Prognostic Significance of Potential Frailty Criteria

Abstract

Objectives-To determine the independent prognostic effect of 7 potential frailty criteria, including 5 from the Fried phenotype, on several adverse outcomes. Design-Prospective cohort study.Setting-Greater New Haven, Connecticut.Participants-Seven hundred fifty-four initially non-disabled, community-living persons aged 70 and older.Measurements-An assessment of 7 potential frailty criteria (slow gait speed, low physical activity, weight loss, exhaustion, weakness, cognitive impairment and depressive symptoms) was completed at baseline and every 18 months for 72 months. Participants were followed with monthly telephone interviews for up to 96 months to determine the occurrence of chronic disability, longterm nursing home (NH) stays, injurious falls, and death.Results-In analyses that were adjusted for age, sex, race, education, number of chronic conditions, and the presence of the other potential frailty criteria, 3 of the 5 Fried criteria (slow gait speed, low physical activity, and weight loss) were independently associated with chronic disability, long-term NH stays, and death. Slow gait speed was the strongest predictor of chronic disability (Hazard ratio [HR] 2.97, 95% confidence interval [CI], 2.32-3.80), and long-term NH stays (HR 3.86, 95% CI, 2.23-6.67), and was the only significant predictor of injurious falls (HR 2.19, 95% CI, 1.33-3.60). Cognitive impairment was also associated with chronic disability (HR 1.82, 95% CI, 1.40-2.38), long-term NH stays (HR 2.64, 95% CI,, and death (HR 1.54, 95% CI, 1.13-2.10), and the magnitude of these associations was comparable to that of weight loss. Conclusions-The results of our study provide strong evidence to support the use of slow gait speed, low physical activity, weight loss and cognitive impairment as key indicators of frailty, while raising concerns about the value of self-reported exhaustion and muscle weakness.

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

“…The results of this study demonstrate that it should not be assumed that individuals classified as frail are necessarily in an extreme and irreversible health condition. Furthermore, it was observed that reduction in muscular strength and gait speed were the most frequently occurring positive items for the presence of the frailty phenotype at both the baseline assessment and after 24 months, which corroborates with previous studies 8 In the present study, approximately 45% of the individuals transitioned to the milder stages of the phenotype and 55% showed a reduction in the number of items that scored positively. This fact corroborates the idea of the possibility of transition among the classification stages of the frailty syndrome that has also been observed in previous studies.…”

“…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.…”

“…In general, these losses may have resulted from the fact that the variables relating to cognitive issues are an important factor in the evolution of frailty syndrome, considering that they act as a protective factor for the installation/evolution of possible dementia, corroborating previous findings. 8 Moreover, it is already known that cognitive disorders are associated with the frailty syndrome, 22 including among elderly Brazilians. 23 Concomitantly, there is the possibility that the losses observed in the present study were related to elderly individuals who, in the initial assessment, had a higher degree of biopsychosocial impairment, with consequent deterioration of their health condition.…”

“…Although the state of frailty of individuals has a tendency to deteriorate, an improvement in the condition is possible in certain situations. 8 This is because, in cases where there is a possibility of resolution or better control of depression, incontinence and obesity, it is likely that an individual will transit from the frail stage to pre-frail, or from this stage to not frail. 4,8 It is also worth noting that, according to Gill et al, 4 these transitions are possible only between adjacent stages.…”

“…8 This is because, in cases where there is a possibility of resolution or better control of depression, incontinence and obesity, it is likely that an individual will transit from the frail stage to pre-frail, or from this stage to not frail. 4,8 It is also worth noting that, according to Gill et al, 4 these transitions are possible only between adjacent stages. 4 Given that frailty is a multifactorial syndrome that can be affected by the health conditions of the individual, it is necessary to investigate the behavior of the variables associated with the condition over time.…”