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Analysis of frailty and survival from late middle age in the Beijing Longitudinal Study of Aging
Jing Shi, Xiaowei Song, Pulin Yu, Zhe Tang, Arnold Mitnitski, Xianghua Fang, Kenneth Rockwood
BMC Geriatrics , 2011, DOI: 10.1186/1471-2318-11-17
Abstract: This study analyzed data from the Beijing Longitudinal Study of Aging, to evaluate the relationship between age and deficit accumulation in men and women and to evaluate the impact of frailty on mortality. Community dwelling people aged 55+ years at baseline (n = 3275) were followed every two to three years between 1992 and 2000, during which time 36% died. A Frailty Index was constructed using 35 deficits, drawn from a range of health problems, including symptoms, disabilities, disease, and psychological difficulties.Most deficits increased the eight-year risk of death and were more lethal in men than in women, although women had a higher mean level of frailty (Frailty Index = 0.11 ± 0.10 for men, 0.14 ± 0.12 for women). The Frailty Index increased exponentially with age, with a similar rate in men and women (0.038 vs. 0.039; r > 0.949, P < 0.01). A dose-response relationship was observed as frailty increased.A Frailty Index employed in a Chinese sample, showed properties comparable with Western data, but deficit accumulation appeared to be more lethal than in the West.As populations age, on average, the need for health care increases. Even so, that average increase masks considerable heterogeneity, a topic of increasing relevance to health care planners. Heterogeneity of health and vulnerability to adverse outcomes in people of the same chronological age is commonly referred to as frailty [1].Despite a growing research literature on frailty, several operational definitions of frailty are employed. Notably, frailty in individuals can be operationalized as a phenotype or as the accumulation of deficits [2-4]. The deficit accumulation approach is based on the observation that as people age, they experience problems which can accumulate. As deficits (symptoms, signs, illnesses, disabilities) accumulate, people become more susceptible to adverse health outcomes, including worse health and even death. Counting deficits allows grades of frailty to be discerned. It also p
A Self-Reported Screening Tool for Detecting Community-Dwelling Older Persons with Frailty Syndrome in the Absence of Mobility Disability: The FiND Questionnaire  [PDF]
Matteo Cesari, Laurent Demougeot, Henri Boccalon, Sophie Guyonnet, Gabor Abellan Van Kan, Bruno Vellas, Sandrine Andrieu
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0101745
Abstract: Background The “frailty syndrome” (a geriatric multidimensional condition characterized by decreased reserve and diminished resistance to stressors) represents a promising target of preventive interventions against disability in elders. Available screening tools for the identification of frailty in the absence of disability present major limitations. In particular, they have to be administered by a trained assessor, require special equipment, and/or do not discriminate between frail and disabled individuals. Aim of this study is to verify the agreement of a novel self-reported questionnaire (the “Frail Non-Disabled” [FiND] instrument) designed for detecting non-mobility disabled frail older persons with results from reference tools. Methodology/Principal Findings Data are from 45 community-dwelling individuals aged ≥60 years. Participants were asked to complete the FiND questionnaire separately exploring the frailty and disability domains. Then, a blinded assessor objectively measured the frailty status (using the phenotype proposed by Fried and colleagues) and mobility disability (using the 400-meter walk test). Cohen's kappa coefficients were calculated to determine the agreement between the FiND questionnaire with the reference instruments. Mean age of participants (women 62.2%) was 72.5 (standard deviation 8.2) years. Seven (15.6%) participants presented mobility disability as being unable to complete the 400-meter walk test. According to the frailty phenotype criteria, 25 (55.6%) participants were pre-frail or frail, and 13 (28.9%) were robust. Overall, a substantial agreement of the instrument with the reference tools (kappa = 0.748, quadratic weighted kappa = 0.836, both p values<0.001) was reported with only 7 (15.6%) participants incorrectly categorized. The agreement between results of the FiND disability domain and the 400-meter walk test was excellent (kappa = 0.920, p<0.001). Conclusions/Significance The FiND questionnaire presents a very good capacity to correctly identify frail older persons without mobility disability living in the community. This screening tool may represent an opportunity for diffusing awareness about frailty and disability and supporting specific preventive campaigns.
