Frailty, polypharmacy, malnutrition, chronic conditions, and quality of life in the elderly: Large population-based study.

Abstract

Aging, a significant public health issue, is associated with multiple concurrent chronic diseases and aging-related conditions (geriatric syndromes). To investigate the impact of age and chronic conditions on geriatric syndromes and the intercorrelations between multiple geriatric syndromes and quality of life (QoL) in the elderly (≥65 years) at the population level. A large representative sample was randomly selected from a county with 17 towns and 811,867 residents, with multiple chronic conditions, geriatric syndromes (frailty, polypharmacy, and malnutrition), and QoL assesses and compared between geriatric and nongeriatric populations and among subgroups of the elderly. Associations of demographic information and chronic conditions with geriatric conditions and QoL in the elderly were assessed using multivariable-adjusted logistic regression. Intercorrelations between age, multiple geriatric syndromes, and QoL were investigated using both correlation analysis and restricted cubic splines (RCS)-based multivariable-adjusted dose-response analysis. Elderly people comprised 43.4% of the whole population, and prevalence of frailty, (pre-)malnutrition, polypharmacy, and impaired QoL among the elderly (median age, 73 years; male proportion, 51.0%) was 8.3%, 15.6%, 3.2%, and 10.8%, respectively. Prevalence of geriatric syndromes mostly did not significantly differ among different age subgroups of the elderly (except that frailty occurred more often with older age) or by gender. (Pre-)malnutrition was significantly associated with less often obesity and more frequent constipation, polypharmacy with more often diabetes and constipation, frailty with more frequent constipation and hernia, and impaired QoL with more often hypertension, diabetes, physical disability, and constipation. MNA-SF, GFI, and EQ-5D-5L scores and number of drugs used mostly significantly predicted the other geriatric syndromes and QoL. Impaired QoL was significantly associated with more often frailty, (pre-)malnutrition, and polypharmacy, and frailty with more frequent (pre-)malnutrition and polypharmacy. At 1.5-year follow-up, impaired QoL was significantly linked to polypharmacy and frailty at baseline; (pre-)malnutrition was significantly associated with frailty at baseline; polypharmacy was significantly linked to frailty at baseline; frailty was significantly linked to both (pre-)malnutrition and polypharmacy at baseline. Causal mediation analyses showed that frailty mediated the linkage between polypharmacy and worse QoL, and also that polypharmacy mediated the linkage between frailty and worse QoL. In this large population-based study of the elderly with prospective follow-up, multiple chronic conditions were associated with one or more of the investigated geriatric syndromes. Geriatric syndromes were mostly significantly intercorrelated with and well predictive of each other and QoL, and there existed causal relationships between geriatric syndromes and QoL with other geriatric syndromes being mediators. The findings might be subject to some bias due to residual confounding factors not available in the dataset. It would be important to perform personalized geriatric syndromes stratified by chronic conditions, and active prevention or intervention of any syndrome might help to reduce the others and improve QoL.