Abstract
BackgroundAlthough frailty and cognitive impairment are critical risk factors for disability and mortality in the general population of older inhabitants, the prevalence and incidence of these factors in individuals treated in the specialty outpatient clinics are unknown.MethodsWe recently established a frailty clinic for comprehensive assessments of conditions such as frailty, sarcopenia, and cognition, and planned 3-year prospective observational study to identify the risk factors for progression of these aging-related statuses. To date, we recruited 323 patients who revealed symptoms suggestive of frailty mainly from a specialty outpatient clinic of cardiology and diabetes. Frailty status was diagnosed by the modified Cardiovascular Health Study (mCHS) criteria and some other scales. Cognitive function was assessed by Mini-Mental State Examination (MMSE), Japanese version of the Montreal Cognitive Assessment (MoCA-J), and some other modalities. Sarcopenia was defined by the criteria of the Asian Working Group for Sarcopenia (AWGS). In this report, we outlined our frailty clinic and analyzed the background characteristics of the subjects.ResultsMost patients reported hypertension (78%), diabetes mellitus (57%), or dyslipidemia (63%), and cardiovascular disease and probable heart failure also had a higher prevalence. The prevalence of frailty diagnosed according to the mCHS criteria, cognitive impairment defined by MMSE (≤27) and MoCA-J (≤25), and of AWGS-defined sarcopenia were 24, 41, and 84, and 31%, respectively. The prevalence of frailty and cognitive impairment increased with aging, whereas the increase in sarcopenia prevalence plateaued after the age of 80 years. No significant differences were observed in the prevalence of frailty, cognitive impairment, and sarcopenia between the groups with and without diabetes mellitus, hypertension, or dyslipidemia with a few exceptions, presumably due to the high-risk subjects who had multiple cardiovascular comorbidities. A majority of the frail and sarcopenic patients revealed cognitive impairment, whereas the frequency of suspected dementia among these patients were both approximately 20%.ConclusionsWe found a high prevalence of frailty, cognitive impairment, and sarcopenia in patients with cardiometabolic disease in our frailty clinic. Comprehensive assessment of the high-risk patients could be useful to identify the risk factors for progression of frailty and cognitive decline.
Highlights
Frailty and cognitive impairment are critical risk factors for disability and mortality in the general population of older inhabitants, the prevalence and incidence of these factors in individuals treated in the specialty outpatient clinics are unknown
The prevalence of frailty diagnosed according to the modified Cardiovascular Health Study (mCHS) criteria in our study population was about twice as high as that of the recently reported community-dwelling older persons, and in most of those, the prevalence was approximately 10% [20,21,22]
We evaluated the depressive mood, nutritional status, and social support network since several reports have revealed that depressive mood and malnutrition could be risks for frailty [35, 36], and a recent report revealed that the older persons living alone are susceptible to becoming frail [37], which indicates that the lack of social support could be a crucial risk factor for frailty
Summary
Frailty clinic Our frailty clinic was opened to comprehensively assess frailty, sarcopenia, cognition, psychological condition, nutrition, medications, and social status of patients in October 2015. Other evaluation tests Self-measured blood pressure at home, ambulatory blood pressure monitoring, central arterial pressure, ankle brachial pressure index, pulse wave velocity, carotid Doppler ultrasonography, echocardiography, brain magnetic resonance imaging, lower extremity motor function analysis to measure power, speed, and balance during a standing-up motion (zaRitz®; Tanita Corp., Tokyo, Japan) and an autonomic nervous function test (Kiritsu-Meijin®; Crosswell Co., Ltd., Kanagawa, Japan) were performed in some patients when necessary. Outcomes of the longitudinal study During the 3-year longitudinal observational study, the following outcomes were evaluated annually using questionnaires and medical charts: (1) incidence of fall and fracture; (2) incidence or progression of frailty status; (3) dementia; (4) cardiovascular disease (myocardial infarction, stroke, cardiovascular interventions); (5) hospitalization; (6) certified level of support or long-term care needs from the insurance system; and (7) death. The significance level was set at P < 0.05
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