Frailty, Dependency and Mortality Predictors in a Cohort of Cuban Older Adults, 2003–2011

Abstract

INTRODUCTION Population aging translates into more people with chronic non-communicable diseases, disability, frailty and dependency. The study of frailty-a clinical syndrome associated with an increased risk of falls, disability, hospitalization, institutionalization and death-is important to improve clinical practice and population health indicators.OBJECTIVES In a cohort of older adults in Havana and Matanzas provinces, Cuba, estimate prevalence of frailty and its risk factors; determine incidence of dependency; estimate mortality risk and identify mortality predictors.METHODS A prospective longitudinal study was conducted door to door, from June 2003 through July 2011, in a cohort of 2813 adults aged ≥65 years living in selected municipalities of Havana and Matanzas provinces; mean followup time was 4.1 years. Independent variables included demographics, behavioral risk factors and socioeconomic indicators, chronic non-communicable diseases (hypertension, stroke, dementia, depression, diabetes, anemia), number of comorbidities, and APOE ε4 genotype. Dependent variables were frailty, dependency and mortality. Criteria for frailty were slow walking speed, exhaustion, weight loss, low physical activity and cognitive decline. Prevalence and frailty risk were estimated by Poisson regression, while dependency and mortality risks and their predictors were determined using Cox regression. RESULTSFrailty syndrome prevalence was 21.6% (CI 17.9%-23.8%) at baseline; it was positively associated with advanced age, anemia and presence of comorbidities (stroke, dementia, depression, three or more physically debilitating diseases). Male sex, higher educational level, married or partnered status, and more household amenities were inversely associated with frailty prevalence.In followup, dependency incidence was 33.1 per 1000 personyears (CI 29.1-37.6) and mortality was 55.1 per 1000 person-years. Advanced age, male sex, lower occupational status during productive years, dependency, frailty, dementia, depression, cerebrovascular disease and diabetes were all associated with higher risk of death.CONCLUSIONS Given the challenge for developing countries presented by demographic and epidemiologic transition; the high prevalence in older adults of frailty syndrome, dependency and chronic non-communicable diseases; and the association of all these with higher mortality, attention should be targeted to older adults as a risk group. This should include greater social protection, age-appropriate health services, and modifi cation and control of cardiovascular risk factors.

Estimation of Life Expectancy for Dependent Population in a Multi-State Context

“…Our results are not comparable with those obtained in previous studies reported in the Introduction. Most of them have estimated life expectancy in small and very localized groups, as [ 17 ] do. Others are specifically focused on studying the life expectancy of the population in nursing homes, such as [ 18 , 19 ] or [ 20 ].…”

“…There were studies of mortality in small groups. [ 17 ] analyzed a small sample of 2813 people aged over 65 years old in the provinces of Havana and Matanzas in Cuba. The authors sought both to assess risk and to detect and identify factors that influence the onset of dependence and that could be used as predictors of mortality.…”

“…All of the above papers use small samples and focus on small geographic areas. Some others epidemiological studies are focused on a specific group of people (i.e., [ 17 ]) or people diagnosed with a concrete illness or disability (Alzheimer’s dementia, Parkinson, cognitive dysfunction or functional disability such as, for instance, [ 30 , 31 ] or [ 32 ].…”

A Single-Case Design Investigation for Measuring the Efficacy of Gestalt Therapy to Treat Depression in Older Adults with Dementia in Italy and in Mexico: A Research Protocol

“…The care and the management of dementia differs country-by-country, depending on epidemiological figures, the long-term care (LCT) system, welfare regimes, and level of country income. In Latin America, the prevalence of diagnosed dementia in 2010 was 3.10 million cases, compared to 9.95 million in Europe, and an increase of 393% is expected by 2050, compared to an 87% rise in Europe [ 36 ]. The increasing number of diagnosed PWD will contribute to growing inequalities in low- and middle-income countries, where 15% of dementia-related costs is covered by social care, compared to 40% in high-income countries [ 37 ].…”