Reduced Health-Related Quality of Life in Elders with Frailty: A Cross-Sectional Study of Community-Dwelling Elders in Taiwan  [PDF]
Cheng-Chieh Lin,Chia-Ing Li,Chiu-Kai Chang,Chiu-Shong Liu,Chih-Hsueh Lin,Nai-Hsin Meng,Yih-Dar Lee,Fei-Na Chen,Tsai-Chung Li
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0021841
Abstract: Exploring the domains and degrees of health-related quality of life (HRQOL) that are affected by the frailty of elders will help clinicians understand the impact of frailty. This association has not been investigated in community-dwelling elders. Therefore, we examined the domains and degree of HRQOL of elders with frailty in the community in Taiwan.
A Theoretical Perspective on the Conceptualisation and Usefulness of Frailty and Vulnerability Measurements in Community Dwelling Older Persons
NICO DE WITTE,LIESBETH DE DONDER,SARAH DURY,TINE BUFFEL
Aporia : The Nursing Journal , 2013,
Abstract: Population ageing is affecting all Western countries. In order to cope with this challenge, governments focus mainly on ageing in place. Detection of frail or vulnerable older people becomes essential in order to provide appropriate support and prevent adverse outcomes. In this article we review the main paradigms on detecting frail or vulnerable older people living in the community, examine the theoretical gaps and develop new research possibilities. While there is increasing literature on frailty and vulnerability in later life, both concepts are still developing. The key question is: to what extent the actual concepts of frailty or vulnerability are appropriate to detect frail/vulnerable community dwelling older persons? The different concepts trying to capture frailty and vulnerability are criticized. Conclusively, the article highlights the need for a new integrated conceptual model for detecting community dwelling frail or vulnerable older persons including physical, psychological, social and environmental variables.
A reliable measure of frailty for a community dwelling older population
Shahrul Kamaruzzaman, George B Ploubidis, Astrid Fletcher, Shah Ebrahim
Health and Quality of Life Outcomes , 2010, DOI: 10.1186/1477-7525-8-123
Abstract: The British Women's Heart and Health Study (BWHHS) cohort of 4286 women aged 60-79 years from 23 towns in Britain provided 35 frailty indicators expressed as binary categorical variables. These indicators were corrected for measurement error and assigned relative weights in its association with frailty. Exploratory factor analysis (EFA) reduced the data to a smaller number of factors and was subjected to confirmatory factor analysis (CFA)which restricted the model by fitting the EFA-driven structure to observed data. Cox regression analysis compared the hazard ratios for adverse outcomes of the newly developed British frailty index (FI) with a widely known FI. This process was replicated in the MRC Assessment study of older people, a larger cohort drawn from 106 general practices in Britain.Seven factors explained the association between frailty indicators: physical ability, cardiac symptoms/disease, respiratory symptoms/disease, physiological measures, psychological problems, co-morbidities and visual impairment. Based on existing concepts and statistical indices of fit, frailty was best described using a General Specific Model. The British FI would serve as a better population metric than the FI as it enables people with varying degrees of frailty to be better distinguished over a wider range of scores. The British FI was a better independent predictor of all-cause mortality, hospitalization and institutionalization than the FI in both cohorts.Frailty is a multidimensional concept represented by a wide range of latent (not directly observed) attributes. This new measure provides more precise information than is currently recognized, of which cluster of frailty indicators are important in older people. This study could potentially improve quality of life among older people through targeted efforts in early prevention and treatment of frailty.Identifying frail elderly people in clinical practice or in the wider population through various aspects of their health and
Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review
Joan Vermeulen, Jacques CL Neyens, Erik van Rossum, Marieke D Spreeuwenberg, Luc P de Witte
