Sensory and motor correlates of frailty: dissociation between frailty phenotype and frailty index

Abstract

Background: Frailty has been associated with a decline in sensory and motor function. However, given that different frailty measures were shown to overlap but also differ in their diagnostic properties, sensory and motor correlates of frailty might be different depending on the operationalization of frailty. Our objective was to identify sensory and motor determinants of frailty and compare the results between frailty phenotype (FP) and frailty index (FI).Methods: Data from 44 pre-frail and frail subjects aged 65 and above were used. Frailty was measured using the FP and the FI. Sensory function in the visual, auditory, and tactile domain was assessed using visual acuity, absolute hearing threshold and mechanical detection threshold. Upper extremity motor performance was evaluated by the Purdue Pegboard Test and the Short Physical Performance Battery was used to assess lower extremity motor function. Multiple logistic regression models were employed to determine associations of sensory and motor function with frailty vs. pre-frailty for both frailty measures. Results:The frailty measures were moderately correlated (0.497, p ≤ 0.01) and had a Kappa agreement of 0.467 (p = 0.002). Using the FP, frailty was significantly associated with reduced upper extremity motor function only (OR = 0.50, 95% CI 0.29-0.87, p = 0.014). Frailty as assessed by the FI was significantly related to higher hearing thresholds (OR = 1.21, 95% CI 1.02-1.43, p = 0.027) and reduced lower extremity performance (OR = 0.32, 95% CI 0.13-0.77, p = 0.012). Conclusion:Frailty is related to reduced performance in measures of sensory and motor function. However, traditional measures of frailty might be differentially sensitive to capture sensory and motor decline, possibly contributing to the much-observed discordance between the diagnostic instruments. This should be taken into account by researchers and clinicians when planning and evaluating therapeutic interventions for frailty. Trial registration: ClinicalTrials.gov NCT03 666039. Registered 11 September 2018 -Retrospectively registered.

Cognitive Hearing Science: Clinical Implications in Audiology

“…Hearing loss often associated with frailty and may warrant measuring clinically. Beier, et al (2022) [80] examined two different assessments of frailty. They determined that the Frailty Index (FI) is more sensitive to hearing loss while the Frailty Phenotype (FP) results are only associated with motor function.…”

“…The FI is calculated by dividing the number of deficits present by the total possible number of deficits (40). Scores exceeding 0.25 (10 deficits) are considered to indicate frailty [80]. The authors emphasize that hearing loss should be included in frailty assessments (using the FI) given their findings and considering previous described association between hearing loss and cognition, gait-speed, fall-risk, depression, hospitalization and mortality.…”

“…Alternatively, hearing aids and PSAPs can offset the effects of hearing loss on audibility for cognitive assessments (i.e., MMSE) [103,106]. A few cochlear implant studies and reviews examined cognitive assessments as outcome measures post-implantation [109,[112][113][114] or to determine candidacy [80,115]. Assessments that are nonverbal (CANTAB and ALACog) or have visual support were preferred (HI-MoCA).…”

Discordance in Frailty Measures in Old Community Dwelling People with Multimorbidity – A Cross-Sectional Study

“… 30 Another study found moderate agreement between the FP and the FI in finding the same frail persons. 31 Furthermore, authors discuss that discordant identification could be related to the measures’ capacity in capturing sensory, motor and psychological impairment. 31 A recent study of the CFS and an electronic FI found substantial heterogeneity between the measures and low support for convergent validity.…”

“… 31 Furthermore, authors discuss that discordant identification could be related to the measures’ capacity in capturing sensory, motor and psychological impairment. 31 A recent study of the CFS and an electronic FI found substantial heterogeneity between the measures and low support for convergent validity. 32 Assessment of frailty increased during the COVID-19 pandemic since it was found to be a useful way to determine risk for adverse outcomes and prognosis of older patients with COVID-19 in the acute care setting.…”