Changes in frailty status in a community-dwelling cohort of older adults: The VERISAÚDE study

Lorenzo-López, Laura; López-López, Rocío; Maseda, Ana; Buján, Ana; Rodríguez-Villamil, José Luis; Millán-Calentí, José Carlos

doi:10.1016/j.maturitas.2018.11.006

Cited by 59 publications

(82 citation statements)

References 44 publications

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“…Around 30% of persons aged ≥ 65 suffer from hearing loss, which might explain the increase in the domain hearing impairment . [ 35 ] Additionally, it seems to be consistent with other research which showed that hearing impairment is a main determinant of deterioration in frailty [ 36 ]. Next to hearing impairment, a diminished psychosocial functioning had a major contribution.…”

Section: Discussionsupporting

confidence: 87%

Transition in Frailty State Among Elderly Patients After Vascular Surgery

et al. 2020

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Background Frailty in the vascular surgical ward is common and predicts poor surgical outcomes. The aim of this study was to analyze transitions in frailty state in elderly patients after vascular surgery and to evaluate influence of patient characteristics on this transition. Methods Between 2014 and 2018, 310 patients, ≥65 years and scheduled for elective vascular surgery, were included in this cohort study. Transition in frailty state between preoperative and follow-up measurement was determined using the Groningen Frailty Indicator (GFI), a validated tool to measure frailty in vascular surgery patients. Frailty is defined as a GFI score ≥4. Patient characteristics leading to a transition in frailty state were analyzed using multivariable Cox regression analysis. Results Mean age was 72.7 ± 5.2 years, and 74.5% were male. Mean follow-up time was 22.7 ± 9.5 months. At baseline measurement, 79 patients (25.5%) were considered frail. In total, 64 non-frail patients (20.6%) shifted to frail and 29 frail patients (9.4%) to non-frail. Frail patients with a high Charlson Comorbidity Index (HR = 0.329 (CI: 0.133–0.812), p = 0.016) and that underwent a major vascular intervention (HR = 0.365 (CI: 0.154–0.865), p = 0.022) had a significantly higher risk to remain frail after the intervention. Conclusions The results of this study, showing that after vascular surgery almost 21% of the non-frail patients become frail, may lead to a more effective shared decision-making process when considering treatment options, by providing more insight in the postoperative frailty course of patients.

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Section: Discussionsupporting

confidence: 87%

Transition in Frailty State Among Elderly Patients After Vascular Surgery

et al. 2020

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“…The disability cascade is neither inevitable, unidirectional nor irreversible. Longitudinal studies of frailty in older populations show an overall tendency for stability and modest net progression, with little reversion from frail to completely robust states; however, significant numbers do improve, transiting from pre-frail to robust, and from frail to pre-frail states (4)(5)(6)(7)(8)(9). Findings are similar from studies of transitions into and out of states of dependence (10)(11)(12)(13), with some suggestion of less stability and more reversion in LMIC (11,12).…”

Section: Introductionmentioning

confidence: 58%

Intrinsic capacity as a framework for Integrated Care for Older People (ICOPE); insights from the 10/66 Dementia Research Group cohort studies in Latin America, India and China

Prince

Acosta

Guerra³

et al. 2019

Preprint

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Background The World Health Organization has reframed health and healthcare for older people around achieving the goal of healthy ageing. Recent evidence-based guidelines on Integrated Care for Older People focus on maintaining intrinsic capacity, addressing declines in mobility, nutrition, vision and hearing, cognition, mood and continence aiming to prevent or delay the onset of care dependence. The target group (with one or more declines in intrinsic capacity) is broad, and implementation at scale may be challenging in less-resourced settings. Planning can be informed by assessing the prevalence of intrinsic capacity, characterising the target group, and validating the general approach by evaluating risk prediction for incident dependence and mortality. Methods Population-based cohort studies in urban sites in Cuba, Dominican Republic, Puerto Rico, Venezuela, and rural and urban sites in Peru, Mexico, India and China. Sociodemographic, behaviour and lifestyle, health, healthcare utilisation and cost questionnaires, and physical assessments were administered to all participants, with ascertainment of incident dependence, and mortality, three to five years later. Results In the 12 sites in eight countries, 17,031 participants were surveyed at baseline. Intrinsic capacity was least likely to be retained for locomotion (71.2%), vision (71.3%), cognition (73.5%), and mood (74.1%). Only 30% retained full capacity across all domains, varying between one quarter and two-fifths in most sites. The proportion retaining capacity fell sharply with increasing age, and declines affecting multiple domains were more common. Poverty, morbidity (particularly dementia, depression and stroke), and disability were concentrated among those with DIC, although only 10% were frail, and a further 9% had needs for care. Hypertension and lifestyle risk factors for chronic disease, healthcare utilization and costs were more evenly distributed in the general older population. 15,901 participants were included in the mortality cohort (2,602 deaths/ 53,911 person years of follow-up), and 12,965 participants in the dependence cohort (1900 incident cases/ 38,377 person-years). DIC (any decline, and number of domains affected) strongly and independently predicted incident dependence and death. Relative risks were higher for those who were frail, but were also substantially elevated for the much larger sub-groups yet to become frail. Mortality was mainly concentrated in the frail and dependent sub-groups. Conclusions Our findings support the strategy to focus on optimizing intrinsic capacity in pursuit of healthy ageing. Most needs for care arise in those with declines in intrinsic capacity who are yet to become frail. Implementation at scale requires community-based screening and assessment, and a stepped-care approach to intervention. Community healthcare workers roles would need redefinition to engage, train and support them in these tasks. ICOPE could be usefully integrated into community programmes orientated to the detection and case management of chronic diseases including hypertension and diabetes.

