Abstract
Objectives
We first estimated the prevalence of physical frailty in older subjects from the population-based
Salus in Apulia Study (Apulia, Southern Italy), and its impact on all-cause mortality.
Second, we explored the relationship between multimorbidity and physical frailty.
Design
Cross-sectional and longitudinal analyses from a population-based study.
Setting and participants
We analyzed data from the Salus in Apulia study, a population-based sample of 1929
subjects aged 65 years and older.
Methods
These older participants underwent clinical, physical, and laboratory assessments.
Physical frailty was operationalized using slightly modified Fried criteria. Multimorbidity
status was defined as the co-presence of 2 or more chronic conditions.
Results
The overall prevalence of physical frailty in this older population from Southern
Italy was 14.8% [95% confidence interval (CI): 13.26–16.49]. Physical frailty subjects
were significantly older (P < .01), had a lower educational level (P < .01), increased executive dysfunction (P < .01), higher serum levels interleukin-6 (P < .01), and white blood cells (P = .01). Multimorbidity status (P < .01), diabetes mellitus (P = .05), peripheral age-related hearing loss (P < .01), cognitive impairment (P < .01), chronic obstructive pulmonary disease (P = .02), and metabolic syndrome (P = .02) were also directly related to physical frailty. Apathy increased according
to the severity of physical frailty status (P = .02). There was a significant increased risk of all-cause mortality for physical
frailty subjects (hazard ratio: 1.48; 95% CI: 1.03–2.12, adjusted for age and sex)
during the observation from the date of enrollment to the date of death (mean ± SD:
55.70 ± 22.19 months, median: 54 months).
Conclusions and Implications
Frailty is the consequence of the contributory action of the aging process and some
chronic diseases that hasten some of the changes concurrent with aging.
Keywords
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References
- Frailty: implications for clinical practice and public health.Lancet. 2019; 394: 1365-1375
- Management of frailty: opportunities, challenges, and future directions.Lancet. 2019; 394: 1376-1386
- Frailty and the prediction of negative health outcomes: A meta-analysis.J Am Med Dir Assoc. 2016; 17: 1163.e1-1163.e17
- Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- Accumulation of deficits as a proxy measure of aging.ScientificWorldJournal. 2001; 1: 323-336
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
- Different cognitive frailty models and health- and cognitive-related outcomes in older age: From epidemiology to prevention.J Alzheimers Dis. 2018; 62: 993-1012
- The essence of frailty: A systematic review and qualitative synthesis on frailty concepts and definitions.Eur J Intern Med. 2018; 56: 3-10
- A comparison between uni- and multidimensional frailty measures: prevalence, functional status, and relationships with disability.Clin Interv Aging. 2015; 10: 1669-1678
- Prevalence of frailty in community-dwelling older persons: a systematic review.J Am Geriatr Soc. 2012; 60: 1487-1492
- Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies.Age Ageing. 2021; 50: 96-104
- Global incidence of frailty and prefrailty among community-dwelling older adults: A systematic review and meta-analysis.JAMA Netw Open. 2019; 2: e198398
- Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis.BMJ Open. 2018; 8: e018195
- Exploring the relationship between national economic indicators and relative fitness and frailty in middle-aged and older Europeans.Age Ageing. 2013; 42: 614-619
- Frailty syndrome and all-cause mortality in demented patients: the Italian Longitudinal Study on Aging.Age (Dordr). 2012; 34: 507-517
- The burden of frailty in older people visiting GPs in Veneto and Sicily, Italy.J Drug Assess. 2019; 8: 87-96
- Assessment of frailty in community-dwelling older adults residents in the Lazio region (Italy): A model to plan regional community-based services.Arch Gerontol Geriatr. 2017; 68: 1-7
- Association of frailty with survival: a systematic literature review.Ageing Res Rev. 2013; 12: 719-736
- Frailty index as a predictor of mortality: a systematic review and meta-analysis.Age Ageing. 2018; 47: 193-200
- The association between frailty, the metabolic syndrome, and mortality over the lifespan.Geroscience. 2017; 39: 221-229
- Cumulative deficits and physiological indices as predictors of mortality and long life.J Gerontol A Biol Sci Med Sci. 2008; 63: 1053-1059
- Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department.J Am Geriatr Soc. 2008; 56: 1651-1657
- Older Adults with weaker muscle strength stand up from a sitting position with more dynamic trunk use.Sensors. 2018; 18: 1235
- The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients.Nutrition. 1999; 15: 116-122
- Association between physical activity, physical performance, and inflammatory biomarkers in an elderly population: the InCHIANTI study.J Gerontol A Biol Sci Med Sci. 2005; 60: 760-767
- Activity energy expenditure predicts clinical average levels of physical activity in older population: Results from Salus in Apulia Study.Sensors (Basel). 2020; 20: 4585
- Measuring balance in the elderly: preliminary development of an instrument.Physiother Can. 1989; 41: 304-311
World Health Organization. Multimorbidity. Available at: https://apps.who.int/iris/handle/10665/252275. Accessed February 12, 2021.
