Transitions Between Frailty States Among Community-Living Older Persons

Abstract

Background: Little is known about the natural course of frailty. We performed a prospective study to determine the transition rates between frailty states and to evaluate the effect of the preceding frailty state on subsequent frailty transitions. Methods: We studied 754 community-living persons, aged 70 years or older, who were nondisabled in 4 essential activities of daily living. Frailty, assessed every 18 months for 54 months, was defined on the basis of weight loss, exhaustion, low physical activity, muscle weakness, and slow walking speed. Participants were classified as frail if they met 3 or more of these criteria, as prefrail if they met 1 or 2 of the criteria, and as nonfrail if they met none of the criteria. Results: Of the 754 participants, 434 (57.6%) had at least 1 transition between any 2 of the 3 frailty states during 54 months. The rates were 36.8%, 21.5%, and 9.2% for 1, 2, and 3 transitions, respectively. During the 18-month intervals, transitions to states of greater frailty were more common (rates up to 43.3%) than transitions to states of lesser frailty (rates up to 23.0%), and the probability of transitioning from being frail to nonfrail was very low (rates, 0%-0.9%), even during an extended period. The likelihood of transitioning between frailty states was highly dependent on one's preceding frailty state. Conclusions: Frailty among older persons is a dynamic process, characterized by frequent transitions between frailty states over time. Our findings suggest ample opportunity for the prevention and remediation of frailty.

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

“…14 This suggests that health promotion interventions may be more effective when targeted at less frail populations. Indeed, positive outcomes of preventative home visits (multidimensional visits addressing medical, functional, psychosocial and/or environmental problems and resources) by nurses on mortality rates appear to be greater for younger-old rather than older-old populations.…”

Frailty Trajectories After Treatment for Coronary Artery Disease in Older Patients

“…For each of 3 transitions (baseline to 6 months, 6 to 12 months, and 12 to 30 months), proportions were estimated for FI score decrease (≥0.02 decrease in FI score), stable FI score (change of <0.02), FI score increase (≥0.02 increase in FI score), deaths, and withdrawals. 32 A change of 0.02 was used as it corresponds with slightly more than a gain or loss of one deficit and is similar to the threshold used by other researchers. 33 To compare age, sex, and treatment group differences associated with change over time, we fitted FI scores to linear mixed models with a random intercept.…”

“…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.…”

Urinary Phytoestrogen Levels and Frailty in Older American Women of the National Health and Nutrition Examination Survey (NHANES) 1999-2002: A Cross-Sectional Study

“…It is possible to recover from frailty to prefrailty and nonfrailty conditions, respectively [10]. This makes the adoption of preventive measures attractive.…”