Trajectories of frailty in aging: Prospective cohort study

Abstract

Background Emerging evidence suggests that there is significant variability in the progression of frailty in aging. We aimed to identify latent subpopulations of frailty trajectories, and examine their clinical and biological correlates. Methods We characterized frailty using a 41-item cumulative deficit score at baseline and annual visits up to 12 years in 681 older adults (55% women, mean age 74·6 years). Clinical risk profile and walking while talking performance as a clinical marker of trajectories were examined. Mortality risk associated with trajectories was evaluated using Cox regression adjusted for established survival predictors, and reported as hazard ratios (HR). Proteome-wide analysis was done. Findings Latent class modeling identified 4 distinct frailty trajectories: relatively stable (34·4%) as well as mild (36·1%), moderate (24·1%) and severely frail (5·4%). Four distinct classes of frailty trajectories were also shown in an independent sample of 515 older adults (60% women, 68% White, 26% Black). The stable group took a median of 31 months to accumulate one additional deficit compared to 20 months in the severely frail group. The worst trajectories were associated with modifiable risk factors such as low education, living alone, obesity, and physical inactivity as well as slower walking while talking speed. In the pooled sample, mild (HR 2·33, 95% CI 1·30–4·18), moderate (HR 2·49, 95% CI 1·33–4·66), and severely frail trajectories (HR 5·28, 95% CI 2·68–10·41) had higher mortality compared to the stable group. Proteomic analysis showed 11 proteins in lipid metabolism and growth factor pathways associated with frailty trajectories. Conclusion Frailty shows both stable and accelerated patterns in aging, which can be distinguished clinically and biologically.

Childhood experiences and frailty trajectory among middle-aged and older adults in China

“…Similar to previous studies (Chamberlain et al 2016;Jung et al 2022;Verghese et al 2021), we have identi ed an increasing pattern of frailty trajectory. When considering childhood conditions, signi cant impacts of all these three childhood antecedents were found on frailty at baseline (Li et al 2019(Li et al , 2020Mian et al 2021), and childhood SES also had a strong relationship with the trajectory of frailty (Linden et al 2020).…”

Association of longitudinal repeated measurements of frailty index with mortality: Cohort study among community-dwelling older adults

“… 30 , 31 , 32 Verghese et.al. 33 assessed the association using multiple assessments of FI and reported similar associations with mortality as in our study. However, with only 1196 older adults (mean age >74 years) and 139 deceased, this study did not assess cause-specific mortality.…”

Progression and trajectory network of age-related functional impairments and their associations with mortality: a two-decade prospective study

“…The incidence rates reported in this study were comparable with previous studies. 37 38 39 40 41 42 43 44 45 For instance, the incidence rate of cognitive impairment was 52.6 cases/1000 person-years in a 5-year follow-up study of Aboriginal Australians aged over 60 years, 46 which is similar to our result (64.6 cases/1000 person-years). The observed sex- and age-disparities in incidence rates also corresponded to prior knowledge.…”