Prevalence of frailty and associated socio-demographic factors among community-dwelling older people in southwestern Iran: a cross-sectional study

Frailty and socioeconomic position: A systematic review of observational studies

BACKGROUND

Frailty, an age-related state of reduced physiological reserve, is often associated with lower socio-economic position (SEP). This systematic review synthesised observational studies assessing (i) the association between SEP and frailty prevalence; (ii) how changes in frailty status over time vary by SEP; and (iii) whether the association between frailty and clinical outcomes is modified by SEP.

METHODS

We searched three electronic databases from 2001 to 2023. We included observational studies measuring early-, mid-, and late-life indicators of SEP (education, income, wealth, housing, occupation, and area-based measures of multiple deprivation) and frailty (assessed using any validated measure). Screening and extraction were performed in duplicate. Findings were synthesised using narrative synthesis.

RESULTS

We included 383 studies reporting findings from 265 independent samples/cohorts across 64 countries. Lower SEP was associated with higher frailty prevalence across all indicators (childhood deprivation 7/8 studies, education 227/248, occupation 28/32, housing 8/9, income 98/108, wealth 39/44 and area-based deprivation 32/34). Lower SEP was also associated with higher frailty incidence (27/30), with greater odds of transitioning towards a more severe frailty state (35/43), lower odds of frailty reversion (7/11), and (in some studies) with more rapid accumulation of deficits (7/15). The relationship between frailty and mortality was not modified by SEP.

INTERPRETATION

Preventative measures across multiple levels of individual and structural inequality are likely to be required to reduce the rising levels of frailty. Resourcing of interventions and services to support people living with frailty should be proportionate to needs in the population to avoid widening existing health inequalities.

Cardiovascular disease risk factors and frailty syndrome in community-dwelling older adults: Results from the Amirkola Health and Aging Project Cohort Study

BACKGROUND

Early diagnosis and control of risk factors affecting frailty syndrome (FS) in older adults may lead to changes in the health/disease process, prevention of disability and dependency in the older adults, and reduction of health care costs and mortality rates. The aim of this study was to determine the predictive role of CVD risk factors and FS in community-dwelling older adults of Amirkola city in Iran.

METHODS

This descriptive-analytic cross-sectional study is part of the second phase of the Amirkola Health and Aging Project (AHAP) cohort study conducted since 2011 on all individuals ≥ 60 years in the city of Amirkola in northern Iran. Totally, 1000 older adults were included in the study and divided into three groups: frail (n = 299), pre-frail (n = 455), and non-frail (n = 246) older adults. In the present study, age ≥ 60 years, female sex, fasting blood sugar (FBS) ≥ 126 mg/dl, affected diabetes mellitus (DM), body mass index (BMI) ≥ 27 kg/m², waist circumference (WC) or abdominal obesity > 102 cm in men and > 88 cm in women, low-density lipoprotein (LDL) > 100 mg/dl, triglyceride > 150 mg/dl, cholesterol > 200 mg/dl, high-density lipoprotein (HDL) < 40 mg/dl and blood pressure (BP) > 90/140 mmHg, uric acid > 7 mg/dl and a positive smoking history were considered CVD risk factors.

RESULTS

The results showed that with each centimeter increase in WC, the odds of frailty compared with non-frailty was 79% higher, and the odds of frailty compared with pre-frailty was 1.43 times higher in older adults. In addition, the prevalence of pre-frailty compared with non-frailty, pre-frailty, and non-frailty was 10.59 times, 6.08 times, and 73.83 times higher in older individuals > 84 years old, respectively. The results of the present study indicated that the prevalence of pre-frailty compared with non-frailty, frailty compared with pre-frailty, and frailty compared with non-frailty was 2.86 times, 3.01 times, and 14.83 times higher in older adults women, respectively. The comparison between frail and non-frail groups represented that in DM older adults, the prevalence of frailty compared with non-frailty was 1.84 times higher and that of frailty compared with pre-frailty was 98% higher. The older adults with an FBS ≥ 126 mg/dl were 53% more likely to become frail, and with each unit increase in uric acid, the odds of becoming frail increased 2.05 times compared with non-frail older adults, and pre-frail compared with non-frail increased 99%.

