The Association of Frailty With Hospitalizations and Mortality Among Community Dwelling Older Adults With Diabetes

Abstract

Background: Diabetes (DM) is associated with an accelerated aging that promotes frailty, a state of vulnerability to stressors, characterized by multisystem decline that results in diminished intrinsic reserve and is associated with morbidity, mortality and utilization. Research suggests a bidirectional relationship between frailty and diabetes. Frailty is associated with mortality in patients with diabetes, but its prevalence and impact on hospitalizations are not well known. Objectives: Determine the association of frailty with all-cause hospitalizations and mortality in older Veterans with diabetes. Design: Retrospective cohort. Setting: Outpatient. Participants: Veterans 65 years and older with diabetes who were identified as frail through calculation of a 44-item frailty index. Measurements: The FI was constructed as a proportion of healthcare variables (demographics, comorbidities, medications, laboratory tests, and ADLs) at the time of the screening. At the end of follow up, data was aggregated on all-cause hospitalizations and mortality and compared non-frail (robust, FI≤ .10 and prefrail FI=>.10, <.21) and frail (FI≥.21) patients. After adjusting for age, race, ethnicity, median income, history of hospitalizations, comorbidities, duration of DM and glycemic control, the association of frailty with all-cause hospitalizations was carried out according to the Andersen-Gill model, accounting for repeated hospitalizations and the association with all-cause mortality using a multivariate Cox proportional hazards regression model. Results: We identified 763 patients with diabetes, mean age 72.9 (SD=6.8) years, 50.5% were frail. After a median follow-up of 561 days (IQR=172), 37.0% they had 673 hospitalizations. After adjustment for covariates, frailty was associated with higher all-cause hospitalizations, hazard ratio (HR)=1.71 (95%CI:1.31-2.24), p<.0001, and greater mortality, HR=2.05 (95%CI:1.16-3.64), p=.014. Conclusions: Frailty was independently associated with all-cause hospitalizations and mortality in older Veterans with diabetes. Interventions to reduce the burden of frailty may be helpful to improve outcomes in older patients with diabetes.

Adherence to Medication in Older Adults with Type 2 Diabetes Living in Lubuskie Voivodeship in Poland: Association with Frailty Syndrome

“…In this study diabetics were at 1.36 (95% CI = 1.18, 1.56) and 1.56 (95% CI = 1.32, 1.85) fold increase in risk of frailty compared to non-diabetic population for prevalence and incidence respectively [ 10 ]. The research by Ferri-Guerra et al (2019) showed that in 763 DM patients (mean age 72.9 years) 50.5% were frail [ 52 ]. Other studies also confirmed that the prevalence of frailty in adults older than 65 years was three- to five-fold higher in patients with diabetes than that in the general population [ 51 , 53 ].…”

Frailty Status and Polypharmacy Predict All-Cause Mortality in Community Dwelling Older Adults in Europe

“…Results from an overview of systematic reviews showed that 24/24 studies demonstrate an increased mortality risk for frail individuals while 7/7 showed a significant impact of pre-frailty in mortality [38]. The relation between frailty and mortality risk among other conditions in older adults was also studied, and it was found to increase the risk of death among diabetic patients [39], after hip fracture [40], after pelvic surgery [41], after mitral valve replacement [42], among others. Frailty is also associated with worse short term-term postoperative outcomes and mortality [43].…”

Should We Care More About Frailty When We Treat Diabetes?

“…Although guidelines agree that looser glycaemic control is more suitable for frail diabetic patients, the routine clinical practice still seems to miss the point. For example, in the study by Ferri-Guerra and colleagues (5), no significant difference was detected in the adherence to a tight glycaemic control between frail and non-frail patients (52.5% vs 57.9%, p=0.15). Frail diabetic participants were also more likely to be treated with agents exposing to a higher risk of hypoglycaemia.…”

“…In conclusion, diabetic patients should be routinely assessed for frailty. As Ferri-Guerra and colleagues (5) showed in their work, frailty independently contributes to the burden of diabetes in terms of healthcare utilization and decreased survival. The identification of frailty should lead to careful evaluation and potentially to an adapted intervention (12,13).…”

“…In this issue of the Journal of Frailty and Aging, Ferri-Guerra and colleagues (5) explore the link between frailty, diabetes and health-related outcomes. In the study, data from 763 community-dwelling Veterans affected by diabetes are retrospectively analysed.…”