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“…To estimate the global incidence of frailty, data were included from 46 studies. 41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,83,84,85,86 Among people without frailty at baseline who survived a median follow-up of 3.0 (range, 1.0-11.7) years, 13.6% (13 678 of 100 313) became frail. The pooled incidence rate of frailty was 43.4 (95% CI, 37.3-50.4; I 2 = 98.5%) cases per 1000 person-years (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-one studies 41,42,46,51,53,57,59,60,65,66,67,68,69,71,72,77,79,80,81,82,83 reported data on the global incidence of prefrailty among 32 268 community-dwelling older adults who were robust at baseline and survived a median follow-up of 2.5 (range, 1.0-10.0) years. During the follow-up, 30.9% (9974 of 32 268) became prefrail.…”

Section: Resultsmentioning

confidence: 99%

Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults

et al. 2019

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IMPORTANCE Frailty is a common geriatric syndrome of significant public health importance, yet there is limited understanding of the risk of frailty development at a population level. OBJECTIVE To estimate the global incidence of frailty and prefrailty among community-dwelling adults 60 years or older.DATA SOURCES MEDLINE, Embase, PsycINFO, Web of Science, CINAHL Plus, and AMED (Allied and Complementary Medicine Database) were searched from inception to January 2019 without language restrictions using combinations of the keywords frailty, older adults, and incidence. The reference lists of eligible studies were hand searched. STUDY SELECTIONIn the systematic review, 2 authors undertook the search, article screening, and study selection. Cohort studies that reported or had sufficient data to compute incidence of frailty or prefrailty among community-dwelling adults 60 years or older at baseline were eligible. DATA EXTRACTION AND SYNTHESISThe methodological quality of included studies was assessed using The Joanna Briggs Institute's Critical Appraisal Checklist for Prevalence and Incidence Studies.Meta-analysis was conducted using a random-effects (DerSimonian and Laird) model. MAIN OUTCOMES AND MEASURESIncidence of frailty (defined as new cases of frailty among robust or prefrail individuals) and incidence of prefrailty (defined as new cases of prefrailty among robust individuals), both over a specified duration. RESULTSOf 15 176 retrieved references, 46 observational studies involving 120 805 nonfrail (robust or prefrail) participants from 28 countries were included in this systematic review. Among the nonfrail individuals who survived a median follow-up of 3.0 (range, 1.0-11.7) years, 13.6% (13 678 of 100 313) became frail, with the pooled incidence rate being 43.4 (95% CI, 37.3-50.4; I 2 = 98.5%) cases per 1000 person-years. The incidence of frailty was significantly higher in prefrail individuals than robust individuals (pooled incidence rates, 62.7 [95% CI, 49.2-79.8; I 2 = 97.8%] vs 12.0 [95% CI, 8.2-17.5; I 2 = 94.9%] cases per 1000 person-years, respectively; P for difference < .001). Among robust individuals in 21 studies who survived a median follow-up of 2.5 (range, 1.0-10.0) years, 30.9% (9974 of 32 268) became prefrail, with the pooled incidence rate being 150.6 (95% CI, 123.3-184.1; I 2 = 98.9%) cases per 1000 person-years. The frailty and prefrailty incidence rates were significantly higher in women than men (frailty: 44.8 [95% CI, 36.7-61.3; I 2 = 97.9%] vs 24.3 [95% CI, 19.6-30.1; I 2 = 8.94%] cases per 1000 person-years; prefrailty: 173.2 [95% CI, 87.9-341.2; I 2 = 99.1%] vs 129.0 (continued) Key PointsQuestion What is the incidence of frailty and prefrailty among communitydwelling adults 60 years or older?Findings In this systematic review and meta-analysis involving data from more than 120 000 older adults from 28 countries, the incidence of frailty and prefrailty was estimated as 43.4 and 150.6 new cases per 1000 person-years, respectively. The frailty and prefrailty incidence rates varied by ...

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Changes in frailty status in a community-dwelling cohort of older adults: The VERISAÚDE study

Cited by 59 publications

References 44 publications

Transition in Frailty State Among Elderly Patients After Vascular Surgery

Transition in Frailty State Among Elderly Patients After Vascular Surgery

Intrinsic capacity as a framework for Integrated Care for Older People (ICOPE); insights from the 10/66 Dementia Research Group cohort studies in Latin America, India and China

Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults

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