Frailty Trajectories in an Elderly Population‐Based Cohort

Abstract

BACKGROUND/OBJECTIVES Little is known about longitudinal changes in frailty and how these changes impact adverse outcomes in elderly patients. Thus, we identified distinct frailty trajectories (clusters of individuals following a similar progression of frailty over time) in an aging population and estimated associations between frailty trajectories and emergency department visits, hospitalizations, and all-cause mortality. DESIGN Population-based cohort study SETTING Olmsted County, Minnesota PARTICIPANTS Olmsted County, Minnesota residents aged 60–89 in 2005 MEASUREMENTS Longitudinal changes in frailty between 2005 and 2012 were measured by constructing a yearly Rockwood frailty index incorporating body mass index, 17 comorbidities, and 14 activities of daily living. The frailty index measures variation in health status as the proportion of deficits present among the 32 considered (range: 0–1). RESULTS Among the 16,443 Olmsted County residents aged 60–89 in 2005, 12,270 (74.6%) had at least 3 years of frailty index measures and were retained for analysis. The median baseline frailty index increased with older age: 0.11 for 60–69 year olds, 0.14 for 70–79 year olds, and 0.19 for 80–89 year olds. Among those 60–69 years of age at baseline, 3 distinct frailty trajectories were identified, whereas 2 trajectories were identified for the 70–79 and 80–89 year olds. Within each decade of age, increasing frailty trajectories were associated with increased risks of emergency department visits, hospitalizations, and all-cause mortality, even after adjustment for baseline frailty index. CONCLUSION The number of frailty trajectories differed by age. Within each age group, those in the highest frailty trajectory experienced greater healthcare utilization and worse survival. Frailty trajectories may offer a way to target aging individuals at higher risk of hospitalization or death for therapeutic or preventive interventions.

Risk of Stroke and Myocardial Infarction After Herpes Zoster in Older Adults in a US Community Population

“…Recent studies found that morbidity and multiple morbidities at younger ages strongly predict increasing morbidities with aging. 36,37 In all reported studies, patients with zoster have greater numbers of chronic conditions at the time of zoster compared to age- and sex-matched controls. Thus, it is possible that an increased long-term risk of MI and stroke is due at least in part to the steeper multi-morbidity trajectory in zoster patients.…”

Time Spent in Sedentary Behaviour as Discriminant Criterion for Frailty in Older Adults

“…Sedentary behaviour is an imminent risk factor that has gained attention in the literature. It is a consensus that this behavioural aspect is associated with deleterious health effects [29,30], including risk for all-cause mortality [4,31] and frailty [11]. …”

“…Experts in the subject indicate that this outcome is a complex, dynamic concept that involves a state of greater vulnerability to adverse health factors, including those that are associated with falls, fractures, disability and health status [1,2,3], and that frailty increases the chances of morbidity and mortality [4]. …”

Pathophysiology of heart failure and frailty: a common inflammatory origin?

“…2001; Morley et al ., 2013; Chamberlain et al ., 2016). Together, these serve to limit mobility, independence, and the ability to perform activities of daily living in older adults (Chamberlain et al ., 2016). In this review, we describe the underlying inflammatory phenotype associated with frailty and speculate how it may be linked to the inflammatory phenotype that occurs with HF.…”