Factors associated with frailty in a community-dwelling population of older adults

Frailty in Diabetic Population: A Study From Northern India

Introduction Frailty, a key issue in geriatric health, signifies heightened vulnerability due to the decline in various physiological systems, exacerbated by conditions such as diabetes. Diabetes and frailty together lead to significant disabilities and higher mortality, necessitating early screening and targeted interventions. The relationship between frailty and diabetes remains under-researched, prompting this study to explore their association in individuals over 50 years of age using the Edmonton Frail Scale (EFS). Methods and materials The study was an observational cross-sectional study conducted at MM Institute of Medical Sciences & Research (MMIMSR), Mullana, India, among 102 diabetic and 100 non-diabetic individuals aged more than 50 years, with data collected through interviews using a pre-validated proforma. Frailty was assessed using the EFS, categorizing patients into fit, vulnerable, and various levels of frailty based on their scores. Results The study found a higher prevalence and severity of frailty among diabetic individuals (61.8%) compared to non-diabetics (29%), with frailty being more pronounced across all age groups and both genders in diabetics. The severity of frailty increased with the duration of diabetes but showed no significant correlation with glycemic control (HbA1c). Strengths and limitations The study prospectively collected data, including middle-aged participants starting from age 50, and uniquely used the EFS to assess frailty in diabetic patients, excluding those with other chronic diseases (end-stage renal disease (ESRD), malignancy, etc.). However, limitations included a small sample size, recruitment from a single institution in India, and some EFS questions being less relevant to the Indian diabetic population. Conclusion The study found a 61.8% prevalence of frailty in diabetics compared to 29% in non-diabetics, with frailty being more severe and positively correlated with the duration of diabetes but not with glycemic control (HbA1c).

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.

Prevalence and health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty: A systematic review and meta-analysis

Polypharmacy is a prevalent issue in older adults, associated with a wide range of adverse health outcomes, amplified in those with frailty. This review aims to synthesize current literature on the prevalence and health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty. A systematic search was carried out within ten databases till December 2021. Data was extracted using a piloted data extraction form, and methodological quality was assessed using JBI critical appraisal checklists. Meta-analyses were conducted for prevalence, and narrative synthesis was conducted for the health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty. Heterogeneity was assessed using Chi² and I² statistics, with sensitivity and subgroup analyses performed to explore sources of heterogeneity. Sixty-six studies were included for this review. The overall pooled prevalence of polypharmacy and hyperpolypharmacy was 59% and 22% respectively. When stratifying the studies by setting, WHO regions, in eighteen frailty assessment instruments, and by its year of publication, subgroup analysis found the highest rates of prevalence in the hospital setting (71%), in the European region (68%), when Reported Edmonton Frail Scale was used (96%), and in studies published in 2015 (86%). Additionally, frail older adults with polypharmacy were less likely to experience an improvement in frailty states, had higher risks of mortality, were more likely to suffer adverse hospital-related outcomes, and required additional assistance compared to those without polypharmacy. Therefore, the high prevalence and poorer health outcomes urges the healthcare providers and health policymakers to develop and implement preventative and restorative measures targeted at the adverse outcomes associated with polypharmacy and hyperpolypharmacy in older adults with frailty.

Relação entre força de preensão manual, funcionalidade e fragilidade física em pessoas idosas

Objetivo: analisar a produção científica nacional e internacional sobre a relação entre funcionalidade, força de preensão manual e a condição de fragilidade física em pessoas idosas. Método: revisão integrativa da literatura realizada nas bases de dados PubMed, CINAHL, Web of Science e Portal BVS, no período amostral de janeiro de 2010 a novembro de 2021. Para ilustrar a seleção dos artigos utilizou-se o fluxograma do Preferred Reporting Items for Systematic Reviews and Meta-analyses, o Oxford Centre for Evidence-Based Medicine para a classificação do nível de evidência e o EndNote Web para gerenciamento da bibliografia. Resultados: a busca inicial resultou em 211 artigos, após aplicação dos critérios de inclusão e exclusão, sete artigos perfizeram o corpus da revisão. A força de preensão manual (FPM) mostrou-se como indicadora da força muscular e determinante na funcionalidade dos idosos. A combinação entre a perda de força de preensão e outros eventos clínicos contribui para o declínio da funcionalidade e dependência nas atividades de vida diária em idosos, com maior prejuízo entre aqueles com 75 anos ou mais e de forma mais significativa entre as mulheres. Conclusão: a relação existente entre o baixo desempenho funcional e a diminuição da FPM determina a condição de fragilidade física em pessoas idosas. Isso reforça a importância do investimento dos profissionais de enfermagem em intervenções que viabilizam a manutenção da força muscular e da funcionalidade e a reversão da fragilidade física em idosos.

