Abstract
BackgroundIn countries with high incomes, frailty indicators predict adverse outcomes in older people, despite a lack of consensus on definition or measurement. We tested the predictive validity of physical and multidimensional frailty phenotypes in settings in Latin America, India, and China.MethodsPopulation-based cohort studies were conducted in catchment area sites in Cuba, Dominican Republic, Venezuela, Mexico, Peru, India, and China. Seven frailty indicators, namely gait speed, self-reported exhaustion, weight loss, low energy expenditure, undernutrition, cognitive, and sensory impairment were assessed to estimate frailty phenotypes. Mortality and onset of dependence were ascertained after a median of 3.9 years.ResultsOverall, 13,924 older people were assessed at baseline, with 47,438 person-years follow-up for mortality and 30,689 for dependence. Both frailty phenotypes predicted the onset of dependence and mortality, even adjusting for chronic diseases and disability, with little heterogeneity of effect among sites. However, population attributable fractions (PAF) summarising etiologic force were highest for the aggregate effect of the individual indicators, as opposed to either the number of indicators or the dichotomised frailty phenotypes. The aggregate of all seven indicators provided the best overall prediction (weighted mean PAF 41.8 % for dependence and 38.3 % for mortality). While weight loss, underactivity, slow walking speed, and cognitive impairment predicted both outcomes, whereas undernutrition predicted only mortality and sensory impairment only dependence. Exhaustion predicted neither outcome.ConclusionsSimply assessed frailty indicators identify older people at risk of dependence and mortality, beyond information provided by chronic disease diagnoses and disability. Frailty is likely to be multidimensional. A better understanding of the construct and pathways to adverse outcomes could inform multidimensional assessment and intervention to prevent or manage dependence in frail older people, with potential to add life to years, and years to life.
Highlights
In countries with high incomes, frailty indicators predict adverse outcomes in older people, despite a lack of consensus on definition or measurement
Are older people defined as frail according to these paradigms at higher risk of dependence and death, even after controlling for major chronic diseases and disability? Does the aggregate of the individual indicators provide a better prediction of these outcomes (judged by population attributable fraction (PAF) derived from multivariable models) than the dichotomised or ordinal frailty scores? Are different frailty indicators differentially associated with the incidence of dependence and mortality? We addressed these questions in a large population-based cohort study in seven Low- and middle-income country (LMIC), in which settings little previous research into frailty has been conducted
In the full baseline sample the prevalence of frailty was 17.5 % according to the physical frailty and 29.1 % according to multidimensional frailty criteria
Summary
In countries with high incomes, frailty indicators predict adverse outcomes in older people, despite a lack of consensus on definition or measurement. Sustained interest in the construct stems mainly from its predictive validity, confirmed through increased risks of adverse health and social outcomes for older people – morbidity, hospitalization, falls and fractures, disability, dependence, institutionalization and death [2,3,4,5]. Trials of complex interventions, designed to promote independence in moderately frail older people have shown potential benefits. These are important findings with global implications [7,8,9]. While morbidities mediate the relationship between population ageing and societal costs, the relationships with chronological age are variable, and potentially amenable to influence from public health, health, and social care interventions [11]
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