Frailty, transition in frailty status and all-cause mortality in older adults of a Taichung community-based population

Mu-Cyun Wang,Chuan-Wei Yang,Chiu-Shong Liu,Tsai-Chung Li,Cheng-Chieh Lin,Shing-Yu Yang,Chia-Ing Li,Wen-Yuan Lin,Chih-Hsueh Lin

doi:10.1186/s12877-019-1039-9

Abstract

BackgroundPrevious studies have reported the associations of frailty phenotype or its components with mortality. However, studies that explored the effects of transition in frailty status on mortality were far less in Asian or Chinese. The aim of this study was to evaluate baseline frailty status and one-year change of frailty status in relation to all-cause mortality in Taiwanese community-dwelling older adults who participated in the Taichung Community Health Study for Elders.MethodsWe conducted a community-based prospective cohort study. A total of 921 community-dwelling elderly men and women aged 65–99 years in Taichung City were enrolled in 2009–2010 and were followed up through 2016. We adopted the definition of frailty proposed by Fried et al., including five components: shrinking, weakness, poor endurance and energy, slowness, and low physical activity. Cox proportional hazards models were used to determine adjusted hazard ratios (HRs) of mortality with 95% confidence intervals (CIs) for frailty at baseline and one-year change in frailty status.ResultsThere were 160 deaths during the follow-up period. The mortality rates in groups of robust and frail were 20.26 and 84.66 per 1000 person-years respectively. After multivariate adjustment, the HR (CIs) for baseline frailty was 2.67 (1.73–4.12). Poor endurance and energy [1.88 (1.03–3.42)], slowness [2.60 (1.76–3.83)] and weakness [1.65 (1.16–2.33)] were found to be predictors of mortality. Increased risks in mortality for subgroups of robust-to-frail [2.76 (1.22–6.27)], frail-to-robust [3.87 (1.63, 9.19)], and frail-to-frail [4.08 (1.92–8.66)] over one-year period were observed compared with those remaining robust.ConclusionBaseline frailty status and one-year change in frailty status are associated with 6-year all-cause mortality among Taiwanese elderly adults. Frailty may be useful for identifying older adults at high risks for mortality prevention.

Highlights

Previous studies have reported the associations of frailty phenotype or its components with mortality
The present study was approved by Human Research Committee (HRC) (CMUH105-REC1–026), the informed consent was not required because the study was a secondary data analysis
Frail older adults at baseline were associated with increased risks of all-cause mortality [hazard ratios (HRs) (CI): 2.67 (1.73–4.12)]

Summary

Introduction

Previous studies have reported the associations of frailty phenotype or its components with mortality. The aim of this study was to evaluate baseline frailty status and one-year change of frailty status in relation to all-cause mortality in Taiwanese community-dwelling older adults who participated in the Taichung Community Health Study for Elders. A dynamic and complex geriatric state, has been used to describe very old individuals in a state of increased vulnerability to stressors resulting from multisystem decline in reserve and function including impaired strength, fatigue, weight loss, slowed motor processing and performance, social withdrawal, decreased balance, impaired cognition, and diminished physical functioning [2]. Frailty adds a clinical value in prognosis and decision-making because frail persons are vulnerable to many adverse outcomes such as impairment of function, infection, falls, institutionalization, and death [5], and frail older persons have adverse pathophysiologic or functional changes not captured fully by comorbidity and disability definitions

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