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Transitions Between Frailty States and Its Predictors in a Cohort of Community-Dwelling Spaniards

  • Ángel Rodríguez-Laso
    Affiliations
    Thematic Area for Frailty and Healthy Ageing of the Network of Biomedical Research Centers (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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  • Francisco José García-García
    Affiliations
    Thematic Area for Frailty and Healthy Ageing of the Network of Biomedical Research Centers (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain

    Geriatric Department, Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain
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  • Leocadio Rodríguez-Mañas
    Correspondence
    Address correspondence to Leocadio Rodríguez-Mañas, PhD, MD, Geriatric Department, Hospital Universitario de Getafe, Ctra de Toledo Km12,5, 28905 Getafe, Madrid, Spain.
    Affiliations
    Thematic Area for Frailty and Healthy Ageing of the Network of Biomedical Research Centers (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain

    Biomedical Research Foundation, Hospital Universitario de Getafe, Madrid, Spain

    Geriatric Department, Hospital Universitario de Getafe, Madrid, Spain
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Published:August 10, 2021DOI:https://doi.org/10.1016/j.jamda.2021.07.008

      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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