Associations between the SHARE frailty phenotype and common frailty characteristics: evidence from a large Danish population study

Abstract

ObjectivesFrailty is a major clinical geriatric syndrome associated with serious adverse events including functional disability, falls, hospitalisation, increased morbidity and mortality. The aim of this study was to study associations between a frailty phenotype and frailty characteristics well known from the literature.DesignRegistry-based cross-sectional study.SettingThe target population consists of inhabitants above the age of 50 living in the Danish municipalities of Lolland and Guldborgsund. Excluded are incapacitated people, inhabitants unable to understand Danish or English and inhabitants without a permanent residence.Participants7327 individuals aged 50+ years were included.Outcome measuresWe examined associations between the frailty measurement and factors known to be associated with frailty: sex, age, income insufficiency, education, comorbidity, self-assessed health, morbidity and mortality.Results7327 individuals aged 50+ years were included. Of these, 6.5% had ≥3 frailty components (frail), 46.7% had 1–2 components (prefrail) and 46.9% had none (non-frail). Those who were frail were older and more likely female than those who were non-frail or prefrail. There was a stepwise decrease in educational level, and in self-assessed health with increasing frailty status, and a stepwise increase in difficulty in making ends meet, number of hospital contacts and mortality with increasing frailty status, p<0.0001 for each comparison. Compared with individuals who were non-frail, mortality was higher among those who were prefrail (HR: 2.90; 95% CI: 1.30 to 6.43) or frail (HR: 8.21; 95% CI: 3.37 to 20.0).ConclusionsBased on these findings, we consider the Lolland-Falster Health Study frailty assessment a valid instrument demonstrating the same characteristics as other validated frailty measures concerning associations with sex, age, income insufficiency, education, comorbidity, self-assessed health, morbidity and mortality.Trial registration numberNCT02482896.

Peer Review #1 of "Using the FRAIL scale to compare pre-existing demographic lifestyle and medical risk factors between non-frail, pre-frail and frail older adults accessing primary health care: a cross-sectional study (v0.1)"

“…Those studies that just assessed trends (Abizanda et al, 2011;Hoogendijk et al, 2016;Langholz et al, 2018;Jacobsen et al, 2019) Manuscript to be reviewed may be related to income, obtaining a similar result to ours. However, other factors studied included clinical and social conditions (attending a healthcare center or hospital, feeling lonely, self-perceived health …), which are not comparable to the factors evaluated in our study (Abizanda et al, 2011;Hoogendijk et al, 2016;Langholz et al, 2018;Jacobsen et al, 2019).…”

“…However, recent longitudinal studies have determined that 8.2-18.2% of older adults in pre-frailty progress to frailty over a mean period of approximately 5 years (Doi et al, 2018;Herr et al, 2019;Kojima et al, 2019), with the risk of this transition increasing with exhaustion, physical inactivity, decreased muscle strength and decreased mobility (Doi et al, 2018). Many studies have assessed the factors associated with both frailty and pre-frailty (Abizanda et al, 2011;Hoogendijk et al, 2016;Langholz et al, 2018;Jacobsen et al, 2019), determining whether there is a trend between a greater degree of frailty and each individual factor studied (trend test), that is, considering the stage of frailty to be an ordinal variable. This, however, does not enable us to draw conclusions about possible differences between the stages of frailty.…”

Using the FRAIL scale to compare pre-existing demographic lifestyle and medical risk factors between non-frail, pre-frail and frail older adults accessing primary health care: a cross-sectional study

“…These studies also assessed various other factors, such as educational level, which may be related to income, obtaining a similar result to ours. However, other factors studied included clinical and social conditions (attending a healthcare center or hospital, feeling lonely, self-perceived health…), which are not comparable to the factors evaluated in our study (Abizanda et al, 2011;Hoogendijk et al, 2016;Langholz et al, 2018;Jacobsen et al, 2019).…”

“…Those studies that just assessed trends (Abizanda et al, 2011;Hoogendijk et al, 2016;Langholz et al, 2018;Jacobsen et al, 2019) mainly used the Fried phenotype. Comparison of their results with the factors also used by us shows total concordance for age, female sex and the number of comorbidities.…”

Questionnaire development for the Lolland-Falster Health Study, Denmark: an iterative and incremental process

“…However, affiliated subprojects are encouraged to validate the scales from which they use data and to discuss validity in their papers. Some of this work has already been published [22][23][24]. We acknowledge that the experiences and recommendations in this article are based on a single project.…”