Frailty and its relationship with mortality among older adults from a Brazilian community: A cohort study

Abstract

Background/Purpose: People are living longer. However, the aging process, coupled with lifestyle and health conditions, may lead to what is known as frailty syndrome. There is a consensus among researchers in the field that frailty is associated with adverse health outcomes, such as functional decline, dependency, recurrent falls, fractures, institutionalization, hospitalization and death. The aim of the present study was to analyze the relationship between frailty and mortality in a population of older people living in a Brazilian community. Methods: A prospective cohort study was conducted through two assessments in the city of Ribeirão Preto, state of São Paulo, with a mean follow-up period of 5.6 years. The sample was made up of 515 (75.37±7.28) older adults who were assessed in 2007/2008, and 262 (79.31±6.34) who were assessed in 2013. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) 22.0; the Wilcoxon test, Cox regression and Kaplan-Meier survival analysis were also used. Results: We verified that most older people were considered non-frail in 2007/2008 (59.5%); 22.9% were identified as apparently vulnerable, and 17.6% were frail. In 2013, 28.7% were considered non-frail, 20.9% apparently vulnerable; and 50.4% were frail (an increase of 186%). A total of 24.7% died during the follow-up period; 45.7% were considered frail according to the Edmonton Frail Scale. The survival analysis showed that frail older people were more likely to die. Conclusion: Frailty developed during the period under study, in association with mortality: a greater proportion of non-frail older people were among the survivors. In the present study, frailty was considered an important predictor of mortality.

Mortality in community-dwelling elderly: coefficient and associated factors

“…Thus, the elderly who seek medical and hospital care frequently may have a more significant functional impairment, which generates disabilities and risk of adverse outcomes. Considering the fragility issue, studies (29,40) evidenced the association between this factor and mortality, which did not appear in this study. A Brazilian study conducted with community-dwelling elderly individuals in a 66-month follow-up identified that frailty increased during the follow-up period and was associated with mortality (29) .…”

“…The variable "inability to read" was also associated with mortality. Studies investigated the variable "education" (27,29) and found no association with mortality. However, the SABE study found out that the higher the survival of the elderly, the higher the level of education (31) .…”

“…The absence of religious practice was associated with mortality. Studies that addressed factors associated with mortality in community-dwelling elderly (4,24,26,29) did not investigate the variable "religious practice. " A longitudinal survey on religiosity and longevity conducted in Taiwan with older adults (n = 3,849), over 18 years of follow-up, showed, using a Gompertz regression, adjusted and unadjusted for covariates and mediating factors, that the risk of dying is lower for the religiously active compared with the non-religious, with a 60-year-old religiously active Taiwanese woman living one year longer than her non-religious counterpart (35) .…”

“…The results showed an association between mortality and the elderly having consultations and hospitalizations in the last 12 months. Such variables were not investigated in studies (4,24,26,29) of mortality among community-dwelling elderly. However, a national household survey conducted with older people (n = 23,815) pointed out that medical consultations and hospitalizations have significant associations with functional limitation of…”

“…Mortality was associated with greater longevity. A study conducted with community-dwelling elderly in Ribeirão Preto, São Paulo, showed that older adults above 80 years were 2.3 times more likely to die than those in the youngest age group (29) . In Ireland, a survey with older adults receiving state-funded home support (n = 1,597) identified one of the main determinants of mortality in advanced age (30) .…”