Frailty syndrome and all-cause mortality in demented patients: the Italian Longitudinal Study on Aging

Abstract

Cognition has already been considered as a component of frailty, and it has been demonstrated that it is associated with adverse health outcomes. We estimated the prevalence of frailty syndrome in an Italian older population and its predictive role on allcause mortality and disability in nondemented subjects and in demented patients. We evaluated 2,581 individuals recruited from the Italian Longitudinal Study on Aging, a population-based sample of 5,632 subjects, aged 65-84 years old. Participants received identical baseline evaluation at the 1st survey (1992)(1993) and were followed at 2nd (1995)(1996) and 3rd survey (2000)(2001). A phenotype of frailty according to partially modified measurement of Cardiovascular Health Study criteria was operationalized. The overall prevalence of frailty syndrome in this populationbased study was 7.6% (95% confidence interval (CI) 6.55-8.57). Frail individuals noncomorbid or nondisable were 9.1% and 39.3%, respectively, confirming an overlap but not concordance in the cooccurrence among these conditions. Frailty was associated with a significantly increased risk of allcause mortality over a 3-year follow-up (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.52-2.60) and over a 7-year follow-up (HR 1.74, 95% CI 1.44-2.16), but with significant increased risk of disability only over a 3-year follow-up (HR 1.32, 95% CI 1.06-1.86 over a 3-year follow-up and HR 1.16, 95% CI 0.88-1.56 over a 7-year follow-up). Frail demented patients were at higher risk of all-cause mortality over 3-(HR 3.33, 95% CI 1.28-8.29) and 7-year follow-up periods (HR 1.89, 95% CI 1.10-3.44), but not of disability. Frailty syndrome was a short-term predictor of disability in nondemented older subjects and short-and long-term predictor of all-cause mortality in nondemented and demented patients.

Different models of frailty in predementia and dementia syndromes

“…in the ilSa, both lower cognition and greater depressive symptoms were associated with physical frailty (45). at present, the ilSa is the first population-based study in which physical frailty has been investigated as possible determinant of short and longterm all-cause mortality in demented subjects.…”

“…Very recently, in the italian longitudinal Study on aging (ilSa), evaluating 2,581 individuals from a population-based sample of 5,632 subjects aged 65-84 years, a phenotype of physical frailty was operationalized slightly modifying the cHS criteria (30), and was identified by the presence of three or more frailty components. in the ilSa, a prevalence rate of 7.6% (95% confidence interval (ci) 6.55-8.57) for physical frailty in a community-defined cohort of 65-84 year old subjects was found (45).…”

“…Frailty was associated with a significantly increased risk of all-cause mortality in 3-and 7-year follow-up periods, but with significant increased risk of disability only in a 3-year followup. Frail demented patients were at higher risk of all-cause mortality over 3-and 7-year follow-up periods, but not of disability (45) (table 1). therefore, in the ilSa, physically frail demented patients, after adjustment for possible confounders at baseline, were at higher risk of all-cause mortality but not of disability in shortand long-term periods (45).…”

Frailty in Older Adults with Mild Dementia: Dementia with Lewy Bodies and Alzheimer’s Disease

“…This condition has traditionally been considered to be independent from purely physical domains. However, there is enough evidence to infer that both frailty and dementia are main drivers of disability related to aging, as well as for increased mortality [10, 11]. Dementia affects several systems and leads to many manifestations beyond cognition.…”

Fragilidade em idosos institucionalizados: aplicação da Edmonton Frail Scale associada à independência funcional

“…Nesta pesquisa, a maioria dos idosos foi classificada como frágil, com percentual bem superior ao encontrado em estudos realizados em ILPIs do Brasil (SANTIAGO, 2013) e de outros países (FREIHEIT et al, 2011;GARRIDO-ABEJAR et al, 2012a;MATUSIK et al, 2012;ROCKWOOD, ABEYSUNDERA, MITNITSKI, 2007) Outro estudo realizado na Itália, com o objetivo de estimar a prevalência da fragilidade em uma grande população idosa e seu papel preditivo na mortalidade por todas as causas e incapacidades em indivíduos dementes e não dementes, utilizando os critérios de Fried et al (2001) com idosos de comunidade e de ILPIs, evidenciou um índice de fragilidade de 7,6%, (SOLFRIZZI et al, 2012). Esse resultado mostra dados inferiores aos encontrados na maioria das pesquisas, tanto nacionais quanto internacionais.…”