CONCLUSION

The results demonstrated that CVD risk factors predictive of FS included central obesity, age > 84 years, female sex, DM, FBS ≥ 126, and uric acid > 7. This problem highlights the need for preventive strategies in the older adults who are simultaneously vulnerable to CVD and frailty.

Causal effects of socioeconomic traits on frailty: a Mendelian randomization study

Background

The relationship between socioeconomic status and frailty has been extensively investigated in the literature, but it remains unclear whether a causal relationship exists. Our goal is to evaluate the causal relationship between six socioeconomic traits and the frailty index using summary-level data for single nucleotide polymorphisms from large genome-wide association studies with individuals of European ancestry.

Methods

A two-sample MR was performed. We applied the inverse variance weighted (IVW) method for the primary estimate, with sensitivity analyses conducted using alternative MR methods to evaluate the robustness of the findings. A subsequent multivariable MR was undertaken to adjust for the effects of body mass index (BMI). Finally, the MR Steiger directionality test was performed to confirm the causal direction.

Results

The IVW MR analysis revealed significant associations between various socioeconomic factors and the frailty index. Specifically, genetically predicated age completed full time education (β = -0.477, 95% confidence interval [CI]: -0.634 to -0.319) and average total household income before tax (β = -0.321, 95% CI: -0.410 to -0.232) were negatively associated with the frailty index. On the other hand, genetically predicted job involves heavy manual or physical work (β = 0.298, 95% CI: 0.113 to 0.484), job involves mainly walking or standing (β = 0.179, 95% CI: 0.013 to 0.345), Townsend deprivation index at recruitment (β = 0.535, 95% CI: 0.285 to 0.785), and social isolation/loneliness (β = 1.344, 95% CI: 0.834 to 1.853) were positively associated with the frailty index. Sensitivity analysis using other MR methods and multivariable MR analysis adjusting for BMI yielded stable results. The MR Steiger directionality test confirmed the causal direction.

Conclusion

Our findings highlight the importance of socioeconomic factors in affecting frailty risk. Future research should focus on unraveling the pathways through which these socioeconomic factors exert their effects on frailty, with the ultimate goal of developing targeted strategies to mitigate the risk of frailty.

The association between frailty and body composition among the elderly: Birjand Longitudinal Aging Study (BLAS)

Background

This study aims to assess the possible relationship between frailty and anthropometric indices in older adults using data from the first phase of the Birjand Longitudinal Aging Study (BLAS).

Methods

In this cross-sectional study, we assessed the association between frailty (Frailty index (FI) and Fried frailty phenotype) and body composition indices in 1364 participants aged ≥ 60 years (September 2018 to April 2019). Analysis was conducted using one-way ANOVA and ordinal logistic regression.

Results

Participants were categorized as frail (n = 164), non-frail (n = 415), and pre-frail (n = 785) based on FI. A significant positive association was observed between the frailty and body mass index (BMI) (OR: 1.04, 95% CI:1.01- 1.07), waist circumference (WC) (OR: 1.02, 95% CI: 1.01- 1.03), waist-to-hip ratio (WHR) (OR: 2.36, 95% CI 1.05- 5.27) and waist-to-height ratio (WHtR) (OR: 1.27, 95%CI: 1.09- 1.47). Body shape index, body roundness index, and body adiposity index showed no significant association with frailty. Moreover, a BMI greater than 29 kg/m2 increased the odds of frailty and prefrailty by 79% (OR = 1.79, 95%CI = 1.30- 2.46, P < 0.001).