Gender differentiated score on the Falls Efficacy Scale International (FES-I Brazil) to assess self-efficacy in falls in community-dwelling older adults

BACKGROUND

Since fear of falling is associated with a history of falls and is more prevalent in women, it is important to define cut-off points differentiated between genders on the Falls Efficacy Scale International Brazil (FES-I Brazil) to implement early prevention and/or rehabilitation strategies.

AIMS

To determine cut-off points on the FES-I Brazil differentiated between genders which discriminate falls and verify their association with the history of falls.

METHODS

This was a cross-sectional study including 306 community-dwelling older adults. Fear of falling score from the FES-I Brazil was the independent variable and the outcome was the history of falls in the last 12 months. The cut-off points differentiated between genders were established according to sensitivity and specificity values evaluated by the Receiver Operating Characteristic Curves (ROC). The multivariable logistic regression was used to verify the association between fear of falling and history of falls.

RESULTS

The cut-off points on the FES-I Brazil to discriminate falls were > 25 points [AUC: 0.67 (95% CI 0.59-0.73)] for women, and > 19 points [AUC: 0.66 (95% CI 0.57-0.74) for men, suggesting that women present a greater fear of falling than men, due to the higher cut-off point found for women. Women and men with fear of falling, respectively, had 2.14 (95% CI 1.11-4.13) and 2.62 (95% CI 1.10-6.85) higher odds of suffering falls compared to those without this condition.

CONCLUSIONS

The FES-I can be used to discriminate falls in the elderly and shows that women have a higher cut-off point than men on the scale.

Exploring the Relationship between Frailty, Functional Status, Polypharmacy, and Quality of Life in Elderly and Middle-Aged Patients with Cardiovascular Diseases: A One-Year Follow-Up Study

The association between frailty, disability in activities of daily living (ADL), polypharmacy, and quality of life (QoL) in middle-aged patients with cardiovascular disease (CVD) is little investigated. This study sought (a) to explore this association comparatively in elderly and middle-aged hospitalized patients with CVD and (b) to determine which domains of ADL and QoL might improve the frailty prediction. A one-year follow-up study including 90 elderly (≥65 years old) and 89 middle-aged patients (40-65 years old) was conducted. At baseline, frailty assessment was performed based on the Fried criteria; Barthel Index (BI) and Duke Activity Status Index (DASI) were used for ADL, and European Quality of Life-5 dimensions (EQ-5D) for QoL. At follow-up, data were collected via telephone. At baseline, 79 patients (51 elderly and 28 middle-aged) were frail. The CVD frail patients showed functional dependency and a poor QoL compared to the non-frail (p < 0.001) and within each subgroup at follow-up. Mobility was found to predict frailty in both elderly (OR = 2.34) (C.I. (1.03-5.29)) and middle-aged patients (OR = 2.58) (C.I. (1.15-5.78)). The ADL assessment and self-reported QoL may help to identify an aggravation or an advanced frailty condition in hospitalized elderly and middle-aged CVD patients.

Frailty is associated with sociodemographic and health factors and related to the care context of older caregivers: a Brazilian cross-sectional study

BACKGROUND

The task of caring can arise suddenly without guidance or support, resulting in psychological tension and health impairment, which can culminate in the development of frailty.

OBJECTIVE

To analyze the relationship between frailty and sociodemographic and health aspects related to the care context of older caregivers.

DESIGN AND SETTING

A cross-sectional study was conducted on 65 older caregivers registered in family health units in the interior of the state of São Paulo.

METHODS

The participants were interviewed individually using the following instruments: a characterization questionnaire, Fried's frailty phenotype, Zarit Burden's Interview, Mini-Mental State Examination, Geriatric Depression Scale, Katz Index, and Lawton Scale. In addition, the following statistical tests were applied: Pearson's chi-squared test, Fisher's exact test, and Mann-Whitney test. A significance level of 5% was considered to be statistically significant.

RESULTS

Women who took care of their spouses predominated without prior training or the help of other people. Most of the patients were pre-frail (72.3%). Frailty was significantly related to marital status (P = 0.016), depressive symptoms (P = 0.029), cognitive decline (P = 0.029), the degree of kinship (P = 0.015), and burden (P = 0.004).

