Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people

Abstract

Background There is a lack of agreement about applicable instrument to screen frailty in clinical settings. Aims To analyze the association between frailty and mortality in Finnish community-dwelling older people. Methods This was a prospective study with 10-and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood's frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used. Results Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10-12.41] in 10-year follow-up, and 6.32 [4.17-9.57] in 18-year follow-up) and , and 3.95 [3.16-4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78-2.69], and 1.69 [1.46-1.96]; FI 1.81[1.25-2.62], and 1.31 [1.07-1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10-(4.41 [3.55-5.34]) and 18-year follow-ups (3.78 [3.19-4.49]). Discussion Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people. Conclusions FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

A practical laboratory index to predict institutionalization and mortality – an 18-year population-based follow-up study

“…Frailty was associated with higher mortality according to three different clinical frailty screening tools. Simple and fast clinical frailty tools were found comparable with a multidimensional and time-consuming FI [15].…”

“…We have earlier demonstrated that clinical frailty tools are applicable screening instruments among Finnish community-dwelling older people [15,16]. Frailty was associated with higher mortality according to three different clinical frailty screening tools.…”

“…Symptoms, signs, diseases, disabilities, medications, or laboratory measurements can be combined in an index to measure frailty [1,[6][7][8], which is calculated as the proportion of individual's deficits in relation to the total amount of deficits chosen [1,[9][10][11][12][13][14]. Frailty indexes (FI) are strongly associated with the risk of death, institutionalization, and worsening health status, especially when at least 30 variables are included although different FIs consider different deficits [1,13,15,16]. FIs show a consistent, sub-maximal limit at about 2/3 of the deficits that are considered [1,[17][18][19].…”

Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines

“…FRAIL predicted mortality in the Survey of Health Aging and Retirement in Europe (SHARE) (23). Numerous other studies have validated the predictive capacity of FRAIL (24)(25)(26)(27)(28). Thus, the FRAIL scale is now recommended as a screen tool for older persons visiting primary care providers in Australia (29) and in Brazil (30).…”

Predictive validity of PRISMA-7 as a screening instrument for frailty in a hospital setting

“…13 PRISMA-7 has been translated into several languages and validated in several countries, but not, to our knowledge, in any Scandinavian setting. [14][15][16][17][18][19] We decided to study the use of PRISMA-7 in a hospital setting since it is simple and quick to perform and already has been validated and recommended for use in a primary setting. 10 Objectives The aim of this study was to evaluate the use of a Danish version of PRISMA-7 and assess the associations of frailty-as measured with PRISMA-7-with use of healthcare resources; including length of hospital stay, use of healthcare resources in the municipalities, readmissions and mortality.…”