Course of frailty stratified by physical and mental multimorbidity patterns: a 5-year follow-up of 92,640 participants of the LifeLines cohort study

R C Oude Voshaar,R M Marijnissen,R H S Van Den Brink,M K Borges,H W Jeuring,E O Hoogendijk,I Aprahamian,B Van Munster

doi:10.1186/s12916-021-01904-x

R C Oude Voshaar, R M Marijnissen + Show 6 more

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https://doi.org/10.1186/s12916-021-01904-x

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Abstract

BackgroundThe frailty index (FI) is a well-recognized measurement for risk stratification in older people. Among middle-aged and older people, we examined the prospective association between the FI and mortality as well as its course over time in relation to multimorbidity and specific disease clusters.MethodsA frailty index (FI) was constructed based on either 64 (baseline only) or 35 health deficits (baseline and follow-up) among people aged ≥ 40 years who participated in LifeLines, a prospective population-based cohort living in the Northern Netherlands. Among 92,640 participants, multivariable Cox proportional hazard models were fitted to study the hazard ratio (HR) of the FI at baseline, as well as for 10 chronic disease clusters for all-cause mortality over a 10-year follow-up. Among 55,426 participants, linear regression analyses were applied to study the impact of multimorbidity and of specific chronic disease clusters (independent variables) on the change of frailty over a 5-year follow-up, adjusted for demographic and lifestyle characteristics.ResultsThe FI predicted mortality independent of multimorbidity and specific disease clusters, with the highest impact in people with either endocrine, lung, or heart diseases. Adjusted for demographic and lifestyle characteristics, all chronic disease clusters remained independently associated with an accelerated increase of frailty over time.ConclusionsFrailty may be seen as a final common pathway for premature death due to chronic diseases. Our results suggest that initiating frailty prevention at middle age, when the first chronic diseases emerge, might be relevant from a public health perspective.

Highlights

The frailty index (FI) is a well-recognized measurement for risk stratification in older people
This may be explained by the inclusion of a heterogeneous population in terms of number, type, and severity of underlying diseases and argues for risk stratification to identify which patients might benefit from a given intervention [4, 7]
According to the prespecified cutoff values, a total of 17,786 (19.2%) people could be classified as robust, 69,828 (74.5%) people as pre-frail, and 5026 (5.4%) people as frail according to the FI consisting of 64 items (FI-64)

Summary

Introduction

The frailty index (FI) is a well-recognized measurement for risk stratification in older people. Randomized controlled trials that test the effectiveness of health-service or patientoriented interventions to improve outcomes in people with multimorbidity are still inconclusive [5, 6]. This may be explained by the inclusion of a heterogeneous population in terms of number, type, and severity of underlying diseases and argues for risk stratification to identify which patients might benefit from a given intervention [4, 7]. Frailty is increasingly recognized as an important concept for risk stratification to prevent further decline and iatrogenic harm [8]. Epidemiological studies have consistently demonstrated that frailty is an independent risk factor for adverse health events, such as falls, disability, hospitalization, admission to long-term care facilities, and mortality [8]

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