Abstract
Objectives
Study the frequency and determinants of frailty transitions in a community-dwelling
older population.
Design
Population-based prospective longitudinal study [The Toledo Study of Healthy Ageing
(TSHA)].
Setting and Participants
1748 community-dwelling individuals aged >65 years living in Toledo, a Spanish province.
Methods
Frailty was measured with the Fried phenotype. Logistic models were used to assess
the associations of sociodemographic, clinical, life-habits, functional, physical
performance, and analytical variables with frailty transitions (losing robustness,
transitioning from prefrailty to robustness, and from prefrailty to frailty) over
a median of 5.2 years.
Results
Mean age on enrolment was 75 years, and 55.8% were females. At baseline, 10.3% were
frail and 43.1% prefrail. At follow-up, 35.8% of the frail individuals recovered to
a prefrail and 15.1% to a robust state. In addition, 43.7% of the prefrail participants
became robust, but 14.5% developed frailty. Of those robust at baseline, 32.9% became
prefrail and 4.2% frail. In multivariate logistic models, chair-stands had a predictive
role in all transitions studied: linearly in keeping robustness and with a floor effect
(5 stands) in transitions from prefrailty to robustness and (inversely) from prefrailty
to frailty. More depressive symptoms were associated with unfavorable transitions.
Not declaring the amount of alcohol drunk and low grip strength were associated with
loss of robustness. Hearing and cognitive impairment, low physical activity and smoking
with transitioning from prefrailty to frailty. Autonomy for instrumental activities
of daily living and uricemia were associated with transitions between robustness and
prefrailty in both directions. Increasing body mass index in the range of moderate
to severe obesity hampered regaining robustness.
Conclusions and Implications
Spontaneous improvement of frailty measured with the Fried phenotype is frequent,
mainly to prefrailty. Most of the variables associated with transitions are modifiable
and suggest research topics and interventions to reduce frailty in clinical and social
care settings.
Keywords
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Article info
Publication history
Published online: August 10, 2021
Footnotes
This work was supported by the Spanish Ministerio de Ciencia e Innovación (grant number PID2019-108408RB). The sponsor's role was supporting the analysis and preparation of the manuscript.
The authors declare no conflicts of interest.
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