Prevalence and correlates of frailty among older adults: findings from the German health interview and examination survey

Abstract

BackgroundDespite having the third highest proportion of people aged 60 years and older in the world, Germany has been recently reported as having the lowest prevalence of frailty of 15 European countries. The objective of the study is to describe the prevalence of frailty in a large nationwide population-based sample and examine associations with sociodemographic, social support and health characteristics.MethodsWe performed a cross-sectional analysis of the first wave of the German Health Interview and Examination Survey for Adults (DEGS1) conducted 2008–2011. Participants were 1843 community-dwelling people aged 65–79 years. Frailty and pre-frailty were defined, according to modified Fried criteria, as 3 and more or 1–2 respectively, of the following: exhaustion, low weight, low physical activity, low walking speed and low grip strength. The Oslo-3 item Social Support Scale (OSS-3) was used. Patient Health Questionnaire (PHQ-9) measured depressive symptoms and the Digit Symbol Substitution Test (DSST) measured cognition. Associations between participants’ characteristics and frailty status were examined using unadjusted and adjusted multinomial logistic regression models estimating relative risk ratios (RRR) of frailty and pre-frailty.ResultsThe prevalence of frailty among women was 2.8% (CI 1.8-4.3) and pre-frailty 40.4% (CI 36.3-44.7) and among men was 2.3% (CI 1.3-4.1) and 36.9% (CI 32.7-41.3) respectively. Independent determinants of frailty, from unadjusted models, included older age, low socioeconomic status, poor social support, lower cognitive function and a history of falls. In adjusted models current depressive symptoms (RRR 12.86, CI 4.47-37.03), polypharmacy (RRR 7.78, CI 2.92-20.72) and poor hearing (RRR 5.38, CI 2.17-13.35) were statistically significantly associated with frailty.ConclusionsFrailty prevalence is relatively low among community-dwelling older adults in Germany. Modifiable characteristics like low physical activity provide relevant targets for individual and population-level frailty detection and intervention strategies.

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

“…Polypharmacy (use of multiple medications) is common among frail persons, (144–147) as is the use of sedating or anticholinergic drugs. (148–150) Observational studies show an association between all three and the subsequent development of frailty.…”

Níveis de fragilidade de idosos e sua associação com as características sociodemográficas

“…Findings from Brazilian (8,24) and international studies (7) support this finding. Studies show that the greater number of elderly women when compared to the number of men is a reality, which is called feminization of old age, (20,(25)(26)(27) and deserves special attention.…”

“…(6) Studies that identify frailty have been developed in several countries, such as Germany where, even with the third largest population of people aged 60 years old or more in the world, the prevalence of frailty is lower when compared to other European countries. (7) In Portugal, a study demonstrates a prevalence of 34.9% of frail elderly in a sample of 339 participants. (8) In Brazil, in Belém do Pará, 23% of the elderly who participated in the study were frail, (9) against 8.7% in Minas Gerais.…”

Frailty and bone health in European men

“…But in people without a disability, frail is still frequent in southern Europe and particularly in Spain rates 21%, in Italy rates 14,3%, in Greece to 11,3% and in France to 9,3% 12 ( Table 1). On the other hand German has the lowest prevalence of frailty in Europe, specifically less than 1% is the prevalence of frailty in Germans over 50 years old 13 .…”