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Transitions in Frailty and 4-Year Mortality Risk in Taiwan Longitudinal Study on Aging

  • An-Chun Hwang
    Affiliations
    Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan

    Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
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  • Liang-Yu Chen
    Affiliations
    Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan

    Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
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  • Ting-Ching Tang
    Affiliations
    Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan
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  • Li-Ning Peng
    Affiliations
    Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan

    Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
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  • Ming-Hsien Lin
    Affiliations
    Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan

    Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
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  • Yiing-Jenq Chou
    Correspondence
    Yiing-Jenq Chou, MD, PhD, Institute of Public Health, National Yang Ming Chiao Tung University, No.115, Sec. 2, Li-Nong Street, Taipei 112, Taiwan.
    Affiliations
    Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan
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  • Fei-Yuan Hsiao
    Affiliations
    Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

    School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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  • Liang-Kung Chen
    Correspondence
    Address correspondence to Liang-Kung Chen, MD, PhD, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.
    Affiliations
    Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan

    Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan
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Published:November 09, 2022DOI:https://doi.org/10.1016/j.jamda.2022.10.005

      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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