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

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.

Longitudinal Association between Late-Life Depression (LLD) and Frailty: Findings from a Prospective Cohort Study (MiMiCS-FRAIL)

“…The index is achieved by the sum of present variables divided by total variables included. The FI is a stronger predictor for adverse health outcome such as death than the presence of its individual components or multimorbidity (42,46). The following health deficits were included: anaemia, arthritis, cognitive impairment, visual impairment, diabetes, dyspnea, chronic renal disease, sleep disorder, peripheral vascular diseases, urinary tract disorders, thyroid disease, respiratory disease, cerebrovascular disease, ischemic heart disease, atrial fibrillation, fracture, hypertension, syncope, heart failure, urinary incontinence, disability, care dependency, osteoporosis, falls, parkinsonism and related disorders, loss of appetite or anorexia, polypharmacy, foot disorders, mobility problems, obesity, hearing loss, valvulopathy, dizziness, social vulnerability, pressure ulcers, peptic ulcers.…”

Excess mortality in depressive and anxiety disorders: The Lifelines Cohort Study

“…[16] As described previously, we constructed a Lifelines-FI based on 64 items regarding chronic somatic diseases (15 items), physical measures (5 items), disabilities (6 items), subjective health measures (8 items), sensory function (2 items), mental health indicators (4 items), neuropsychological markers (4 items), and blood biomarkers (15 items). [23] Following the guidelines for the construction of an FI by Searle et al (2008), these health deficits were included in the Lifelines-FI, because they (a) were biologically meaningful in representing several organ systems, and (b) accumulate with age, but were not too prevalent at some younger age, and (c) had less than 5% missing values. [24] Each deficit was coded as 0 (absence) or 1 (presence) or when clinically Accepted manuscript: Authors' Copy relevant, as any number between 0 and 1.…”

“…This procedure has resulted in a baseline Lifelines-FI consisting of 64 items. [23] In order to prevent confounding with either depressive or anxiety disorders, we have recalculated the FI excluding all mental health variables, i.e., a) feeling depressed in the past two weeks, b) loss of interest/anhedonia in the past two weeks, c) feeling happy, and d) feeling nervous. This resulted in a 60-item FI used in the present paper.…”

The management of multi-morbidity in elderly patients: Ready yet for precision medicine in intensive care?

“…During the COVID-19 pandemic, multi-morbidity, frailty as well as the severity of the acute condition were all strong predictors of in-hospital death [40]. A recent study showed the additive role of functional disabilities for mortality in very old multi-morbid individuals [41]. Although multimorbidity, frailty and functional disabilities overlap in many older patients [42,43], there are individuals with multi-morbidity who cannot be classified as frail or disabled.…”