Trajectories of physical and mental functioning over 25 years before onset of frailty: results from the Whitehall II cohort study

Abstract

Background Research on frailty, a major contributor to heterogeneity in health, is undertaken on older adults although the processes leading to frailty are likely to begin earlier in the life course. Using repeat data spanning 25 years, we examined changes in physical and mental functioning before the onset of frailty, defined using Fried's frailty phenotype (FFP). Methods Functioning was measured using the Short-Form 36 General Health Survey (SF-36) on nine occasions from 1991 (age range 40-63 years) to 2015 (age range 63-85 years). The poorest of four FFP scores from 2002, 2007, 2012 and 2015 was used to classify participants as frail, pre-frail, or robust. We used linear mixed models with a backward timescale such that time 0 was the person-specific date of frailty classification for frail and pre-frail participants and the end of follow-up for robust participants. Analyses adjusted for socio-demographic factors, health behaviours, body mass index and multi-morbidity status were used to compare SF-36 physical (PCS) and mental (MCS) component summary scores over 25 years before time 0 as a function of FFP classification, with estimates extracted at time 0, À5, À10, À15, À20 and À25 years. We also used illness-death models to examine the prospective association between SF-36 component summary scores at age 50 and incident FFP-defined frailty. Results Among 7044 participants of the Whitehall II cohort study included in the analysis [29% female, mean age 49.7 (SD = 6.0) at baseline in 1991], 2055 (29%) participants remained robust, and 4476 (64%) became pre-frail and 513 (7%) frail during follow-up. Frail compared with robust participants had lower SF-36 scores at t = À25 before onset of frailty with a difference of 3.4 [95% confidence interval (CI) 1.6, 5.1] in PCS and 1.8 (À0.2, 3.8) in MCS. At t = 0, the differences increased to 11.5 (10.5, 12.5) and 9.1 (8.0, 10.2), respectively. The differences in SF-36 between the robust and pre-frail groups, although smaller [at t = 0, 1.7 (1.2, 2.2) in PCS and 4.0 (3.4, 4.5) in MCS], were already observed 20 and 25 years, respectively, before the onset of pre-frailty. Prospective analyses showed that at age 50, scores in the bottom quartiles of PCS [hazard ratio (HR) compared with the top quartile = 2.39, 95% CI 1.85, 3.07] and MCS [HR = 1.49 (1.15, 1.93)] were associated with a higher risk of FFP-defined frailty at older ages. Conclusions Differences in trajectories of physical and mental functioning in individuals who developed physical frailty at older ages were observable 25 years before onset of FFP-defined frailty. These findings highlight the need for a life course approach in efforts to prevent frailty.

Understanding the Causes of Frailty Using a Life-Course Perspective: A Systematic Review

“…After screening 5681 articles by title and abstract, 84 articles were retrieved for eligibility analyses through a full-text reading. Of these, 33 articles were finally selected [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Each section may be divided by subheadings.…”

Bidirectional causal relational between frailty and mental illness: a two-sample Mendelian randomization study

“…Both individuals classified as frail and pre-frail exhibited significantly diminished scores in mental and physical quality of life compared to non-frail individuals ( 33 ). A 25-year study utilizing replicated data revealed that individuals experiencing frailty exhibited significantly lower scores in the Short-Form 36 General Health Survey (SF-36) in comparison to non-frailty individuals ( 34 ). For instance, a prior study conducted in western China, involving 4,103 community residents aged 60 years and older, revealed that individuals grappling with co-morbidities of depression and anxiety exhibited elevated odds of pre-frailty (OR=1.86, 95% CI=1.41-2.45) and frailty (OR=7.03, 95% CI=4.48-11.05) in contrast to individuals without depressive and anxiety symptoms ( 35 ).…”

Quality of life in retired workers with past exposure to asbestos

“…5 This patient-reported outcome has strong links to more traditional health outcomes, such as mortality in general population 6 or survival in cancer patients, 7 and often precedes declines in objective health by years, especially in elderly patients. 8 While HRQoL in subjects with current long-term environmental exposures to chemicals or pollution has been the focus of a few studies, 9,10 none investigated the aftermath of these exposures. Former asbestos-exposed workers live with the knowledge that they have been exposed to a dangerous substance and that they might someday fall ill, a situation that Leibovits 11 likened to that of healthy genetic cancer carriers.…”

“…Health‐related quality of life (HRQoL) can be defined as “the health aspects of quality of life, generally considered to reflect the impact of disease and treatment on disability and daily functioning” and it also reflects “the impact of perceived health on an individual's ability to live a fulfilling life.” 5 This patient‐reported outcome has strong links to more traditional health outcomes, such as mortality in general population 6 or survival in cancer patients, 7 and often precedes declines in objective health by years, especially in elderly patients 8 …”