Prevalence, measurement, and implications of frailty in stroke survivors: An analysis of three global aging cohorts

Abstract

Background: Our understanding of the relationship between frailty and stroke, beyond the acute phase of stroke, is limited. We aimed to estimate the prevalence of frailty in stroke survivors using differing methods of assessment and describe relationships with stroke outcomes. Methods: We used data from three international population surveys (American Health and Retirement Survey/English Longitudinal Study of Ageing/Survey for Health and Retirement in Europe) of ageing. Frailty status was assessed using the Fried frailty phenotype, a 40-item frailty index (FI) and the clinical frailty scale (CFS). We created estimates of frailty prevalence and assessed association of frailty with outcomes of mortality/hospital admission/recurrent stroke at 2 years follow-up using logistic regression models adjusted for age/sex. Additional analyses explored effects of adding cognitive measures to frailty assessments and of missing grip strength data. Findings: Across 9617 stroke survivors, using the frailty phenotype, 23.8% (n=2094) identified as frail; with CFS 30.1% (n=2906) were moderately or severely frail; using FI, 22.7% (n=2147) had moderate frailty and 31.9% (n=3021) severe frailty. Frailty was associated with increased risk of mortality/hospitalization/recurrent stroke using all three measures. Adding cognitive variables to the frailty index produced minimal difference in prevalence of frailty. People with physical frailty (phenotype or CFS) plus cognitive impairment had a greater risk of mortality than people with an equivalent level of frailty but no cognitive impairment. Excluding people unable to provide grip strength underestimated frailty prevalence. Interpretation: Frailty is common in stroke and associated with poor outcomes, regardless of measure used. Adding cognitive variables to frailty phenotype/CFS measures identified those at greater risk of poor outcomes. Physical and cognitive impairments in stroke survivors do not preclude frailty assessment.

Development and Validation of a Nomogram for Predicting Nutritional Risk Based on Frailty Scores in Older Stroke Patients

“…The literature emphasizes that malnutrition and frailty often coexist in hospitalized geriatric stroke patients [ 19 , 20 ]. This concomitance not only perpetuates each condition but also culminates in a detrimental feedback loop, posing amplified health risks.…”

“…These figures markedly surpass prior findings, insinuating that stroke patients with functional impairments confront more adverse nutritional statuses. The literature emphasizes that malnutrition and frailty often coexist in hospitalized geriatric stroke patients [19,20]. This concomitance not only perpetuates each condition but also culminates in a detrimental feedback loop, posing amplified health risks.…”

Impact of Frailty on Healthcare Outcomes after Cardioembolic Ischaemic Stroke Due to Atrial Fibrillation

“…The Mann–Whitney U test and the Kruskal–Wallis test were used to examine differences between non-parametric continuous variables. Frailty was categorised into two groups: frail and non-frail using a cut-off of ≥5 on the CFS to denote frailty [ 24 ], as this is widely used in the measurement of frailty in those with stroke [ 34 ]. Logistic and multiple linear regression were performed to examine if frailty status was an independent predictor of adverse outcomes.…”

Assessment and Management of Atrial Fibrillation in Older Adults with Frailty

“…Frailty increases the risk of stroke in AF [7,23], driven in part by physiologic changes such as inflammatory cytokines and renal impairment [24] and lower utilization of anticoagulants [7,23,25]. Moreover, older adults with frailty who have strokes have longer post-stroke hospitalization and a higher risk of death than those without frailty [26][27][28].…”