Multidimensional Frailty Predicts Mortality Better than Physical Frailty in Community-Dwelling Older People: A Five-Year Longitudinal Cohort Study.

Alberto Cella,Monica Pomata,Nicola Veronese,Giacomo Siri,Erica Tavella,Barbara Senesi,Clarissa Musacchio,Camilla Prete,Alberto Pilotto,Katerin Leslie Quispe Guerrero,Ekaterini Zigoura

doi:10.3390/ijerph182312435

Abstract

Frailty is a common syndrome in older people that carries an increased risk of mortality. Two main models describe frailty, either as a loss of physical functions or as an accumulation of multiple deficits. The aim of our study was to compare the physical frailty index developed in the Cardiovascular Health Study (CHS) with a multidimensional frailty tool, the Multidimensional Prognostic Index (MPI), in predicting death in community-dwelling older subjects. Four hundred and seven community-dwelling older subjects were enrolled. Each subject underwent a comprehensive geriatric assessment (CGA) with calculation of the MPI and CHS index. Mortality was recorded over the following 5 years. In the overall sample (mean age of 77.9 ± 4.5 years; 51.6% female), 53 subjects (13%) died during the 5-year follow-up period. Both the MPI and CHS index were able to predict mortality; however, the MPI was significantly more accurate than the CHS index in predicting mortality (C-index = 0.69 and 0.59, respectively; p < 0.001), with a statistically significant difference of 10%. In conclusion, multidimensional frailty, assessed by the MPI, predicts five-year mortality in community-dwelling older people better than physical frailty, as assessed by the CHS index. These findings suggest the usefulness of assessing frailty by means of CGA-based tools to predict relevant health-negative outcomes in older people.

Highlights

All the people included in the Multidimensional Prognostic Index (MPI)-3 group were classified as frail using the Cardiovascular Health Study (CHS) index, but only 30/108 of the subjects included in the MPI-2 group were ranked as pre-frail
Dividing the participants according to survival status, people who died during the follow-up period were significantly older, had higher presence of frailty, according to the MPI (p < 0.0001)
Our results indicated that multidimensional frailty is more strongly associated with mortality than physical frailty, suggesting that the comprehensive geriatric assessment (CGA), beyond physical evaluation, is needed to identify different risks of mortality in older people

Summary

Introduction

Frailty is a condition characterized by a decline in functioning across multiple physiological systems, accompanied by elevated vulnerability to stressors [1]. It is a common condition in older people, with some data indicating that one person in ten suffers with this condition in any given community [2]. This condition is associated with several negative outcomes in older people, including cardiovascular disease [3], mood disorders [4], disability [5], hospitalization [6], and, mortality [7]

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