Conclusion

Results of this study showed that the risk of frailty increases as BMI and abdominal obesity indices increase. Therefore, BMI and abdominal obesity indices (WC, WHR, and WHtR) could serve as suitable tools for evaluating frailty in the elderly. However, additional studies are needed to evaluate the utility of the newly developed anthropometric indices in older adults.

Cross-cultural adaptation and psychometric evaluation of the social frailty scale in Iranian older adults

BACKGROUND

Social frailty is a holistic concept encompassing various social determinants of health. Considering its importance and impact on health-related outcomes in older adults, the present study was conducted to cross-culturally adapt and psychometrically evaluate the Social Frailty Scale in Iranian older adults in 2023.

METHODS

This was a methodological study. The translation and cross-cultural adaptation of the Social Frailty Scale 8-item (SFS-8) was conducted according to Wild's guideline. Content and face validity were assessed using qualitative and quantitative methods. Then, 250 older adults covered by comprehensive health centers were selected using multistage random sampling. Participants completed the demographic questionnaire, the Abbreviated Mental Test score, the SFS-8, and the Lubben Social Network Scale. Construct validity was assessed by principal component analysis (PCA) and known-group comparisons. The Mann‒Whitney U test was used to compare social frailty scores between the isolated and non-isolated older adults. Internal consistency, equivalence, and stability were assessed using the Kuder-Richardson method, the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and the minimum detectable change (MDC). The ceiling and floor effects were also assessed. The data were analyzed using JASP 0.17.3.

RESULTS

The ratio and index of content validity and the modified kappa coefficient of all the items were 1.00. The impact score of the items was greater than 4.6. PCA identified the scale as a single component by removing two questions that could explain 52.9% of the total variance in the scale score. The Persian version of the Social Frailty Scale could distinguish between isolated and non-isolated older adults (p < 0.001). The Kuder-Richardson coefficient, ICC, SEM, and MDC were 0.606, 0.904, 0.129, and 0.358, respectively. The relative frequencies of the minimum and maximum scores obtained from the scale were 34.8 and 1.2, respectively.

CONCLUSIONS

The Persian version of the Social Frailty Scale (P-SFS) can be used as a valid and reliable scale to assess social frailty in Iranian older adults.

Demographic and biological factors in interrelationships between physical, cognitive, psychological, and social frailty in community-dwelling older adults: Data from the Birjand Longitudinal Aging Study (BLAS)

Complex interrelationships may exist among different types of frailty. This study aimed to evaluate the demographic and biological factors that influence the different types of frailty in community-dwelling older adults in Iran through a cross-sectional analysis of data obtained from the Birjand Longitudinal Aging Study. This study is an ongoing cohort study of people aged 60 years and over and employed a multistage stratified cluster random sampling. Anthropometric measures were obtained by nurses. The "Fried frailty phenotype" was defined as physical frailty. Cognitive frailty was assessed using the Mini-Mental State Examination. Social frailty was evaluated by some questions, and psychological frailty was assessed using a patient health questionnaire. Blood samples were taken after overnight fasting. All statistical analyses were performed using Stata12 (Texas, USA) and Python. Some type of frailty had been experienced by 62.27 % of the older adults. Cognitive frailty was the dominant type of frailty (55.69 %). Based on multivariate regression analysis, age, sex, education, and marital status were the influencing factors in all types of frailty. Network analysis revealed that physical, cognitive, psychological, and social frailty had synergistic effects on each other, and age and sex had dominant interactions with frailty types. Cognitive frailty was dominant compared with other types of frailty, indicating the need to detect cognitive frailty at the earliest stage and to implement an appropriate program to manage cognitive frailty in older adults.

Frailty syndrome in women with osteoporosis, should physicians consider screening? A cross-sectional study

Despite its high prevalence and profound impact, frailty syndrome often goes undiagnosed. The study revealed a significant correlation between osteoporosis and frailty syndrome, with predictive accuracy exceeding 75 %. Given these findings and the existing recommendation for osteoporosis screening in older women, we underscore the importance of concurrently screening osteoporotic women for frailty.