BMC Geriatrics , 2011, DOI: 10.1186/1471-2318-11-33
Abstract: A systematic search was performed in 3 databases (PubMed, CINAHL, EMBASE) from January 1975 until April 2010. Prospective, longitudinal studies that assessed the predictive value of individual physical frailty indicators on ADL disability in community-dwelling elderly people aged 65 years and older were eligible for inclusion. Articles were reviewed by two independent reviewers who also assessed the quality of the included studies.After initial screening of 3081 titles, 360 abstracts were scrutinized, leaving 64 full text articles for final review. Eventually, 28 studies were included in the review. The methodological quality of these studies was rated by both reviewers on a scale from 0 to 27. All included studies were of high quality with a mean quality score of 22.5 (SD 1.6). Findings indicated that individual physical frailty indicators, such as weight loss, gait speed, grip strength, physical activity, balance, and lower extremity function are predictors of future ADL disability in community-dwelling elderly people.This review shows that physical frailty indicators can predict ADL disability in community-dwelling elderly people. Slow gait speed and low physical activity/exercise seem to be the most powerful predictors followed by weight loss, lower extremity function, balance, muscle strength, and other indicators. These findings should be interpreted with caution because the data of the different studies could not be pooled due to large variations in operationalization of the indicators and ADL disability across the included studies. Nevertheless, our study suggests that monitoring physical frailty indicators in community-dwelling elderly people might be useful to identify elderly people who could benefit from disability prevention programs.In ageing Western societies, the prevalence of frailty and its adverse outcomes increases [1]. Disability in Activities of Daily Living (ADL), which are the essential activities that a person needs to perform to be able to
Sensitivity and Specificity of a Short Questionnaire to Screen Frailty in the Community-Dwelling Older Population  [PDF]
Alessandra Capanna, Paola Scarcella, Francesco Gilardi, Sandro Mancinelli, Leonardo Palombi, Maria Cristina Marazzi, Fabio Riccardi, Giuseppe Liotta
Advances in Aging Research (AAR) , 2018, DOI: 10.4236/aar.2018.73005
Abstract: Introduction. Frailty represents a major risk factor for death and Use of Hospital Services (UHS) among older adults. A simple tool to detect frailty might permit stratification of the community-dwelling older population according to the risk of negative outcomes. The present study aims at determining the sensitivity and specificity in predicting mortality and UHS of the Short Functional Geriatric Evaluation (SFGE), a short questionnaire to screen for frailty in community-dwelling older citizens. Methods. The study is a secondary analysis of all the data collected through an observational longitudinal cohort study carried out in Lazio region (Italy). The SFGE is compared with the Functional Geriatric Evaluation (FGE) questionnaire to define sensitivity and specificity for mortality and for UHS during the first year following its administration. Results. The SFGE classifies 36.3% of the respondents as frail and shows a sensitivity of 90.4% and a specificity of 78.3% compared to the FGE (area under the ROC: 0.928; CL95%: 0.910 - 0.947; p-value < 0.001). Those respondents identified by the SFGE as frail also include some of those classified by the FGE as pre-frail, who also show a high rate of UHS. The results show that the SFGE score predicts the UHS more accurately than it does the mortality rate. Conclusion. The SFGE identifies as frail a larger portion of the enrolled population than the FGE. Those people so identified show a high rate of UHS. Because of its easy and quick administration, it can be considered a useful primary screening tool but it must be followed up with a more extensive assessment of those identified as frail. The small time needed to fill in the tool and the possibility of administering it by telephone makes the SFGE a useful tool to screen for frailty and to plan the provision of care services at both individual and population level.