- Dyslipidemia.Ann Intern Med. 2017; 167: ITC81-ITC96
- Global Costs of Unaddressed Hearing Loss and Cost-Effectiveness of Interventions: A WHO Report.2017 (Available at:)https://apps.who.int/iris/bitstream/handle/10665/254659/9789241512046-eng.pdfDate accessed: January 31, 2021
- Global estimates of visual impairment: 2010.Br J Ophthalmol. 2012; 96: 614-618
- “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- The Global Initiative for Asthma (GINA): 25 years later.Eur Respir J. 2019; 54 (1900598)
- COPD Guidelines: A Review of the 2018 GOLD Report.Mayo Clin Proc. 2018; 93: 1488-1502
- Metabolic syndrome--a new world-wide definition. A Consensus Statement from the International Diabetes Federation.Diabet Med. 2006; 23: 469-480
- Reliability, validity, and clinical correlates of apathy in Parkinson's disease.J Neuropsychiatry Clin Neurosci. 1992; 4: 134-139
- The FAB: a Frontal Assessment Battery at beside.Neurology. 2000; 55: 1621-1626
- Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries.J Gerontol A Biol Sci Med Sci. 2009; 64: 675-681
- Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants.Lancet Public Health. 2018; 3: e323-e332
- Frail phenotype and mortality prediction: a systematic review and meta-analysis of prospective cohort studies.Int J Nurs Stud. 2015; 52: 1362-1374
- Frailty among community-dwelling older people in France: the three-city study.J Gerontol A Biol Sci Med Sci. 2008; 63: 1089-1096
- Frailty, cognitive impairment and mortality among the oldest old.J Nutr Health Aging. 2011; 15: 678-682
- Frailty syndrome: a transitional state in a dynamic process.Gerontology. 2009; 55: 539-549
- Inflammation and frailty in the elderly: A systematic review and meta-analysis.Ageing Res Rev. 2016; 31: 1-8
- Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects.Obes Rev. 2015; 16: 1001-1015
- Frailty, inflammation, and immunity.Aging Dis. 2011; 2: 466-473
- Metabolic syndrome and insulin resistance are associated with frailty in older adults: A prospective cohort study.Age Ageing. 2017; 46: 807-812
- Frailty and the metabolic syndrome – Results of the Berlin Aging Study II (BASE-II).J Frailty Aging. 2019; 8: 169-175
- The metabolic syndrome and the phenotype of frailty: A causal link?.J Am Med Dir Assoc. 2016; 17: 956-957
- Frailty and sarcopenia - newly emerging and high impact complications of diabetes.J Diabetes Complications. 2017; 31: 1465-1473
- Physical disability among older Italians with diabetes. The ILSA Study.Diabetologia. 2004; 47: 1957-1962
- Platelet number is positively and independently associated with glycated hemoglobin in non-diabetic overweight and obese subjects.Nutr Metab Cardiovasc Dis. 2019; 29: 254-259
- Association of hearing impairment with incident frailty and falls in older adults.J Aging Health. 2016; 28: 644-660
- Relationship between central and peripheral age-related hearing loss and different frailty phenotypes in an older population of Southern Italy.JAMA Otolaryngol Head Neck Surg. 2021 Feb 11; ([Epub ahead of print])
- Cognitive dysfunction in older adults with diabetes: What a clinician needs to know.Diabetes Care. 2017; 40: 461-467
- Physical frailty and cognitive impairment is associated with diabetes and adversely impact functional status and mortality.Postgrad Med. 2018; 130: 561-567
- Aging with multimorbidity: a systematic review of the literature.Ageing Res Rev. 2011; 10: 430-439
- How to measure comorbidity: A critical review of available methods.J Clin Epidemiol. 2003; 56: 221-229
- Global multimorbidity patterns: a cross-sectional, population-based, multi-country study.J Gerontol A Biol Sci Med Sci. 2016; 71: 205-214
- Frailty and multimorbidity: A systematic review and meta-analysis.J Gerontol A Biol Sci Med Sci. 2019; 74: 659-666
- Frailty: A global measure of the multisystem impact of COPD.Chron Respir Dis. 2018; 15: 347-355
- Explaining the association between educational level and frailty in older adults: Results from a 13-year longitudinal study in the Netherlands.Ann Epidemiol. 2014; 24: 538-544.e2
- Severe apathy as a risk factor for falls in older adults with frailty symptoms.J Am Med Dir Assoc. 2019; 20: 1473-1475
- Symptoms of apathy independently predict incident frailty and disability in community-dwelling older adults.J Clin Psychiatry. 2017; 78: e529-e536
- Executive function predicts risk of falls in older adults without balance impairment.BMC Geriatr. 2011; 11: 74
- Modifications to the frailty phenotype criteria: Systematic review of the current literature and investigation of 262 frailty phenotypes in the Survey of Health, Ageing, and Retirement in Europe.Ageing Res Rev. 2015; 21: 78-94
Article info
Publication history
Published online: January 22, 2021
Footnotes
FC and LL equally contributed.
The authors declare no conflicts of interest.
Funding received from the Italian Ministry of Health, ricerca corrente 2019 grant and Regione Puglia Grant 2018.
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