Introduction

Frailty syndrome, a prevalent and significant geriatric condition, impacts healthcare costs and quality of life. Previous reviews have associated frailty syndrome with osteoporosis, but original research on this link is limited and has produced conflicting results. This study aims to investigate the relationship between frailty syndrome, osteoporosis, bone mineral densitometry T-score, and other influencing factors.

Methods

In this cross-sectional study, post-menopausal women underwent screening for osteoporosis and frailty syndrome using bone mineral densitometry and the Fried phenotype. Exclusion criteria included a history of diseases related to bone loss or medications affecting bone metabolism. Bivariate and multivariable tests were used to examine the correlation between frailty syndrome and various covariates, including the diagnosis of osteoporosis.

Results

A total of 272 women aged 60 to 89 years (mean age 68.57 ± 6.22) were evaluated. Osteoporosis was prevalent in 44.9 % of participants, and frailty syndrome was identified in 36.4 %. The regression model identified age, menopausal age, and the diagnosis of osteoporosis as variables significantly and independently associated with frailty syndrome. A T-score lower than -2.5 in the femur neck or lumbar spine exhibited a sensitivity of 86.6 % and specificity of 76.5 % in predicting frailty syndrome.

Conclusion

Older adults with osteoporosis face an increased risk of frailty syndrome. Therefore, we recommend that primary care providers screen osteoporotic women for frailty syndrome and, when appropriate, refer this group to geriatric specialists for further evaluation.

Relationship between Lifestyle and Frailty among Iranian Community-Dwelling Older Adults: Pilot Study

Background

Aging affects physical, mental, and social functions, which can lead to an increase in frailty. Old adults with frailty syndrome are prone to disabilities and hospitalization. Lifestyle is a context-based factor that has the potential to prevent frailty.

Objectives

This study aimed to assess the relationship between lifestyle and frailty among Iranian community-dwelling older adults.

Design Setting

This is a descriptive-analytical cross-sectional study. The participants were 513 older adults over 60 years by the convenience sampling method from the retirement center.

Measurements

Data were collected using Tilberg's frailty index, the Iranian elderly lifestyle questionnaire, and the Mini-Cog test. Data were analyzed with SPSS v.26 software by chi-square and logistic regression tests.

Results

The age of the participants was 66.43 ± 4.69 years. The male-to-female sex ratio was 1.5 (39.2% women). The lifestyle of 96 (19.3%) old adults was unfavorable. 18.7 percent of older adults had Frailty syndrome. The logistic regression test showed that moderate and favorable lifestyle (OR= 0.06; 95% CI: 0.02-0.16), age over 75 years (OR= 5.25; 95% CI: 2.35-11.69), retired employment status (OR= 0.13; 95% CI: 0.29-0.05) are factors that have a significant relationship with frailty (P< 0.05).

Conclusion

The findings showed that lifestyle can predict frailty. Therefore, it seems that an optimal lifestyle can prevent the frailty of older adults.

Impact of COVID-19 on Lifestyle: A Sample of Iranian Older Adults

The COVID-19 pandemic and prolonged quarantine affect the health behaviors of older adults. We investigated the changes in older adults' lifestyles during the pandemic in a sample of 1020 people aged 60 years old and over in Tehran. The results revealed that the COVID-19 pandemic had a positive impact on nutritional behaviors and social support while having a negative impact on physical activity and anxiety in older adults. Due to the greater deterioration of health behaviors among unmarried older adults, low socio-economic status, and COVID-19 inpatients, policymakers must pay attention to interventions to promote healthy lifestyles.

