Frequency of frailty and its association with cognitive status and survival in older Chileans

Abstract

BackgroundAge-associated brain physiologic decline and reduced mobility are key elements of increased age-associated vulnerability.ObjectiveTo study the frequency of frailty phenotype and its association with mental health and survival in older Chileans.MethodsFollow-up of ALEXANDROS cohorts designed to study disability associated with obesity in community-dwelling people 60 years and older living in Santiago, Chile. At baseline, 2,098 (67% women) of 2,372 participants were identified as having the frailty phenotype: weak handgrip dynamometry, unintentional weight loss, fatigue/exhaustion, five chair-stands/slow walking speed and difficulty walking (low physical activity). After 10–15 years, 1,298 people were evaluated and 373 had died. Information regarding deaths was available for the whole sample.ResultsThe prevalence of frailty at baseline (≥3 criteria) in the whole sample was 13.9% (women 16.4%; men 8.7%) and the pre-frailty prevalence (1–2 criteria) was 63.8% (65.0% vs 61.4%), respectively. Frailty was associated with cognitive impairment (frail 48.1%; pre-frail 21.7%; nonfrail 20.5%, P<0.001) and depression (frail 55.1%; pre-frail 27.3%; nonfrail 18.8%, P<0.001). Logistic regression models for frailty adjusted for sex and age showed a strong association between frailty and mild cognitive impairment (MCI) (odds ratio [OR] =3.93; 95% CI: 1.41–10.92). Furthermore, an important association was found for depression and frailty (OR =2.36; 95% CI 1.82–3.06). Age- and sex-adjusted hazard ratios (HRs) for death showed an increased risk with increasing frailty: pre-frail HR =1.56 (95% CI: 1.07–2.29), frail HR =1.91 (95% CI: 1.15–3.19); after adjustment by age and sex, a higher risk of death was observed for people identified as frail (HR =1.56, P=0.014) and pre-frail (HR =1.30, P=0.065). MCI and dementia were also risk factors for death (MCI: HR =1.69, P<0.027; dementia: HR =1.66, P=0.016).ConclusionFrailty is highly prevalent and strongly associated with cognitive impairment and depression in older Chileans. The risk for death was higher for frail people, but underlying cognitive impairment is a key component of the lower survival rate.

Association between cognitive impairment and criteria for frailty syndrome among older adults

“…The regression analysis adjusted by gender, age and education level showed that older adults with frailty had a 100% increased chance of presenting MCI 33 . In a study involving Chilean older adults, individuals with frailty had 3.93 times more chance of presenting MCI 34 . A study conducted in Brazil, with 51 prefrail and frail older adults used a similar MMSE cut-off.…”

Factores asociados al síndrome de fragilidad en adultos mayores que acuden a consulta externa de Geriatría del Hospital Nacional Hipólito Unanue, Lima-Perú

“…A su vez, el SF se asoció con deterioro cognitivo y depresión, de manera similar a publicaciones previas que han llegado a sugerir que aunque no se considera como un criterio del SF, la salud mental forma parte del fenotipo de fragilidad [31] . Sargent L, et al [32] en una reciente revisión sistemática, proponen que el SF y el deterioro cognitivo tendrían mecanismos fisiopatológicos comunes.…”

Fragilidade e doença de Parkinson

“…Para isto, o cuidado primário parece ser o melhor ambiente para realizar esta tarefa no cuidado dos idosos (Espinoza, Walston, 2005;Gray et al, 2016) (Cesari et al, 2016b;Gilardi et al, 2018). Os critérios de Fried para SF parecem ser, até o momento, os que melhor se encaixam nestes pressupostos (Woo et al, 2012;Op het Veld et al, 2015;Le Cossec et al, 2016;Albala et al, 2017;Ensrud et al, 2018).…”

“…Como apresentado na introdução, esta relação pode estar relacionada à múltiplos fatores subjetivos importantes na avaliação de pacientes idosos em geral, como fatores sociais e estados depressivos (Albala et al, 2017;Park et al, 2018;Tsutsumimoto et al, 2018), uso de múltiplas medicações (polifarmácia) (Gutiérrez-Valencia et al, 2018), número e tipos de comorbidades (Onder et al, 2018), suporte familiar, desnutrição (Chye et al, 2018), condições de moradia, violência doméstica, aspectos culturais específicos e condições financeiras (Grden, CRB, 2015;Cho et al, 2017 (Siriwardhana et al, 2018;Veninsek, Gabrovec, 2018;Windhaber et al, 2018). Na tentativa de melhor elucidar as relações entre a SF e DP, encontramos associação entre o tempo de caminhada no momento inicial do estudo e a evolução para SF (FRAGILIDADE FINAL) e pior avaliação na escala UPDRS após 6 meses (UPDRS FINAL).…”

“…Para citar a definição deYu et al (2018): cognitive frailty may be defined as the ocurrence of both cognitive impairment and pre-frailty, not necessarily progressing to dementia". Segundo o estudo deAlbala et al (2017):"cognitive impairment is a key component of the lower survival rate (in frailty)".…”