Relationship between frailty and respiratory function in the community-dwelling elderly Estudo da rela o entre fragilidade e fun o respiratória em idosos comunitários  [cached]
Maycon S. Pegorari,Gualberto Ruas,Lislei J. Patrizzi
Brazilian Journal of Physical Therapy , 2013,
Abstract: OBJECTIVE: To evaluate the impact of frailty on respiratory function in a community- dwelling elderly. METHOD: 51 community-dwelling elderly were evaluated (mean age of 73±6 years), being 29 men (56.7%) and 22 women (43.3%). We collect the following variables: sociodemographic characteristics, frailty phenotype, pulmonary function test and assessment of the respiratory muscles using an analog manometer. The statistical analysis was performed using the Kolmogorov and Smirnov tests, one-way ANOVA, Paired Student's t-test and Pearson correlation coefficient (p<0.05). RESULTS: There were no statistically significant between-group differences among the frail group (FG=9.8%), pre-frail group (PG=47.1%) and non-frail group (NG=43.1%), in relation to anthropometric, demographic and spirometric data. Regarding to the maximum inspiratory and expiratory pressures (MIP and MEP), statistically significant between-group differences were observed among the three groups, being these pressures significantly lower in the FG and PG compared to the NG. With regards to the obtained and predicted values, the FG and PG showed statistically significant difference (p=0.004). The PG showed positive correlations between the MIP and MEP with the values of hand grip strength (r=0.7). The NG showed positive correlation between the MEP and the values of physical activity level (r=0.7). CONCLUSIONS: The study demonstrated that maximal respiratory pressures may decrease according to the frailty condition among the non-frail, pre-frail and frail elderly. Furthermore, it also indicated a positive correlation between inspiratory muscle strength, expiratory muscle strength and hand grip strength in pre-frail elderly. Further investigation with regards to prevention or intervention programs that incorporate actions to minimize the loss of respiratory function are necessary in order to reverse or prevent the progression of the frailty condition. OBJETIVO: Avaliar o impacto da fragilidade sobre a fun o respiratória em idosos comunitários. MéTODO: Foram avaliados 51 idosos comunitários (73±6 anos), sendo 29 homens (56,7%) e 22 mulheres (43,3%), por meio de aspectos sociodemográficos, fenótipo de fragilidade, prova de fun o pulmonar e manovacuometria analógica para os músculos respiratórios. Procedeu-se à análise estatística com os testes Kolmogorov e Smirnov, ANOVA one-way, t de Student Pareado e Coeficiente de Correla o de Pearson (p<0,05). RESULTADOS: N o houve diferen as significativas entre os grupos frágeis (GF=9,8%), pré-frágeis (GP=47,1%) e n o frágeis (GN=43,1%) em rela o aos dados
Patterns of Frailty in Older Adults: Comparing Results from Higher and Lower Income Countries Using the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Study on Global AGEing and Adult Health (SAGE)  [PDF]
Kenneth Harttgen, Paul Kowal, Holger Strulik, Somnath Chatterji, Sebastian Vollmer
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0075847
Abstract: We use the method of deficit accumulation to describe prevalent and incident levels of frailty in community-dwelling older persons and compare prevalence rates in higher income countries in Europe, to prevalence rates in six lower income countries. Two multi-country data collection efforts, SHARE and SAGE, provide nationally representative samples of adults aged 50 years and older. Forty items were used to construct the frailty index in each data set. Our study shows that the level of frailty was distributed along the socioeconomic gradient in both higher and lower income countries such that those individuals with less education and income were more likely to be frail. Frailty increased with age and women were more likely to be frail in most countries. Across samples we find that the level of frailty was higher in the higher income countries than in the lower income countries.
Frailty and Its Impact on Health-Related Quality of Life: A Cross-Sectional Study on Elder Community-Dwelling Preventive Health Service Users  [PDF]
Yaw-Wen Chang, Wei-Liang Chen, Fu-Gong Lin, Wen-Hui Fang, Ming-Yung Yen, Chia-Chuan Hsieh, Tung-Wei Kao
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0038079
Abstract: Background The purpose of this study was to identify the incidence of frailty and to investigate the relationship between frailty status and health-related quality of life (HRQoL) in the community-dwelling elderly population who utilize preventive health services. Methods People aged 65 years and older who visited a medical center in Taipei City from March to August in 2011 for an annual routine check-up provided by the National Health Insurance were eligible. A total of 374 eligible elderly adults without cognitive impairment had a mean age of 74.6±6.3 years. Frailty status was determined according to the Fried frailty criteria. HRQoL was measured with Short Form-36 (SF-36). Multiple regression analyses examined the relationship between frailty status and the two summary scales of SF-36. Models were adjusted for the participants' sociodemographic and health status. Results After adjusting for sociodemographic and health-related covariables, frailty was found to be more significantly associated (p<0.001) with lower scores on both physical and mental health-related quality of life summary scales compared with robustness. For the frailty phenotypes, slowness represented the major contributing factor in the physical component scale of SF-36, and exhaustion was the primary contributing factor in the mental component scale. Conclusion The status of frailty is closely associated with HRQoL in elderly Taiwanese preventive health service users. The impacts of frailty phenotypes on physical and mental aspects of HRQoL differ.
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