Abstract
Objectives
To explore the associations of (1) the frailty phenotype or frailty index transition
with cause-specific mortality, and (2) different combinations of transition in frailty
phenotype and frailty index with all-cause mortality.
Design
Retrospective cohort study.
Setting and Participants
Data from 3529 respondents aged >50 years who completed the 1999 and 2003 surveys
of the Taiwan Longitudinal Study on Aging were analyzed.
Methods
Cox regression and subdistribution hazard models were constructed to investigate frailty
phenotype or frailty index transitions (by categories of frailty phenotype, absolute
and percentage changes in frailty index, and combined categories of the 2 measurements)
and subsequent 4-year all-cause and cause-specific mortality, respectively.
Results
Among the frailty phenotype transition groups, the improved frailty group had overall
mortality risk comparable to that of the maintained robustness/prefrailty group [hazard
ratio (HR): 0.9; 95% CI: 0.7–1.2] and lower risk of mortality due to organ failure
(HR: 0.4; 95% CI: 0.2–0.8; P = .015), whereas the worsened frailty group had the highest risk of all-cause mortality
and death from infection, malignancy, cardiometabolic/cerebrovascular diseases, and
other causes (HR: 1.8–3.7; all P < .03). The rapidly increased frailty index group had significantly higher all-cause
and every cause-specific mortality than the decreased frailty index group (HR: 1.8–7.7;
all P < .05). When frailty phenotype and frailty index transition groups were combined,
participants with worsened frailty/rapidly increased frailty index had increased risk
under the same frailty index/frailty phenotype transition condition, particularly
for large changes in each factor (HR: 1.5–2.2; P < .01 for worsened frailty; 1.7–4.5, P < .03 for rapidly increased frailty index).
Conclusions and Implications
We found that considering both frailty phenotype and frailty index provided best mortality
prediction. These associations were independent of baseline frailty status and comorbidities.
Nevertheless, even capturing transitions in frailty phenotype or frailty index only
can provide good mortality prediction, which supported adopting these approaches in
different clinical settings.
Keywords
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Article Info
Publication History
Published online: November 09, 2022
Accepted:
October 11,
2022
Received in revised form:
October 7,
2022
Received:
June 27,
2022
Publication stage
In Press Corrected ProofFootnotes
Y.J.C. and L.K.C. contributed equally to the study.
This work was supported by the Ministry of Science and Technology, Taiwan (MOST 109–2314-B-010 -047 -MY2 and MOST 111-2314-B-A49-018-MY3 ), National Health Research Insitute, Taiwan (NHRI-11A1-CG-CO-01-2225-1) and Taipei Veterans General Hospital . The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no conflicts of interest.
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© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