CONCLUSION

Older caregivers without a partner, with severe depressive symptoms and cognitive changes, who cared for their parents, and had higher levels of burden, presented a higher proportion of frailty.

Association between swallowing function, malnutrition and frailty in community dwelling older people

BACKGROUND & AIMS

Swallowing function decreases with age and impacts nutritional state and frailty. The aim of the study was to test the relationship between swallowing function, dysphagia, frailty, malnutrition and depression in community dwelling older participants.

METHODS

Community dwelling older participants (n = 180), were enrolled (74 men aged 75.9 ± 7.8, 65-91 years, and 107 women aged 75.9 ± 8.0, 65-95 years). Swallowing function was assessed by the Test of Mastication and Swallowing Solids (TOMASS) and the Timed Water Swallow Test (TWST). Dysphagia was identified using Hebrew 10-Item Eating Assessment Tool (H-EAT-10). Frailty was assessed by grip strength and the FRAIL Questionnaire. The Mini Nutritional Assessment - Short Form (MNA-SF) was used to identify nutritional status. Depression was screened with the Geriatric Depression Scale - Short Form (GDS-SF).

RESULTS

18.3% of the participants had a score of 3 or above in H-EAT-10, indicating suspected dysphagia. 17.8% of the participants were malnourished or at risk of malnutrition, and 48.3% were defined as frail or pre-frail. The odds of being malnourished/at risk of malnutrition were 3 times greater in those with suspected dysphagia. The odds of being frail/pre-frail were also 3 times greater in those with suspected dysphagia. Moreover, suspected dysphagia and frail/pre-frail health status coincided in 69.7% of participants. Participants that were malnourished/at risk of malnutrition required more masticatory cycles (p < .05) and more time (p < .05) to eat a cracker and drink 150 mL of water (p < .05), and had reduced swallowing capacity (volume/sec) in the TWST (p < .05) than those who were at normal nutritional statues. Similar results were found for frail/pre-frail participants versus robust health status. A decrease in grip strength was associated with increased (worse) frailty score, decreased nutritional score, decreased chewing function in TOMASS and decreased water drinking function in TWST (p < .05). MNA-SF score, age, GDS-SF score and EAT-10 were the best predictors of FRAIL score.

CONCLUSION

A simple multi-dimensional screen should be employed by trained allied health professionals, nurses and their assistants to improve early identification and early referral to relevant health providers in order to provide preventive intervention for dysphagia, nutrition, frailty and depression.

A Comprehensive Overview of Activities of Daily Living in Existing Frailty Instruments: A Systematic Literature Search

BACKGROUND AND OBJECTIVES

The relationship between frailty and disability in activities of daily living (ADLs) can be seen in different ways, with disability being-to varying degrees-a characteristic, negative outcome, or predictor of frailty. This conflation of definitions is partly a result of the different frailty tools used in research. Aiming to provide a comprehensive overview, this systematic literature search analyzed (i) if, (ii) to what extent, and (iii) how ADLs are evaluated by frailty instruments.

RESEARCH DESIGN AND METHODS

A search was performed in PubMed, Web of Knowledge, and PsycINFO to identify all frailty instruments, followed by categorization of the ADL items into basic (b-), instrumental (i-), and advanced (a-) ADLs.

RESULTS

In total, 192 articles described 217 frailty instruments, from which 52.1% contained ADL items: 45.2% b-ADLs, 35.0% i-ADLs, and 10.1% a-ADLs. The most commonly included ADL items were bathing (b-ADLs); using transportation (i-ADLs); and semiprofessional work engagement in organized social life or leisure activities (a-ADLs). These instruments all had a multidomain origin (χ 2 = 122.4, p < .001).

DISCUSSION AND IMPLICATIONS

Because 52.1% of all instruments included ADL items, the concepts of frailty and disability appear to be highly entangled. This might lead to circular reasoning, serious concerns regarding contamination, and invalid research results.

Is living alone a risk factor of frailty? A systematic review and meta-analysis

OBJECTIVES

To examine the association of living alone with frailty in cross-sectional and longitudinal studies by a systematic review and meta-analysis.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Community-dwelling older adults with a mean age of >60 years.

METHODS

A systematic search of the literature was conducted according to the PRISMA guidelines. We searched PubMed in February 2019 without language restriction for cohort studies that examined the associations between living alone and frailty. The reference lists of the relevant articles and the included articles were reviewed for additional studies. We calculated pooled odds ratios (OR) of the presence and incidence of frailty for living alone from cross-sectional and longitudinal studies.

