morbidity and fall risk-increasing drugs. Results The prevalence of people admitted to hospital due to a fall increased according to the number of medications taken, from 1.5% of falls for people reporting no medications, to 4.7% of falls among those taking 1–4 medications, 7.9% of falls among those with polypharmacy and 14.8% among those reporting heightened polypharmacy. Fully adjusted SHRs for hospitalization due to a fall among people who reported taking 1–4 medications, polypharmacy and heightened polypharmacy were 1.79 (1.18; 2.71), 1.75 (1.04; 2.95), and 3.19 (1.61; 6.32) respectively, compared with people who were not taking medications. Conclusions The risk of hospitalization due to a fall increased with polypharmacy. It is suggested that prescriptions in older people should be revised on a regular basis, and that the number of medications prescribed be kept to a minimum, in order to reduce the risk of fall-related hospital admissions.

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Evaluation of Clinically Meaningful Changes in Measures of Frailty

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa003 ◽

2020 ◽

Vol 75 (6) ◽

pp. 1143-1147 ◽

Cited By ~ 2

Author(s):

Il-Young Jang ◽

Hee-Won Jung ◽

Hea Yon Lee ◽

Hyungchul Park ◽

Eunju Lee ◽

...

Keyword(s):

Older Adults ◽

Clinical Trials ◽

Clinical Care ◽

Frailty Index ◽

Large Change ◽

Community Dwelling ◽

Deficit Accumulation ◽

Frailty Phenotype ◽

Euroqol 5D ◽

Community Dwelling Older Adults

Abstract Background To determine the clinically meaningful changes and responsiveness of widely used frailty measures. Methods We analyzed data from a prospective cohort study of 1,135 community-dwelling older adults who underwent assessments of frailty and health-related quality of life using the EuroQol-5D at baseline and 1 year later. Frailty measures included deficit-accumulation frailty index (FI); frailty phenotype; Fatigue, Resistance, Ambulation, Illness, and Loss of Weight scale; and the Study of Osteoporotic Fracture (SOF) index. We determined the clinically meaningful changes by the distribution-based method and the anchor-based method using the EuroQol-5D score and responsiveness indices. Results Frailty measures were available in 925 participants at 1 year (81.5%). Based on the distribution-based method, small and large clinically meaningful changes were 0.019 and 0.057 for FI, 0.249 and 0.623 for frailty phenotype, 0.235 and 0.587 for FRAIL scale, and 0.116 and 0.289 for SOF index, respectively. The anchor-based estimates of small and large changes were 0.028 and 0.076 for FI, 0.097 and 0.607 for frailty phenotype, 0.269 and 0.368 for FRAIL scale, and 0.023 and 0.287 for SOF index, respectively. Based on the responsiveness index, per-group sample sizes to achieve 80% power in clinical trials, ranged from 51 (FI) to 7,272 (SOF index) for a small change and 9 (FI) to 133 (FRAIL scale) for a large change. Conclusions The estimates of clinically meaningful change of frailty measures can inform the choice of frailty measures to track longitudinal changes of frailty in clinical trials and clinical care of community-dwelling older adults.

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