Abstract
BackgroundNo study has tried to distinguish subjects that become frail due to diseases (frailty related to diseases) or in the absence of specific medical events; in this latter case, it is possible that aging process would act as the main frailty driver (age-related frailty).ObjectivesTo classify subjects according to the origin of physical frailty: age-related frailty, frailty related to diseases, frailty of uncertain origin, and to compare their clinical characteristics.Materials and methodsWe performed a secondary analysis of the Multidomain Alzheimer Preventive Trial (MAPT), including 195 subjects ≥70 years non-frail at baseline who became frail during a 5-year follow-up (mean age 77.8 years ± 4.7; 70% female). Physical frailty was defined as presenting ≥3 of the 5 Fried criteria: weight loss, exhaustion, weakness, slowness, low physical activity. Clinical files were independently reviewed by two different clinicians using a standardized assessment method in order to classify subjects as: “age-related frailty”, “frailty related to diseases” or “frailty of uncertain origin”. Inconsistencies among the two raters and cases of uncertain frailty were further assessed by two other experienced clinicians.ResultsFrom the 195 included subjects, 82 (42%) were classified as age-related frailty, 53 (27%) as frailty related to diseases, and 60 (31%) as frailty of uncertain origin. Patients who became frail due to diseases did not differ from the others groups in terms of functional, cognitive, psychological status and age at baseline, however they presented a higher burden of comorbidity as measured by the Cumulative Illness Rating Scale (CIRS) (8.20 ± 2.69; vs 6.22 ± 2.02 frailty of uncertain origin; vs. 3.25 ± 1.65 age-related frailty). Time to incident frailty (23.4 months ± 12.1 vs. 39.2 ± 19.3 months) and time spent in a pre-frailty condition (17.1 ± 11.4 vs 26.6 ± 16.6 months) were shorter in the group of frailty related to diseases compared to age-related frailty. Orthopedic diseases (n=14, 26%) were the most common pathologies leading to frailty related to diseases, followed by cardiovascular diseases (n=9, 17%) and neurological diseases (n = 8, 15%).ConclusionPeople classified as age-related frailty and frailty related to diseases presented different frailty-associated indicators. Future research should target the underlying biological cascades leading to these two frailty classifications, since they could ask for distinct strategies of prevention and management.
Highlights
No study has tried to distinguish subjects that become frail due to diseases or in the absence of specific medical events; in this latter case, it is possible that aging process would act as the main frailty driver
Considering clinical data, we focused on: past and current comorbidities at baseline ; all available clinical assessments: cognitive status assessed by the Mini-Mental State Examination (MMSE), functional status assessed by the Short Physical Performance Battery (SPPB), nutritional status assessed by the Body Mass Index (BMI), psychological status assessed by the Geriatric Depression Scale (GDS) and physical frailty assessed by Fried criteria ; the intervening medical events; drug treatments and all medical records available in the clinical file of the subject
Comparing the 3 groups according to the origin of physical frailty, we did not find any significant differences in terms of MMSE, SPPB and its items, BMI, GDS, but participants with frailty related to diseases presented a higher burden of comorbidity as measured by Cumulative Illness Rating Scale (CIRS)-G (8.20 ± 2.69 vs. 6.22 ± 2.02 frailty of uncertain origin; vs. 3.25 ± 1.65 age related frailty, p < 0.0001)
Summary
No study has tried to distinguish subjects that become frail due to diseases (frailty related to diseases) or in the absence of specific medical events; in this latter case, it is possible that aging process would act as the main frailty driver (age-related frailty). Objectives: To classify subjects according to the origin of physical frailty: age-related frailty, frailty related to diseases, frailty of uncertain origin, and to compare their clinical characteristics. Clinical files were independently reviewed by two different clinicians using a standardized assessment method in order to classify subjects as: “age-related frailty”, “frailty related to diseases” or “frailty of uncertain origin”. Results: From the 195 included subjects, 82 (42%) were classified as age-related frailty, 53 (27%) as frailty related to diseases, and 60 (31%) as frailty of uncertain origin. Patients who became frail due to diseases did not differ from the others groups in terms of functional, cognitive, psychological status and age at baseline, they presented a higher burden of comorbidity as measured by the Cumulative Illness Rating Scale (CIRS) (8.20 ± 2.69; vs 6.22 ± 2.02 frailty of uncertain origin; vs 3.25 ± 1.65 age-related frailty). Future research should target the underlying biological cascades leading to these two frailty classifications, since they could ask for distinct strategies of prevention and management
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