Abstract
Objectives
Determine the incidence rates of frailty among community-dwelling older veterans.
Design
Population-based retrospective cohort study.
Setting and Participants
Veterans Health Administration Medical Center study included community-dwelling veterans
60 years and older with determinations of frailty from 2013 to 2014 and followed until
September 2019.
Methods
A 31-item frailty index was generated at baseline and during each subsequent primary
care encounters as a proportion of potential variables from electronic health record
data. Period prevalence was calculated by dividing total number of cases of frailty
during the baseline period. After adjusting for covariates, the association of frailty
with mortality was determined using a multivariate Cox regression model. Using baseline
and follow-up data, incidence rates of frailty per 1000 person/years based on event
rates and mean duration of follow-up were calculated, including survivor and entire
cohorts.
Results
Patients in this cohort were 16,761 veterans, mean age 72.18 (9.32) years, 74.00%
Caucasian, 90.75% non-Hispanic, and 97.78% male. The period prevalence of frailty
in this cohort was 20.84%. Over a median follow-up of 3.96 (interquartile range = 3.73)
years, 25.86% of the baseline population died during follow up. Veterans with frailty
had a higher all-cause mortality during follow up, adjusted hazard ratio = 3.12 (95%
confidence interval 2.87-3.38), P value of < .0005. Among 10,513 veterans who survived a median follow-up of 4.81 (interquartile
range = 3.12) years, 29.84% became frail. The incidence rate of frailty was 75.05
cases per 1000 person-years. Among the entire cohort of 13,268 nonfrail veterans,
29.93% became frail. The incidence rate of frailty was 84.03 cases per 1000 person-years.
Conclusions and Implications
This study shows high incidence of frailty in community dwelling older US veterans.
Future studies should be done for identification, implementation of adequate interventions
aimed at preventing frailty or reducing frailty-related complications in community
dwelling older individuals.
Keywords
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Article info
Publication history
Published online: November 21, 2020
Footnotes
This material is the result of work supported with resources and the use of facilities at the Miami VA Healthcare System GRECC.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
