Frailty Odds Ratio Research Articles

From the December Issue of JAMDA

From the December Issue of JAMDA

Prevalence and Social Correlates of Frailty Among Rural Community-Dwelling Older Adults

Background: Frailty, a multidimensional geriatric syndrome, confers a high risk of falls, disability, hospitalization, and mortality. The prevalence and correlates of frailty in older people dwelling in rural communities are unknown. Methods: We examined frailty, as defined by the Korean Geriatric Society, and social correlates among rural communitydwelling older adults (n=419) aged 65 or older. Results: The prevalence of frailty and prefrailty was 11.5% and 38.7%, respectively. Among eight frailty criteria, the prevalence of multiple medications was highest (57.3%), while self-rated health as “unhealthy” was the second highest (45.1%). In contrast, the prevalence of exhaustion was the lowest (10%) among the eight frailty criteria. The prevalence of frailty was 12.6% among women and 6.3% among men (p=0.02). Uneducated older adults showed a significantly higher prevalence of frailty (13.1%) than any other educational groups (6.3-9.2%). In addition, older adults with high social support showed lower frailty than the other groups. After adjustment for other factors; however, a lack of social support (odds ratio for frailty, 1.98; 95% confidence interval, 1.14-3.44) was associated with increased odds of frailty. Conclusion: Frailty is not uncommon among rural community-dwelling old men and women in Korea. In the rural community, females with a lack of social support might be at a higher risk of frailty, as those were two of the strongest risk factors discovered in this study. This study calls for more interest and concern for the frail older adults with a lack of social support in rural communities.

Higher Levels of Endogenous Estradiol are Associated with Frailty in Postmenopausal Women from the Toledo Study for Healthy Aging

Adverse effects of higher endogenous estradiol (E2) levels on various clinical outcomes and on determinants of the frailty syndrome have recently been reported. However, there are no data about the potential relationship between E2 and frailty. We aimed to study the association between E2 levels and frailty among older postmenopausal women not taking hormonal therapy. We used data from the Toledo Study for Healthy Aging, a Spanish population-based cohort study. Frailty was defined according to Fried's approach. Multivariate odds ratios (OR) and 95% confidence intervals (CI) associated with E2 levels were estimated using polytomous logistic regression. E2 levels decreased significantly with age and educational level, whereas they increased with body mass index, high-sensitivity C-reactive protein (hs-CRP), and impairment in Katz activities of daily living. Higher E2 levels were associated with the prevalence of frailty among women younger than 79 yr, but not in the oldest group (p interaction = 0.047). After adjustment, OR of frailty associated with a 1 sd increase of E2 was 1.51 (95% CI, 1.04-2.20; P = 0.03). We identified an interaction between E2 and hs-CRP on the prevalence of frailty (P value = 0.042). Women with both higher E2 and hs-CRP (defined as values into the upper tertile) had an age-adjusted OR of 4.2 (95% CI, 1.7-10.5; P = 0.002), compared with women with low levels of both E2 and hs-CRP. Higher E2 levels were associated with frailty in postmenopausal women. The synergism between higher E2 and hs-CRP levels suggests the existence of physiopathological mechanisms connecting inflammation and estrogen to frailty.

Sex differences in the association between serum levels of testosterone and frailty in an elderly population: the Toledo Study for Healthy Aging.

BackgroundAge-associated decline in testosterone levels represent one of the potential mechanisms involved in the development of frailty. Although this association has been widely reported in older men, very few data are available in women. We studied the association between testosterone and frailty in women and assessed sex differences in this relationship.MethodsWe used cross-sectional data from the Toledo Study for Healthy Aging, a population-based cohort study of Spanish elderly. Frailty was defined according to Fried's approach. Multivariate odds-ratios (OR) and 95% confidence intervals (CI) associated with total (TT) and free testosterone (FT) levels were estimated using polytomous logistic regression.ResultsIn women, there was a U-shaped relationship between FT levels and frailty (p for FT2 = 0.03). In addition, very low levels of FT were observed in women with ≥4 frailty criteria (age-adjusted geometric means = 0.13 versus 0.37 in subjects with <4 components, p = 0.010). The association of FT with frailty appeared confined to obese women (p-value for interaction = 0.05).In men, the risk of frailty levels linearly decreased with testosterone (adjusted OR for frailty = 2.9 (95%CI, 1.6–5.1) and 1.6 (95%CI, 1.0–2.5), for 1 SD decrease in TT and FT, respectively). TT and FT showed association with most of frailty criteria. No interaction was found with BMI.ConclusionThere is a relationship between circulating levels of FT and frailty in older women. This relation seems to be modulated by BMI. The relevance and the nature of the association of FT levels and frailty are sex-specific, suggesting that different biological mechanisms may be involved.

The Association of Race With Frailty: The Cardiovascular Health Study

Frailty, which has been conceptualized as a state of decreased physiologic reserve contributing to functional decline, has a prevalence among older African Americans that is twice that in older whites. This study assesses the independent contribution of race to frailty. We evaluated 786 African-American and 4491 white participants of the Cardiovascular Health Study (CHS). Frailty is defined as meeting three or more of five criteria derived from CHS measures: lowest quintile for grip strength, self-reported exhaustion, unintentional weight loss of 10 lbs or greater in 1 year, slowest quintile for gait speed, and lowest quintile for physical activity. Controlling for age, sex, comorbidity, socioeconomic factors, and race, multinomial logistic regression estimated the odds ratio (OR) of prefrail (one or two criteria) to not frail and frail to not frail. Among African Americans, 8.7% of men and 15.0% of women were frail compared with 4.6% and 6.8% of white men and women, respectively. In adjusted models, nonobese African Americans had a fourfold greater odds of frailty compared with whites. The increased OR of frailty associated with African-American race was less pronounced among those who were obese or disabled. African-American race is associated independently with frailty.