Frailty is a multifactorial syndrome characterized by social, physical, and psychological stressors. Network analysis is a graphical statistical technique that can contribute to the understanding of this complex, multifactorial phenomenon. The aim of this study was to investigate the relationships between social, physical, and psychological factors and frailty in older persons.
A cross-sectional study.
Settings and Participants
A total of 2588 community-dwelling older persons from the FIBRA (Frailty in Brazilian Older Persons) 2008 to 2009 study.
Participants were assessed for sociodemographic variables, physical and mental health, and the frailty phenotype. Partial correlation network analysis with the Graphical Least Absolute Shrinkage and Selection Operator (glasso) estimator was performed to determine the relationships between social, physical, and psychological factors and frailty.
Mean participant age was 72.31 years, 7.0% were frail, and 50.6% were prefrail. In the network structure, frailty correlated most strongly with physical and psychological factors such as diabetes and depression and exhibited greater proximity to physical factors such as disability, urinary incontinence, and cardiovascular risk as measured by waist-to-hip ratio.
Conclusions and Implications
The analytical strategy used can provide information for specific subpopulations of interest and here confirmed that frailty is not uniformly determined but associated with different psychological and physical health factors, thereby allowing better understanding and management of this condition.
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- Frailty in relation to the accumulation of deficits.J Gerontol A Biol Sci Med Sci. 2007; 62: 722-727
- Frailty in older adults: Evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M157
- Frailty as a predictor of hospitalisation among community-dwelling older people: A systematic review and meta-analysis.J Epidemiol Community Health. 2016; 70: 722-729
- Frailty as a predictor of death or new disability after surgery: A prospective cohort study.Ann Surg. 2020; 271: 283-289
- Frailty profile in Brazilian older adults: ELSI-Brazil.Rev Saude Publica. 2018; 52: 17s
- Prevalence of frailty status among the European elderly population: Findings from the Survey of Health, Aging and Retirement in Europe.Geriatr Gerontol Int. 2019; 19: 723-729
- Determinants of frailty.J Am Med Dir Assoc. 2010; 11: 356-364
- Depression and incidence of frailty in older people from six Latin American countries.Am J Geriatr Psychiatry. 2019; 27: 1072-1079
- A tutorial on regularized partial correlation networks.Psychol Methods. 2018; 23: 617-634
- Estimating psychological networks and their accuracy: A tutorial paper.Behav Res Methods. 2018; 50: 195-212
- Examining health disparities by gender: A multimorbidity network analysis of electronic medical record.Int J Med Inform. 2017; 108: 22-28
- Metodologia e perfil sociodemográfico, cognitivo e de fragilidade de idosos comunitários de sete cidades brasileiras: Estudo FIBRA.Cad Saude Publica. 2013; 29: 778-792
- “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Obesity. Part I—Pathogenesis.West J Emerg Med. 1988; 149: 429-441
- Studies of illness in the aged: The index of ADL: A standardized measure of biological and psychosocial function.JAMA. 1963; 185: 914-919
- Development and validation of a geriatric depression screening scale: A preliminary report.J Psychiatr Res. 1982; 17: 37-49
- Short versions of the Geriatric Depression Scale: A study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV.Int J Geriatr Psychiatry. 1999; 14: 858-865
- Developments in satisfaction-research.Soc Indic Res. 1996; 37: 1-46
- Sugestões para o uso do mini-exame do estado mental no Brasil.Arq Neuropsiquiatr. 2003; 61: 777-781
- The phi-coefficient, the tetrachoric correlation coefficient, and the Pearson-Yule debate, Department of Statistics, UCLA.(Available at:)https://escholarship.org/uc/item/7qp4604r(2011)Date accessed: July 22, 2019
- qgraph: Network visualizations of relationships in psychometric data.J Stat Softw. 2012; 48: 1-18
- Network psychometrics.(Available at:)https://arxiv.org/pdf/1609.02818.pdf(2016)Date accessed: July 28, 2019
- Multidimensional predictors of physical frailty in older people: identifying how and for whom they exert their effects.Biogerontology. 2017; 18: 237-252
- Prevalence of frailty and associated factors in the community-dwelling population of China.J Am Geriatr Soc. 2018; 66: 559-564
- Frailty prevalence and factors associated with the frailty phenotype and frailty index: Findings from the North West Adelaide Health Study.Australas J Ageing. 2018; 37: 120-126
- Frailty prevalence and related factors in the older adult-FrailTURK Project.Age (Dordr). 2015; 37: 9791
- Prospective association among diabetes diagnosis, HbA1c, glycemia and frailty trajectories in an elderly population.Diabetes Care. 2019; 42: 1903-1911
- The prevalence and incidence of frailty in Pre-diabetic and diabetic community-dwelling older population: Results from Beijing longitudinal study of aging II (BLSA-II).BMC Geriatr. 2017; 17: 47
- Waist circumference is a better predictor of risk for frailty than BMI in the community-dwelling elderly in Beijing.Aging Clin Exp Res. 2018; 30: 1319-1325
- Effects of body mass index, abdominal obesity, and type 2 diabetes on mortality in community-dwelling elderly in Sao Paulo, Brazil: Analysis of prospective data from the SABE study.J Gerontol A Biol Sci Med Sci. 2014; 70: 503-510
- The metabolic syndrome: A risk factor for the frailty syndrome?.J Am Med Dir Assoc. 2016; 17: 364-366
- A summary of the biological basis of frailty. Frailty: Pathophysiology, Phenotype and Patient Care.Nestle Nutr Inst Workshop Ser. 2015; 83: 41-44
- Frailty, cognitive impairment, and functional disability in older women with female pelvic floor dysfunction.Int Urogynecol J. 2015; 26: 823-830
- Urinary incontinence and its association with frailty among men aged 80 years or older in Taiwan: A cross-sectional study.Rejuvenation Res. 2017; 20: 111-117
- Are depression and frailty overlapping syndromes in mid-and late-life? A latent variable analysis.Am J Geriatr Psychiatry. 2013; 21: 560-569
- Association between pain and frailty among Chinese community-dwelling older adults: Depression as a mediator and its interaction with pain.Pain. 2018; 159: 306-313
- Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: Results from the Cardiovascular Health Study.Arch Intern Med. 2002; 162: 2333-2341
- Longitudinal association between depression and inflammatory markers: Results from the Netherlands Study of Depression and Anxiety.Biol Psychiatry. 2019; 85: 829-837
- Functional disability and social conflict increase risk of depression in older adulthood among Bolivian forager-farmers.J Gerontol B Psychol Sci Soc Sci. 2014; 70: 948-956
- Depression and frailty in later life: A systematic review.Clin Interv Aging. 2015; 10: 1947
- Depression and frailty in late life: Evidence for a common vulnerability.J Gerontol B Psychol Sci Soc Sci. 2016; 71: 630-640
- The Gaussian graphical model in cross-sectional and time-series data.Multivariate Behav Res. 2018; 53: 453-480
Published online: March 27, 2020
This work was supported by the Agency for the Support and Evaluation of Graduate Education (CAPES).
The authors declare no conflicts of interest.
© 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.