Determinants of Multidimensional and Physical Frailty and Their Individual Components: Interactions between Frailty Deficits

Abstract

Purpose: To identify the interrelations among determinants of multidimensional frailty, physical frailty, and their individual components. Methods: A group of 1024 community-dwelling people older than 65 years completed questionnaires regarding: multidimensional frailty (Tilburg Frailty Indicator, TFI) and physical frailty (FRAIL scale), and common frailty risk factors. Results: Multidimensional frailty was recognized in 559 subjects (54.6%) and determined by 13 factors (R2 = 0.21 in logistic regression). After incorporating TFI components to the models, the majority of previous risk factors became non-essential, and the frailty deficits mainly determined each other with R2 ranging between 0.07–0.67. Physical frailty and non-robust status (i.e., either physical frailty or pre-frailty) were recognized in 64 (6.3%) and 542 (52.9%) participants, and were determined by 5 factors (R2 = 0.33) and 11 factors (R2 = 0.34), respectively. Associations between the frailty deficits were detected within and between different dimensions (i.e., physical, psychological and social); the physical domain was mainly related to the psychological one which in turn was additionally associated with the social one. Conclusion: Frailty is the accumulation of deficits and is determined by factors other than the determinants of the individual deficits. The associations between deficits coming from various dimensions of human functioning presumably amplify their effects and accelerate frailty development.

Comparing the Adverse Outcomes of Different Frailty Subgroups by Employing the Tilburg Frailty Indicator (TFI) Among Elderly Patients with Gastric Cancer

“…Studies have revealed that about half of the hospitalized older adults had 2 or perhaps 3 of physical debilitating conditions while the most of these patients also suffer from psychological and social issues, such as anxiety, depression, and low social support [25][26] . Furthermore, studies have shown that there were some interactions between these three domains of the TFI 12 , contributing to the acceleration of frailty development. It implies that these three domains cannot be seen in isolation from each other when assessing frailty.…”

“…Their physiological reserve, psychological state, and living environment are quite nonidentical before surgery, which probably cause frailty in different domains. Combining these different frailty domains, the different frailty subgroups are formed, which may be capable of recognizing the patient's status more accurately and predicting the adverse outcomes more targeted 12 . One study distinguished the community dwelling elderly individuals into four frailty subgroups and found that the subgroup of multidimensional frailty reported the most health de cits and required a comprehensive management strategy to improve not only their physical decline but also their psychological disturbances and social issues 13 .…”