Abstract
Background: The etiology of frailty is complex and incompletely understood, and is associated with alterations in the immune system, resulting in chronic low-grade inflammation. However, few studies have explored the inflammatory biomarkers related to physical performance in the elderly. Methods: We evaluated the prevalence of frailty with a cross-sectional study among older adults in rural communities in Thailand (n = 457, mean age of 71.4 ± 5.8 years) with Fried’s frailty phenotype including five criteria: weight loss, exhaustion, slowness, weakness, and inactivity. The association between inflammatory biomarkers (serum interleukin-6, IL-6 and C-reactive protein, CRP levels) and physical performance (grip strength, walk times and VO2Max) was examined in frail participants (n=64). Results: The prevalence of frailty and pre-frailty in this population was 37.4% (95% CI, 32.9-42.0) and 54% (95% CI, 49.4-58.7). Multiple linear regression analysis found that serum IL-6 level was significantly elevated in frail older adults with low grip strength (beta = -0.348, SE= 0.155, p = 0.029). Serum CRP level was also elevated significantly in frail older adults with low grip strength (beta = -0.049, SE= 0.023, p = 0.04) and low VO2Max (beta = -0.047, SE= 0.019, p = 0.016) after adjustment for sex, age, hypertension, diabetes, osteoporosis, heart disease, and BMI. Conclusion: Our findings support a low level of grip strength as predictor of inflammatory biomarkers in older adults with frailty. Primary care practitioners could use frailty indicators and performance combined with serum biomarkers for early health risk detection in older adults.
Highlights
In a report from a survey of older people in 2017, Thailand (NSO) showed that the number of elderly has increased to 11.23 million or 17.13 percent of the total population in 2017, and it will become an aging society in 2021 when the number will rise to 13.1million or 20 percent of the total population [1, 2]
We found that the grip strength was significantly correlated with serum IL-6 level (p = 0.029) and C-reactive protein (CRP) level (p = 0.040) while the VO2Max was significantly correlated with serum CRP level (p = 0.016) using Linear regressions
There is consistent scientific evidence showing that IL-6 is associated with sarcopenia and inflammation in the elderly and their association with limited mobility, disability, falls, morbidity and mortality [21, 42, 43]. These results suggest that inflammatory mediators, for example, IL-6 might be biomarkers for frailty and decreased physical function in older adults, which was consistent with other studies that evaluated inflammatory factors related to frailty and used to predict frailty as IL-6, TNF, C-Reactive Protein [44 - 46]
Summary
In a report from a survey of older people in 2017, Thailand (NSO) showed that the number of elderly has increased to 11.23 million or 17.13 percent of the total population in 2017, and it will become an aging society in 2021 when the number will rise to 13.1million or 20 percent of the total population [1, 2]. Aging-related changes in skeletal muscle result in a decline in physical function, physical performance, physical activity, and an increased risk of adverse health outcomes [6]. Studies on the prevalence of frailty worldwide have shown a range of frailty in Spain between 3-37% [10]; associated factors include being female and advanced age [11]. Frailty affects long-term care costs, rising health costs and adverse health outcomes [13, 14]. A few studies on the prevalence of frailty in Thailand reported a range of frailty between 8-22% [15, 16]. Few studies have explored the inflammatory biomarkers related to physical performance in the elderly
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