The prevalence and predictors of geriatric giants in community-dwelling older adults: a cross-sectional study from the Middle East

The term "geriatric giants" refers to the chronic disabilities of senescence leading to adverse health outcomes. This study aimed to investigate the prevalence and predictors of geriatric giants in Southern Iran. The participants were selected from Bushehr city using a multistage cluster random sampling method. Demographic data were collected through interviews. Frailty, incontinence, immobility, depression, cognitive impairment, and malnutrition were measured by questionnaires and instruments. Finally, data from 2392 participants were analyzed. The prevalence of fecal incontinence was less than 1% among all participants and similar in men and women. In contrast, compared with men, women had higher prevalence of urinary incontinence (36.44% vs. 17.65%), depression (39.05% vs. 12.89%), anorexia and malnutrition (2.35% vs. 0.82%), immobility (8.00% vs. 2.5%), frailty (16.84 vs. 7.34), and pre-frailty (54.19 vs. 38.63%). The prevalence of dependence and cognitive impairment was also higher in women and considerably increased with the age of participants. In total, 12.07% of subjects were frail, and 46.76% were pre-frail. The prevalence of frailty exponentially increased in older age, ranging from 4.18% among those aged 60-64 years to 57.35% in those aged ≥ 80 years. Considering 95% confidence interval (CI), multivariate logistic regression revealed that low physical activity [odds ratio (OR) 31.73 (18.44-54.60)], cancer (OR 3.28 (1.27-8.44)), depression [OR 2.42 (1.97-2.98)], age [OR 1.11 (1.08-1.14)], waist circumference [OR 1.03 (1.01-1.06)], BMI [OR 1.07 (1.01-1.14)], MNA score [OR 0.85 (0.79-0.92)], polypharmacy [OR 2.26 (1.30-3.95)] and male gender [OR 0.63 (0.42-0.93)] were independently associated with frailty. White blood cell count (WBC), smoking, marital status, and number of comorbidities were not independently associated with frailty. Low physical activity was the strongest predictor of frailty, which may need more attention in geriatric care. Frailty, its predictors, and other components of geriatric giants were considerably more common among women and older ages.

A global perspective on risk factors for frailty in community-dwelling older adults: A systematic review and meta-analysis

BACKGROUND

Frailty has become an important determinant of a series of adverse health outcomes. We explored the risk factors for frailty in older adults in the community from a global perspective and explore whether there are ethnic differences in these risk factors.

METHODS

The systematic review and meta-analysis (PROSPERO registration number: CRD42022323342) was searched using six electronic databases, including PubMed, Embase, the Cochrane Library, Web of Science, PsycINFO (EBSCO) and CINAHL (EBSCO) from inception to October 2021. We assessed study eligibility by inclusion and excluded criteria. Cohort studies included were assessed according to the Newcastle-Ottawa Scale. Cross-sectional studies were assessed by the bias risk evaluation standard recommended by the Agency for Health care Research and Quality. The results were reported by a narrative synthesis and pooled analyses. Statistical analyses were performed in Review Manager 5.3 software.

RESULTS

We reviewed 10870 studies, and 62 studies were included. The results showed a significant association between multidomain risk factors and the frailty of global older adults, including demographic factors, health-related factors, and physical factors. Marital status, depression, risk of malnutrition, history of falls and disease-related symptoms are also risk factors for frailty among older people in Asia.

CONCLUSION

Multiple domain factors were associated with frailty among older people around the world. Compared with the rest of the world, Asian populations are exposed to more risk factors for frailty. Therefore, health care providers should consider the characteristics of risk factors for frailty in this region when formulating intervention measures related to frailty.