RESULTS

Among the 203 studies identified, data of 44 cross-sectional studies (46 cohorts) and 6 longitudinal studies were included in this review. The meta-analysis showed that older adults living alone were more likely to be frail than those who were not (46 cohorts: pooled OR = 1.28, 95 % confidence interval (CI) = 1.13-1.45, p < 0.001). Gender-stratified analysis showed that only men living alone were at an increased risk of being frail (20 cohorts: pooled OR = 1.71, 95 %CI = 1.49-1.96), while women were not (22 cohorts: pooled OR = 1.00, 95 %CI = 0.83-1.20). No significant association was observed in a meta-analysis of longitudinal studies (6 cohorts: pooled OR = 0.88, 95 %CI = 0.76-1.03).

CONCLUSIONS/IMPLICATIONS

The present systematic review and meta-analysis showed a significant cross-sectional association between living alone and frailty, especially in men. However, living alone did not predict incident frailty. More studies controlling for important confounders, such as social networks, are needed to further enhance our understanding of how living alone is associated with frailty among older adults.

Prevalence of Frailty in Brazilian Older Adults: A Systematic Review and Meta-analysis

OBJECTIVES

Frailty is characterized by a functioning decline in multiple systems accompanied by an increase in individual's vulnerability to stressors. It appears to be higher in low and middle-income countries compared with high-income ones. This study aimed to evaluate the prevalence of frailty in non-institutionalized Brazilian older adults.

DESIGN

a systematic review and meta-analysis study.

SETTING

Cross-sectional and prospective data from Brazil.

PARTICIPANTS

non-institutionalized adults aged 60 and older.

METHODS

Electronic searches were performed in PubMed/MEDLINE, LILACS, SCOPUS and Web of Science, considering the studies published between March 2001 and July 2018, using a combination of the following terms and correlates: "elder" AND "frail" AND "prevalence" AND "Brazil". Two independent reviewers selected studies according to the inclusion criteria. Disagreements were resolved by a third reviewer (title/abstract) and by consensus. Studies with samples ≥221 subjects were considered for meta-analysis.

RESULTS

28 studies were included, while 18 had the data meta-analyzed. The majority of studies (61%) included older adults only from the Southeastern region. The number of subjects ranged from 53 to 5,532 individuals (N = 17,604) and the average age ranged from 65.6 to 85.5 years. The overall prevalence of frailty was 24%. When considering the different assessment methods, the prevalence was lower for frailty phenotype (16%) compared with other criteria (40%). Regarding sex, the prevalence of frailty was similar for women (28%) and men (25%). The prevalence of frailty was higher in older adults recruited from health care services (30%) compared to community ones (22%).

CONCLUSION

In Brazil, the overall prevalence of frailty in non-institutionalized older adults is higher than observed from more developed countries. However, it may vary according to the assessment methods and settings.

Prevalence and determinants of frailty in the absence of disability among older population: a cross sectional study from rural communities in Nepal

Background

Longevity and frailty have significant implications for healthcare delivery. They increase demands for healthcare service and surge risk of hospitalization. Despite gaining global attention, determinants of frailty have remained unmeasured in the rural community settings in Nepal. This study aimed to address this gap by accessing the prevalence and determinants of frailty in the absence of disability among older population living in rural communities in eastern Nepal.

Methods

We conducted a cross-sectional analytical study of 794 older adults aged ≥60 living in the rural part of Sunsari and Morang district of eastern Nepal between January and April in 2018. Multi-stage cluster sampling was applied to recruit the study participants. Study measures included socio-demographics; Frail Non-disabled scale (FiND) measuring frailty, Barthel’s Index measuring basic activities of daily living and Geriatric depression scale. Determinants of frailty in the absence of disability were identified using generalized estimating equation (GEE).

Results

About 65% of the participants self-reported the presence of frailty in the absence of disability. In the adjusted models, those from underprivileged ethnic groups, lack of daily physical exercise, presence of depressive symptoms and those not getting enough social support from family were found to be significantly associated with frailty among older participants.

Conclusions

The prevalence of frailty in the absence of disability was high among rural community old population living in eastern Nepal. Our findings suggest that need of frailty awareness (both for clinicians and general public), so as to avoid negative consequences. To reduce the healthcare burden early screening frailty in primary care has potentials to prevent implications of frailty in Nepal.