Serum 25‐Hydroxyvitamin D, Transitions Between Frailty States, and Mortality in Older Adults: The Invecchiare in Chianti Study

Abstract

OBJECTIVES Frailty is a dynamic geriatric syndrome characterized by decreased reserve and increased vulnerability. Low serum 25-hydroxyvitamin D [25(OH)D] concentrations in older adults are associated with many physiological changes that portend frailty and its consequences. We aimed to assess whether serum 25(OH)D concentrations relate to transitions between the states of robustness, prefrailty, and frailty, and to mortality. DESIGN, SETTING, and PARTICIPANTS Adults aged≥65 years (N=1,155) enrolled in Invecchiare in Chianti (InCHIANTI), a prospective cohort study in Tuscany, Italy. MEASUREMENTS Serum 25(OH)D concentrations measured at baseline and frailty state (robust, prefrail, frail) assessed at baseline and at three and six years post enrollment. Vital status was also determined at three and six years post enrollment. RESULTS The median (interquartile range) 25(OH)D concentration was 16.0 (10.4—25.6) ng/mL (multiply by 2.496 to convert to nmol/L). Prefrail participants with 25(OH)D<20 ng/mL were 8.9% (95% Confidence Interval [CI], 2.5—15.2%) more likely to die, 3.0% (95%CI, −5.6—14.6%) more likely to become frail, and 7.7% (95%CI, −3.5—18.7%) less likely to become robust than prefrail participants with 25(OH)D≥20 ng/mL. Among prefrail participants, each 5 ng/mL decrement of continuous 25(OH)D was associated with 1.46 times higher odds of dying (95%CI, 1.18—2.07) and 1.13 higher odds of incident frailty (95%CI, 0.90—1.39) versus recovery of robustness. Transitions from robustness or frailty were not associated with 25(OH)D. CONCLUSION Results provide evidence that prefrailty is an “at risk” state from which older adults with high 25(OH)D are more likely to recover than to decline. However, high 25(OH)D was not associated with recovery from frailty. Thus, 25(OH)D should be investigated as a potential therapy to treat prefrailty and prevent further decline.

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

“…41 l In pre-frail older adults, low vitamin D levels significantly increase the risk of mortality by 8.9%. 44 l Greater centre of mass sway and longer bouts of walking are associated with an increased falls risk, while longer bouts of standing are associated with reduced falls risk in pre-frail older adults. 42 …”

“…39,41,42,44 They assessed the impact of medication burden on frailty status and death, 39 the effects of smoking and body mass index (BMI) and Mini Mental State Examination score on frailty status, 41 gait parameters on falls in pre-frail older adults, 42 and the effects of high or low vitamin D on frailty and mortality. 44 Follow-up ranged from 6 months to 6 years. Total sample sizes ranged from 128 to 3018 at baseline and, within these, pre-frailty prevalence ranged from one-third to half of the sample.…”

Associations Between Frailty and Serum 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Concentrations in Older Australian Men: The Concord Health and Ageing in Men Project

“…Low levels of 1,25D may also occur due to the age-related decline in the renal conversion of 25D to 1,25D (10). Although low levels of 25D have been shown in a small number of studies to be associated with frailty (11,12), we are unaware of any studies that have examined whether 1,25D is also associated with frailty. 1,25D has not been used in many other studies because the assay is expensive and requires extensive experience to produce reliable results.…”

Frailty Trajectories After Treatment for Coronary Artery Disease in Older Patients

“…Numerous publications have looked at frailty longitudinally in general populations: characterizing frailty transitions, 22,32,33,40 examining potential predictors of transitions, [41][42][43] testing interventions to limit worsening frailty, 44 and comparing static versus dynamic frailty measures to predict functional decline. 45 However, few have looked longitudinally at a cohort of patients with cardiovascular disease.…”