Frailty and Associated Factors among Centenarians in the 5-COOP Countries

Herr, Marie; Jeune, Bernard; Fors, Stefan; Andersen‐Ranberg, Karen; Ankri, Joël; Arai, Yasu; Cubaynes, Sarah; Santos-Eggimann, Brigitte; Zekry, Dina; Parker, Marti G.; Saito, Yasuhiko; Herrmann, Françoís; Robine, Jean‐Marie

doi:10.1159/000489955

Cited by 48 publications

(89 citation statements)

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“…Frailty predicts increased falls, hospitalization, dependence, morbidity, mortality and increase in healthcare costs [1,2,[4][5][6][7]. Prevalence of frailty has varied to some extent between studies, but it has been found to increase with age and to be higher in women than in men [8][9][10][11][12][13]. Women seem to tolerate frailty better than men, as demonstrated by a lower mortality rate at any given level of frailty or age among women [11,14].…”

Section: Introductionmentioning

confidence: 99%

Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people

et al. 2019

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Background There is a lack of agreement about applicable instrument to screen frailty in clinical settings. Aims To analyze the association between frailty and mortality in Finnish community-dwelling older people. Methods This was a prospective study with 10-and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood's frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used. Results Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10-12.41] in 10-year follow-up, and 6.32 [4.17-9.57] in 18-year follow-up) and , and 3.95 [3.16-4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78-2.69], and 1.69 [1.46-1.96]; FI 1.81[1.25-2.62], and 1.31 [1.07-1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10-(4.41 [3.55-5.34]) and 18-year follow-ups (3.78 [3.19-4.49]). Discussion Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people. Conclusions FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Introductionmentioning

confidence: 99%

Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people

et al. 2019

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“…Third, differences in the use of healthcare services between countries may be partly explained by variations in the involvement of informal caregivers, a dimension which our indicators were unable to capture. In the same vein, differences in centenarians’ health status could have contributed to variable use patterns, as suggested by the uneven prevalence of the frailty phenotype recently shown in another 5-COOP paper 8. However, health status and care habits are sometimes difficult to disentangle, and differences in use did not show any systematic patterns or match the prevalence of frailty.…”

Section: Discussionmentioning

confidence: 90%

“…It is milder in Japan, which shows the fastest increase in the number of centenarians, intermediate in France and Switzerland, and stronger in Sweden and Denmark where the rate of increase is the lowest. The 5-Country Oldest Old Project (5-COOP) was set up to assess and compare the sociodemographic characteristics, health status, living conditions and healthcare services use of people living in these countries who were exactly 100 years of age 7 8…”

Section: Introductionmentioning

confidence: 99%

Use of healthcare services and assistive devices among centenarians: results of the cross-sectional, international 5-COOP study

et al. 2020

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ObjectivesTo measure the use of healthcare services and assistive devices by centenarians in five countries.DesignCross-sectional study using a survey questionnaire.SettingCommunity-dwelling and institutionalised centenarians living in Japan, France, Switzerland, Sweden and Denmark.Participants1253 participants aged 100 or in their 100th year of life, of whom 1004 (80.1%) were female and 596 (47.6%) lived in institutions.Main outcome measuresRecent use of medical visits, nursing care at home, home-delivered meals, acute care hospital stays overnight, professional assessments such as sight tests, mobility aids and other assistive devices. A set of national healthcare system indicators was collected to help interpret differences between countries.ResultsThere was considerable variability in the healthcare services and assistive devices used by centenarians depending on their country and whether they were community-dwelling or institutionalised. In contrast to the relatively homogeneous rates of hospitalisation in the past year (around 20%), community-dwelling centenarians reported widely ranging rates of medical visits in the past 3 months (at least one visit, from 32.2% in Japan to 86.6% in France). The proportion of community-dwellers using a mobility device to get around indoors (either a walking aid or a wheelchair) ranged from 48.3% in Japan to 79.2% in Sweden. Participants living in institutions and reporting the use of a mobility device ranged from 78.6% in Japan to 98.2% in Denmark.ConclusionsOur findings suggest major differences in care received by centenarians across countries. Some may result from the characteristics of national healthcare systems, especially types of healthcare insurance coverage and the amounts of specific resources available. However, unexplored factors also seem to be at stake and may be partly related to personal health and cultural differences.

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“…The age range for our study participants was limited to older adults, specifically between the ages of 40-90 years (due to FRAX age limitation); however, it should be noted that most studies on frailty use participants aged 60 years and older as this is the age range at higher risk of frailty [2,12,32]. We acknowledge that the older old participants (≥80 yr) are more likely to have more characteristics for frailty [33]. Between the two time points used, there was attrition due to death, relocation, nonrespondents and withdrawal from the study.…”

Section: Discussionmentioning

confidence: 99%

The association between a fracture risk tool and frailty: Geelong Osteoporosis Study

et al. 2020

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Background: Frailty is characterised by age-related declines in physical, psychological and social functioning. Features of frailty overlap with risk factors for fragility fractures. The aim of this study was to investigate the association between the fracture risk assessment tool (FRAX®) and frailty. Methods: In cross-sectional analysis, frailty status was determined for participants aged 60-90 yr at 15-year followup of the Geelong Osteoporosis Study, using a modified Fried frailty phenotype. Using the FRAX on-line tool, scores for hip and major osteoporotic fracture (MOF) were calculated with and without bone mineral density (BMD). Using the area under Receiver Operating Characteristic (AUROC) curves, and FRAX scores calculated at the baseline visit for these participants, we investigated the association of FRAX and frailty 15 years later. Results: Forty-seven of 303 women (15.5%) and 41 of 282 men (14.5%) were frail at the 15-year visit. There was a gradient of increasing median FRAX scores from robust to frail. For example, for women, median MOF-FRAX without BMD increased from 5.9 for the robust to 7.5 for the pre-frail and 14.0 for the frail (p < 0.001). In secondary analyses, an association was observed between FRAX and frailty over 15 years, with the highest AUROC for women being 0.72 for MOF-FRAX with BMD, and for men, 0.76 hip-FRAX without BMD. Conclusion: An association was observed between FRAX and frailty where frail men and women had higher FRAXscores compared to the other groups. Preliminary data suggest that FRAX, with or without BMD, may be useful in enhancing the information on frailty. Further research using larger datasets will be required to explore this.

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Frailty and Associated Factors among Centenarians in the 5-COOP Countries

Cited by 48 publications

References 31 publications

Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people

Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people

Use of healthcare services and assistive devices among centenarians: results of the cross-sectional, international 5-COOP study

The association between a fracture risk tool and frailty: Geelong Osteoporosis Study

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