Sex differences in frailty: the Frailty Index and the male-female health-survival paradox

Gordon, Emily H

doi:10.14264/uql.2020.620

Cited by 2 publications

(3 citation statements)

References 185 publications

(390 reference statements)

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“…Our novel finding of a decreasing magnitude of the association between ACEs and frailty across age groups in men but not women requires further research: it is not clear whether the burden of childhood traumatic experiences is greater and therefore has greater longevity in women, or is instead due to a survival bias, given that women are more likely to live longer than men, despite higher rates of frailty. The latter reason is in line with a potential healthy survivor bias found in older men in our study [42]. Additional longitudinal studies of young and middle-aged adults will be critical in order to parse these findings.…”

Section: Discussionsupporting

confidence: 88%

Associations of Adverse Childhood Experiences with Frailty in Older Adults: A Cross-Sectional Analysis of Data from the Canadian Longitudinal Study on Aging

et al. 2021

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Introduction: Frailty in older adults, characterized by a decline in multiple physiological systems and increasing vulnerability to loss of independence, disability, and death, is a public health priority in developed countries. Etiology of frailty extends across the lifespan and may begin in early life, but empirical evidence for this association is scarce. In this study, we examined whether adverse childhood experiences (ACEs) are associated with frailty in later life. Methods: We conducted a cross-sectional analysis of data for a population-based sample of 27,748 adults aged 45–85 years from the Canadian Longitudinal Study on Aging. The frailty index (FI) was computed with 76 health-related characteristics of physical and cognitive performance, self-rated health, chronic conditions, visual and hearing ability, activities of daily living, and well-being. Self-reported exposure to ACEs included physical, emotional, and sexual abuse, neglect, and witnessing intimate partner violence prior age of 16 and parental death, divorce, and living with a family member with mental illness prior age of 18. Generalized linear regression models with gamma error distribution and identity link function, adjusted for age and sex, were used to examine associations of each ACE type and the number of ACE types (0, 1, 2, or 3+) reported by an individual with FI. All models were adjusted for income, education, smoking, and alcohol consumption in sensitivity analysis. Results: Individuals exposed to ACEs had elevated levels of FI (mean = 0.13, SD = 0.09) than those unexposed, with the largest difference observed for neglect (B [95% CI]: 0.05 [0.04, 0.06]) and the smallest for parental death and divorce (0.015 [0.01,0.02]). The ACE count was associated with frailty in a graded manner, with the FI difference reaching 0.04 [0.037, 0.044] for participants exposed to 3+ ACE types. The association between ACEs and frailty tended to be stronger for women than men and for men aged 45–64 years than older men. Conclusions: Our study supports previous studies showing that exposure to ACEs is associated with frailty in adults. Our findings suggest that screening for ACEs involving childhood maltreatment may be useful for identifying individuals at risk of frailty and prevention of ACEs may have long-term benefits for healthy aging.

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Section: Discussionsupporting

confidence: 88%

Associations of Adverse Childhood Experiences with Frailty in Older Adults: A Cross-Sectional Analysis of Data from the Canadian Longitudinal Study on Aging

et al. 2021

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“…Many studies have shown that the prevalence of frailty is higher in females than in males, even in the same age group. However, the mortality rate of older men is higher than that of older women [7,8], which is known as the "sex-frailty paradox" [8,27]. Furthermore, our ndings support the abovementioned paradox.…”

Section: Discussionsupporting

confidence: 67%

“…Furthermore, our ndings support the abovementioned paradox. Sex differences in genetic, biological, or psychosocial factors as well as in physiological reserve, burden of disease, and disability might contribute to this paradox [8,27]. However, our data suggested that a potentially unrecognized factor -polypharmacy -might contribute differentially to mortality in the male and female groups.…”

Section: Discussionmentioning

confidence: 85%

Gender-specific Association of Frailty, Polypharmacy, and the Five-year Mortality Risk: A Real-world Retrospective Study

Lin

Chen

Chou

et al. 2022

Preprint

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Background: With higher age, frailty escalates the risk of falls, unexpected physical dysfunction, hospitalization, and mortality. Polypharmacy in the older population is a major challenge that not only increases medical costs, but also may worsen the risk of hospitalization and death. This study aimed to investigate the sex difference in the association of polypharmacy and frailty with mortality.Methods: Participants older than 65 years who attended the geriatric outpatient clinic of the study center between January 2015 and July 2020 were invited to participate in this retrospective study. Comprehensive geriatric assessment (CGA) data were collected and the phenotype of frailty was determined by Fried’s criteria. Cox regression and the Kaplan–Meier curve were used to identify risk factors of 5-year survival along with intergroup differences in the risks.Results: Of the 2077 participants, 47.5% were female. The prevalence of frailty and the rate of polypharmacy were 44.7% and 60.6%, respectively. Higher age, male sex, low body mass index, low Mini-Mental State Examination scores, low activities of daily living, frailty status, polypharmacy, and a high Charlson Comorbidity Index score were significant risk factors that were associated with the 5-year all-cause mortality. Male patients with frailty exhibited the highest risks of mortality compared with male patients without frailty and female patients with or without frailty. Polypharmacy was significantly associated with a higher 5-year mortality rate in the frail male group compared with the non-frail male. Conclusions: Polypharmacy synergistically interacted with frailty and intensified the 5-year mortality risk in a gender-specific manner. To mitigate mortality risks, clinicians should prudently identify polypharmacy in the non-frail male older population.

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Sex differences in frailty: the Frailty Index and the male-female health-survival paradox

Cited by 2 publications

References 185 publications

Associations of Adverse Childhood Experiences with Frailty in Older Adults: A Cross-Sectional Analysis of Data from the Canadian Longitudinal Study on Aging

Associations of Adverse Childhood Experiences with Frailty in Older Adults: A Cross-Sectional Analysis of Data from the Canadian Longitudinal Study on Aging

Gender-specific Association of Frailty, Polypharmacy, and the Five-year Mortality Risk: A Real-world Retrospective Study

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