Transitions in Frailty Status in Older Adults in Relation to Mobility: A Multistate Modeling Approach Employing a Deficit Count

Abstract

OBJECTIVES To investigate how changes in frailty status and mortality risk relate to baseline frailty state, mobility performance, age and sex. SETTING The Yale Precipitating Events Project, a cohort study based in New Haven CT. PARTICIPANTS 754 community-dwelling people, aged 70+ years at baseline followed-up at 18, 36 and 54 months. METHODS Frailty status, assessed at 18-month intervals, was defined by a frailty index, as the number of deficits in 36 health variables. Mobility was defined as the time in seconds on the rapid gait test, where participants walked back and forth over a 20-ft course as quickly as possible. Multi-state transition probabilities were calculated with baseline frailty, mobility, age and sex estimated by Poisson and logistic regressions in survivors and those who died, respectively. RESULTS In multivariable analyses, baseline frailty status and age were significantly associated with changes in frailty status and the risk of death, while mobility was significantly associated with the former, but not with mortality. At all values of the frailty index, compared to those with poor mobility, participants with better mobility were more likely to remain stable or to improve. For example, at 54 months, 20.6% (95% confidence interval (CI) =16–25.2) of participants with poor mobility had the same or fewer deficits compared to 32.4% (95% CI=27.9–36.9) of those with better mobility. CONCLUSION A multi-state transition model effectively measured the probability of changes in frailty status and in the risk of death. Mobility, age and baseline frailty were significant factors in frailty state transitions.

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“…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. Visit was modeled as a repeated categorical measure to accommodate a possible nonlinear relationship between…”

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