Toward a Comprehensive Model of Frailty: An Emerging Concept From the Hong Kong Centenarian Study

Kwan, Joseph; Lau, Bobo Hi Po; Cheung, Karen Siu-Lan

doi:10.1016/j.jamda.2015.03.005

Cited by 24 publications

(15 citation statements)

References 52 publications

(21 reference statements)

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“…Other studies have been published since then. Chinese studies have implemented a cumulative frailty index in samples of centenarians or near-centenarians [21,22]. A Spanish study reported that phenotypic frailty was present in 21% of 273 community-dwelling people aged 86 years participating in a clinical trial [23].…”

Section: Introductionmentioning

confidence: 99%

Frailty and Associated Factors among Centenarians in the 5-COOP Countries

et al. 2018

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Background: The global number of centenarians is still strongly growing and information about the health and healthcare needs of this segment of the population is needed. This study aimed to estimate the prevalence of frailty among centenarians included in a multinational study and to investigate associated factors. Methods: The 5-COOP study is a cross-sectional survey including 1,253 centenarians in 5 countries (Japan, France, Switzerland, Denmark, and Sweden). Data were collected using a standardized questionnaire during a face-to-face interview (73.3%), telephone interview (14.5%), or by postal questionnaire (12.2%). The 5 dimensions of the frailty phenotype (weight loss, fatigue, weakness, slow walking speed, and low level of physical activity) were assessed by using self-reported data. Factors associated with frailty criteria were investigated by using multivariate regression models. Results: Almost 95% of the participants had at least 1 frailty criterion. The overall prevalence of frailty (3 criteria or more) was 64.7% (from 51.5% in Sweden to 77.6% in Switzerland), and 32.2% of the participants had 4 or 5 criteria. The most frequent criteria were weakness (84.2%), slow walking speed (77.6%), and low level of physical activity (72.5%), followed by fatigue (43.8%) and weight loss (23.8%). Factors associated with frailty included data collection modes, country of residence, gender, living in institution, depression, dementia, disability, falls, and sensory impairments. Conclusions: This study shows that reaching 100 years of age rarely goes without frailty and sheds light on factors associated with frailty at a very old age.

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Section: Introductionmentioning

confidence: 99%

Frailty and Associated Factors among Centenarians in the 5-COOP Countries

et al. 2018

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“…Due to unavailability of data and research on frailty in centenarians, we are not able to make comparisons between China and other countries to examine whether the sex difference in the DI scores persists. However, two recent studies focusing on nearcentenarians and centenarians show that women are frailer than men in terms of phenotypic frailty [41] and accumulative deficit index [13]. More studies are clearly needed to further verify the gender difference.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the capacity of reflecting accumulative health risks in old ages, this measurement holds important values in research and practice, especially for the public health system to face the unprecedented trend of population aging [30,31]. However the current literature has not adequately studied this important measurement in centenarians [13]. In particular, the prevalence and mortality/health predictive This study makes an initial effort to fulfill such a research gap and it has some important strengths.…”

Section: Discussionmentioning

confidence: 99%

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Frailty Still Matters for Health and Survival in Centenarians: The Case of China

2015

The Gerontologist

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Background: Frailty indicates accumulated vulnerability of adverse health outcomes in later life. Its robustness in predicting dependent living, falls, comorbidity, disability, health change, mortality, and health care utilization at older ages is well-documented. However, almost no studies have ever attempted to examine its robustness in centenarians, mainly due to data unavailability. This study examines prevalence of frailty in centenarians and its predictive powers on subsequent mortality and health conditions. Methods: We use a sample of 4434 centenarians from the 2002, 2005, 2008, and 2011 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with elders in three younger age groups 65-79, 80-89, and 90-99 as comparisons. Frailty is measured by a cumulative deficit index (DI) that is constructed from 39 variables covering physical and cognitive function, disease conditions, psychological well-being, and other health dimensions. Survival analysis is conducted to examine how frailty is associated with subsequent mortality at an average follow-up length of 3.7 years (2.6 years for deceased persons died in 2002-2011 and 7.6 years for survived persons at the 2011 wave). Logistic regressions are applied to examine how frailty is associated with subsequent physical and cognitive functions, disease conditions, and self-rated health with an average follow-up length of 3.0 years. Results: The study reveals that centenarians are frailer than younger elders. The DI scores increase from less than 0.1 at ages 65-79 to over 0.30 in centenarians. Women are frailer than men at all ages. However, there is a great variation in frailty among all age groups. We also find that each additional increase of 0.01 score of the DI is associated with 1.6 % higher mortality risk (95 % CI: 1.014-1.018) in female centenarians and 1.4 % higher mortality risk (95 % CI: 1.010-1.018) in male centenarians, although these associations are weaker than those in other three younger age groups. Conclusions: Frailty still plays an important role in determining subsequent health outcomes and mortality in centenarians.

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“…However, for health and social care professionals involved in providing direct service to older people who are being introduced to frailty as an entity that is preventable, reversible, and detectable, confusion results. At the same time, different groups continue to propose descriptors of ageing populations that includes the word 'frailty', although the concepts are similar to other more widely used instruments [29][30][31]. From social science researchers, there is also an opinion that the term frailty may be stigmatising and not acceptable by older people themselves [32].…”

Section: Diversions From Recent Research and Public Health Discoursementioning

confidence: 99%

Challenges of population ageing: putting frailty as a cornerstone of health and social care systems

Woo

2018

Eur Geriatr Med

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Geriatric medicine as a specialty has a fairly short history, its establishment resting on the efforts of prominent UK doctors initially. The core of geriatric medicine is the multi-domain approach that covers physical, functional, psychological, nutritional, and social domains versus the system approach, embodied by the comprehensive geriatric assessment. The dissemination of this specialty to other countries depended much on continuing advocacy by doctors who received training from established geriatric departments and then incorporating the specialty into the training curriculum and service delivery models of their own countries. Such efforts have varying degrees of success, and the specialty has seldom achieved the same status as other organ-based specialty such as cardiology or gastroenterology, being reflected by fewer (and declining) number of trainees. Neither has this approach been adopted widely in the primary care setting [1]. Worldwide there are various reasons for this such as: the observations that there are nothing special and everyone looks after elderly patients; attractions to specialties involving advanced technologies and procedures; negative images of ageing and lower health care prioritizations; and lower professional income or status. One major obstacle is that it is difficult to explain the need for this specialty in a concise way. The concept of frailty that has been developing in the past 20 years represents a unique opportunity to describe the essence of geriatric medicine in a concise, quantifiable, and measurable way that can be understood by clinicians, health managers, and policy makers.

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Toward a Comprehensive Model of Frailty: An Emerging Concept From the Hong Kong Centenarian Study

Cited by 24 publications

References 52 publications

Frailty and Associated Factors among Centenarians in the 5-COOP Countries

Frailty and Associated Factors among Centenarians in the 5-COOP Countries

Frailty Still Matters for Health and Survival in Centenarians: The Case of China

Challenges of population ageing: putting frailty as a cornerstone of health and social care systems

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