Abstract
ObjectiveTo identify modifiable risk factors for development and progression of frailty in older adults living in England, as conceptualised by a multidimensional frailty index (FI).MethodsData from participants aged 50 and over from the English Longitudinal Study of Ageing (ELSA) was used to examine potential determinants of frailty, using a 56-item FI comprised of self-reported health conditions, disabilities, cognitive function, hearing, eyesight, depressive symptoms and ability to carry out activities of daily living. Cox proportional hazards regression models were used to measure frailty development (n = 7420) and linear regression models to measure frailty progression over 12 years follow-up (n = 8780).ResultsIncreasing age (HR: 1.08 (CI: 1.08–1.09)), being in the lowest wealth quintile (HR: 1.79 (CI: 1.54–2.08)), lack of educational qualifications (HR: 1.19 (CI: 1.09–1.30)), obesity (HR: 1.33 (CI: 1.18–1.50) and a high waist-hip ratio (HR: 1.25 (CI: 1.13–1.38)), being a current or previous smoker (HR: 1.29 (CI: 1.18–1.41)), pain (HR: 1.39 (CI: 1.34–1.45)), sedentary behaviour (HR: 2.17 (CI: 1.76–2.78) and lower body strength (HR: 1.07 (CI: 1.06–1.08)), were all significant risk factors for frailty progression and incidence after simultaneous adjustment for all examined factors.ConclusionThe findings of this study suggest that there may be scope to reduce both frailty incidence and progression by trialling interventions aimed at reducing obesity and sedentary behaviour, increasing intensity of physical activity, and improving success of smoking cessation tools. Furthermore, improving educational outcomes and reducing poverty may also reduce inequalities in frailty.
Highlights
Frailty is a common geriatric state [1] which affects roughly 10% of over 65 year olds [1] and is forecast to present extensive problems for health and social care systems across the globe because of rising life expectancy [2]
The findings of this study suggest that there may be scope to reduce both frailty incidence and progression by trialling interventions aimed at reducing obesity and sedentary behaviour, increasing intensity of physical activity, and improving success of smoking cessation
Longitudinal Study of Ageing was developed by a team of researchers based at the University College London, NatCen Social Research, the Institute for Fiscal Studies and the University of Manchester
Summary
Frailty is a common geriatric state [1] which affects roughly 10% of over 65 year olds [1] and is forecast to present extensive problems for health and social care systems across the globe because of rising life expectancy [2]. Frailty occurs as a consequence of age-related physiological decline in multiple organ systems and leaves individuals vulnerable to relatively minor stressors (e.g.: low/high temperatures; minor infections) that can lead to sudden and disproportionate changes in their health (i.e.: from a state of independence to dependence) [1]. The frailty index (FI) [7] defines frailty as a state and is measured by the accumulation of agerelated health deficits which includes a wide range of health problems, including hearing, eyesight, cognitive problems and general health [7,8]. Older adults showing signs of frailty are at greater risk of adverse health outcomes including reduced functional independence [15], increased disability [16,17], poor quality of life [16], dementia [18], institutionalisation [19], and mortality [16,20]. Exploring modifiable risk factors that might delay the onset or reduce the progression of frailty is important, especially in the context of an ageing society
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