Assessment of Physical Fitness and Risk Factors for the Occurrence of the Frailty Syndrome among Social Welfare Homes' Residents over 60 Years of Age in Poland

The study aimed at assessing physical fitness and occurrence of the frailty syndrome among social welfare homes’ residents as well as defining factors which determine the level of frailty and its occurrence. The examination included 198 residents (115 females and 83 males of average age 75.5 ± 10.21) and was carried out with the use of the Short Physical Performance Battery (SPPB) test with the following cut-off points: 0−6—frail, 7−9—pre-frail, 10−12—non-frail. The research additionally collected data regarding age, gender, number of chronic diseases, education level, type of prior work and current physical activity. In addition, the height and weight of the respondents were measured. The frailty syndrome was found in more than a half of the examinees (104; 52.53%), the pre-frailty state in 30.30% (n = 60) and 17.17% (n = 34) were non-frail. The average result of the SPPB test was 6.52 ± 2.73, which proves a moderate limitation of the sample group’s fitness. No significant differences were noted between female and male respondents (p = 0.27). The multifactorial linear regression model showed that independent and direct frailty syndrome predicators included age, number of chronic diseases and regular physical activity (p < 0.05). In conclusion, promoting and encouraging regular, age and interest-related forms of physical activity among seniors might foster the maintenance of their physiological reservoir and functional efficiency.

Low physical activity is the strongest factor associated with frailty phenotype and frailty index: data from baseline phase of Birjand Longitudinal Aging Study (BLAS)

Background

Frailty is the most complicated expression of aging that is related to disability or multi-morbidity. The aim of the present study was to estimate the prevalence of frailty and its associated factors among community-dwelling aged population.

Methods

A total of 1529 eligible community- dwelling older adults (≥ 60 years) were enrolled in the baseline phase of Birjand Longitudinal Aging Study (BLAS) from 2019 to 2020. Their frailty status was assessed using the Fried’s frailty phenotype and frailty index. Sociodemographic factors, including sex, age, marital status, and education level, were collected. Health status assessment included the history of hypertension, diabetes mellitus, cardiovascular disease, Alzheimer’s diseases and dementia, and other health conditions. Furthermore, functional assessment (ADL, IADL) and anthropometric measurements including height, weight, waist, calf, and mid-arm circumference were made and the body mass index was calculated. The nutrition status and polypharmacy (use 3 or more medication) were also evaluated.

Results

The prevalence of frailty was 21.69% according to the frailty phenotype and 23.97% according to the frailty index. A multiple logistic regression model showed a strong association between low physical activity and frailty phenotype (OR = 36.31, CI = 16.99–77.56, P < 0.01), and frailty index (OR = 15.46, CI = 5.65–42.34, P < 0.01). Other factors like old age (≥80), female sex, malnutrition, polypharmacy, obesity, and arthritis were also associated with frailty. The Kappa coefficient of the agreement between these two instruments was 0.18.

Conclusion

It seems that low physical activity is the most important determinant of frailty. Low physical activity and some other factors may be preventable or modifiable and thus serve as clinically relevant targets for intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03135-y.

Prevalence of Frailty among Community-Dwelling Older Adults in Asian Countries: A Systematic Review and Meta-Analysis

This study aimed to synthesize frailty prevalence among community-dwelling older adults in Asia and identify factors influencing prevalence estimates. Five electronic databases were searched by 29 April 2022, including representative samples of community-dwelling adults who were aged 60 years and older and lived in Asia. Cross-sectional or national longitudinal population-based cohort studies completed with validated instruments were selected. Twenty-one studies with 52,283 participants were included. The pooled prevalence rate of frailty was 20.5% (95% CI = 15.5% to 26.0%). The estimated frailty prevalence was 14.6% (95% CI = 10.9% to 18.8%) while assessed by the Fried frailty phenotype, 28.0% (95% CI = 21.3% to 35.3%) by the Cumulative Frailty Index, 36.4% (95% CI = 33.6% to 39.3%) by the Study of Osteoporotic Fractures (SOF) index, and 46.3% (95% CI = 40.1% to 52.4%) by the Clinical Frailty Scale (p < 0.01). Subgroup analysis in studies using the Fried’s phenotype tool found that frailty prevalence was increased with older age (p = 0.01) and was higher in those who were single (21.5%) than in married participants (9.0%) (p = 0.02). The study results supported a better understanding of frailty prevalence in different geographical distributions and provide references for health policy decision-making regarding preventing frailty progression in older adults.