Different subjective and objective measures and cut-points of physical activity in frailty phenotype screening: A need for standardization?

BACKGROUND

Frailty phenotype has been extensively modified. Among the five criteria, the low physical activity (PA) is often changed, however, it is still uncertain how this modification might impact frailty classification.

AIMS

To examine the variance in the prevalence of frailty by modifying PA criterion using different cut-points of both subjective and objective measures, and to determine the agreement between these on classifying individuals with low PA. Finally, a surrogate PA criterion of frailty phenotype was proposed using objectively measured moderate-to-vigorous physical activity (MVPA).

METHODS

This cross-sectional study comprised a convenience sample of 135 community-dwelling older adults. Frailty was evaluated using a modified frailty phenotype. PA was assessed using International Physical Activity Questionnaire-short form (IPAQ-SF) and objectively measured using a uniaxial accelerometer for 7 days. Four different low PA criteria were created and compared (population dependent and independent cut-points) using subjective and objective measures.

RESULTS

Different measures and cut-points resulted in an overall variation of 12.5% on frailty prevalence. The agreement in the categorization of participants with low PA between population dependent cut-points of both IPAQ-SF and accelerometer was none to slight (%Overallagreement = 43.70%; Kappa = 0.082, p = 0.114). Results from ROC curve analysis showed an optimal threshold of 15.13 min/day of MVPA to discriminate between non-frail and pre-frail individuals.

CONCLUSION

Modifications of the low PA criterion of frailty phenotype can greatly impact frailty classification. MVPA measured through an accelerometer may present a possible solution to standardize this criterion, and improve frailty screening and between-studies comparability.

Frailty prevalence in 42 European countries by age and gender: development of the SHARE Frailty Atlas for Europe

Comparative frailty prevalence data across European countries is sparse due to heterogeneous measurement methods. The Survey of Health, Ageing and Retirement (SHARE) initiative conducted interviews with probability sampling of non-institutionalized elderly people in several European countries. Previous frailty analyses of SHARE datasets were limited to initial SHARE countries and did not provide age- and gender-stratified frailty prevalence. Our aim was to provide age- and gender-stratified frailty prevalence estimates in all European countries, with predictions where necessary. From 29 SHARE participating countries, 311,915 individual surveys were analyzed. Frailty prevalence was estimated by country and gender in 5-year age bands using the SHARE Frailty Instrument and a frailty index. Association of frailty prevalence with age, gender, and GDP per capita (country-specific economic indicator for predictions) was investigated in multivariate mixed logistic regression models with or without multiple imputation. Female gender and increasing age were significantly associated with higher frailty prevalence. Higher GDP per capita, with or without purchasing power parity adjustment, was significantly associated with lower frailty prevalence in the 65-79 age groups in all analyses. Observed and predicted data on frailty rates by country are provided in the interactive SHARE Frailty Atlas for Europe. Our study provides age- and gender-stratified frailty prevalence estimates for all European countries, revealing remarkable between-country heterogeneity. Higher frailty prevalence is strongly associated with lower GDP per capita, underlining the importance of investigating transferability of evidence across countries at different developmental levels and calling for improved policies to reduce inequity in risk of developing frailty across European countries.

The temporal trend in frailty prevalence from 2011 to 2020 and disparities by equity factors among middle-aged and older people in China: A population-based study

BACKGROUND

Frailty is a challenging issue in China, however the prevalence of frailty across different population groups and whether this is changing over time remain unclear.

METHODS

Unstandardized and age-and sex-standardized prevalence of frailty (95 % confidence interval (95 % CI)) (Frailty Index) in the overall sample and for subgroups defined by equity factors (PROGRESS-Plus framework) from 2011 to 2020 were estimated using analyses of cross-sectional surveys in adults aged 45 and older participating in 5 waves (N = 16,784 to 18,904 across waves) of the China Health and Retirement Longitudinal Studies (CHARLS). Poisson regression was used to estimate prevalence ratios (PRs) of frailty by equity factors.

RESULTS

Unstandardized prevalence of frailty increased from 13.6 % (13.0 %-14.1 %) in 2011 to 18.7 % (18.1 %-19.3 %) in 2020.The standardized prevalence increased from 13.5 % (13.0 %-14.0 %) in 2011 to 16.3 % (15.8 %-16.9 %) in 2020. Frailty was consistently more prevalent at advanced ages, in rural areas, among females, as well as those less educated, without social engagement, and non-drinkers. Based on the Poisson regression model, non-north region, being female and older, lower education, having no social engagement, smoking and non-drinking, and higher household capital consumption were associated with higher prevalence.

CONCLUSIONS

The prevalence of frailty among the middle-aged and older population in China has increased. There will be an associated health and social care cost. Interventions targeted at older adults, those in rural areas, women, as well as those less educated, having no social engagement, and non-drinkers to mitigate the negative effects of frailty may be warranted.