Frailty Transitions in the San Antonio Longitudinal Study of Aging

Abstract

OBJECTIVES To examine frailty transitions in Mexican American (MA) and European American (EA) older adults. DESIGN Longitudinal, observational cohort study. SETTING Socioeconomically diverse neighborhoods in San Antonio, Texas. PARTICIPANTS 312 MA and 285 EA community-dwelling older adults (65+) with frailty information at baseline (1992–96) and transition information at follow-up (2000–01) in the San Antonio Longitudinal Study of Aging (SALSA). MEASUREMENTS Five frailty characteristics (weight loss, exhaustion, weakness, slowness, and low physical activity), frailty score (0–5), and overall frailty state (non-frail = 0 characteristics, pre-frail = 1 or 2, frail = 3+) were assessed at baseline. Transitions (progressed, regressed, or no change) were assessed for frailty score and state. Odds ratios (OR) of progression and regression in individual characteristics were estimated using generalized estimating equations, adjusting for age, sex, ethnic group, socioeconomic status, comorbidity, diabetes, and follow-up interval. RESULTS Diabetes with macrovascular complications (OR=1.84, 95%CI: 1.02–3.33), fewer years of education (OR=0.96, 95%CI: 0.93–1.0) and follow-up interval (OR=1.3, 95%CI: 1.17–1.46) were significant predictors of progression in any frailty characteristic. Mortality increased by frailty state, and pre-frail individuals were more likely than frail to regress. CONCLUSION Diabetes with macrovascular complications and fewer years of education are important predictors of progression in any frailty characteristic. Because of increased risk of death compared with the non-frail state and the increased likelihood of regression compared with the frail state, the pre-frail state may be an optimal target for intervention.

Transição entre níveis de fragilidade em idosos no município de Belo Horizonte, Minas Gerais

“…18 Thus, it is believed that muscular strength and gait speed are of the utmost importance for elderly people, since it has been observed that loss of muscle mass 19 and low gait speed 20 are associated with negative outcomes in elderly persons, 20 among which are the establishment of frailty syndrome 19,20 and death. 5 Literature reports that this occurs due to the aging process tending to reduce muscle mass. 21 In this context, one can hypothesize that possible interventions and changes, even if subtle, such as for example, an increase in overall muscle strength and mobility of elderly individuals, could further enhance the transition towards improving their condition.…”

“…On the other hand, muscle strength and gait speed remained relatively stable over time, and were the items that were most often positive for the phenotype in both evaluations, agreeing with the findings of previous studies. 5,8,18 A study carried out in 2012 by Espinoza et al 5 observed that muscle strength and gait speed are the most prevalent variables in frail elderly persons. Associated with this, previous studies concluded that the reduction of muscle strength is not only the main variable that contributes to the establishment of the frailty syndrome, 19 but also that lower muscle strength identified in the baseline assessment is associated with a negative evolution of the phenotype.…”

“…4 Thus, it is believed that an individual previously classified as frail will remain in that state or die. [5][6][7] However, the possibility of the transition occurring in the opposite direction has been increasingly investigated. Although the state of frailty of individuals has a tendency to deteriorate, an improvement in the condition is possible in certain situations.…”

“…4 However, this dynamism takes place most frequently in one direction, with individuals moving from the not frail stage to the pre-frail stage and culminating in the frail stage. 4,5 This is due to deterioration of the human physiological systems over time, suggesting a gradual progression of a previously existing condition. 4 Thus, it is believed that an individual previously classified as frail will remain in that state or die.…”

Frailty syndrome in an independent urban population in Brazil (FIBRA study): a cross-sectional populational study

“…[3][4][5] The incidence and prevalence of frailty syndrome vary and are influenced by the geographic location studied, by socioeconomic factors such as education, and by age, such that its incidence and prevalence are higher among individuals aged 80 years or over. 2,3,[6][7][8][9][10] Studies conducted both in Brazil and in other countries have reported different prevalence rates, ranging from 6.9% to 40.6% among frail elderly individuals and 46.3% to 60.1% among prefrail individuals. 2,4,[11][12][13][14] In this regard, frailty syndrome should be targeted by earlier investigations and interventions, given its impact on elderly individuals, their families and society as a whole.…”