Healthy behaviors at age 50 years and frailty at older ages in a 20-year follow-up of the UK Whitehall II cohort: A longitudinal study

Abstract

Background Frailty is associated with increased risk of various health conditions, disability, and death. Health behaviors are thought to be a potential target for frailty prevention, but the evidence from previous studies is based on older populations with short follow-ups, making results susceptible to reverse causation bias. We examined the associations of healthy behaviors at age 50, singly and in combination, as well as 10-year change in the number of healthy behaviors over midlife with future risk of frailty. Methods and findings In this prospective cohort study of 6,357 (29.2% women; 91.7% white) participants from the British Whitehall II cohort, healthy behaviors—nonsmoking, moderate alcohol consumption, ≥2.5 hours per week of moderate to vigorous physical activity, and consumption of fruits or vegetables at least twice a day—were measured at age 50, and change in behaviors was measured between 1985 (mean age = 44.4) and 1997 (mean age = 54.8). Fried’s frailty phenotype was assessed in clinical examinations in 2002, 2007, 2012, and 2015. Participants were classified as frail if they had ≥3 of the following criteria: slow walking speed, low grip strength, weight loss, exhaustion, and low physical activity. An illness–death model accounting for both competing risk of death and interval censoring was used to examine the association between healthy behaviors and risk of frailty. Over an average follow-up of 20.4 years (standard deviation, 5.9), 445 participants developed frailty. Each healthy behavior at age 50 was associated with lower risk of incident frailty: hazard ratio (HR) after adjustment for other health behaviors and baseline characteristics 0.56 (95% confidence interval [CI] 0.44–0.71; p < 0.001) in nonsmokers, 0.73 (95% CI 0.61–0.88; p < 0.001) for moderate alcohol consumption, 0.66 (95% CI 0.54–0.81; p < 0.001) for ≥2.5 hours of physical activity per week, and 0.76 (95% CI 0.59–0.98; p = 0.03) for consumption of fruits or vegetables at least twice a day. A greater number of healthy behaviors was associated with reduced risk of frailty, with the HR for each additional healthy behavior being 0.69 (95% CI 0.62–0.76; p < 0.001) and the HR for having all versus no healthy behaviors at age 50 being 0.28 (95% CI 0.15–0.52; p < 0.001). Among participants with no or 1 healthy behavior in 1985, those who increased the number of healthy behaviors by 1997 were at a lower risk of frailty (mean follow-up = 16 years) compared with those with no such increase: the HR was 0.64 (95% CI 0.44–0.94; p = 0.02) for change to 2 healthy behaviors and 0.57 (95% CI 0.38–0.87; p < 0.001) for change to 3–4 healthy behaviors in 1997. The primary limitation of this study is potential selection bias during the follow-up due to missing data on frailty components. ...

Brain Activity in the Prefrontal Cortex during Cognitive Tasks and Dual Tasks in Community-Dwelling Elderly People with Pre-Frailty: A Pilot Study for Early Detection of Cognitive Decline

“…Holtzer et al [26] and Beurskens et al [27] reported that older adults exhibit reduced activation in the prefrontal cortex during different tasks compared with younger subjects. Furthermore, decreased physical activity has been reported to cause reduced blood flow to the brain [28], leading to frailty [29]. In addition, a previous report found that older adults who go outdoors on a daily basis had greater oxygenated hemoglobin changes in the inferior frontal gyrus compared with those who do not have this habit [30].…”

Use of standardized brief geriatric evaluation compared with routine care in general practice for preventing functional decline: a pragmatic cluster-randomized trial

“…The question of when and in what population to begin interventions is still unresolved. Evidence from the Whitehall II study suggests that prevention of frailty should begin in midlife, 32 but how and when to promote this patient-provider dialogue should be the objective of future research.…”

Fruit and Vegetable Consumption and Incident Prefrailty and Frailty in Community-Dwelling Older People: The English Longitudinal Study of Ageing

“…There are three studies with the main focus on the association between fruit and vegetable consumption and incident frailty [ 31 , 32 , 33 ]. Fruit and vegetables were measured by quantity [ 31 , 32 ] or frequency [ 33 ].…”

“…The last study using the Whitehall II study cohort measured fruit and vegetables by frequency and showed that those eating fruit and vegetables at least twice a day had a significantly lower risk of developing frailty during 20-year follow-up (hazard ratio = 0.70, 95% CI = 0.53–0.92, p = 0.01) compared with those eating less than once a day [ 33 ].…”