Highlights
- •Frailty is a dynamic condition that may improve as well as worsen.
- •Frailty trajectories may change within a 1-year period.
- •Hearing impairment, cardiovascular diseases, and polypharmacy are associated with a worse frailty status.
- •Frail individuals are capable of significant natural improvement over time.
Abstract
Objectives: Greater understanding of changes in the degree of frailty is important
for clarifying the natural history of frailty and may help clinical decision-making
regarding preventive interventions. The objectives of this study were to explore natural
frailty transition rates at 1-year follow-up and to identify the main determinants
of such transitions.
Study design: Prospective longitudinal study covering a representative sample of community-dwelling
older adults aged ≥65 years (n = 749) at baseline, and transition information at 1-year
follow-up (n = 537).
Mean outcome measures: The assessment of frailty status was based on phenotypic criteria
(unintentional weight loss, weakness, exhaustion, slow walking speed, low physical
activity). Frailty transitions (progressed, regressed, no change, or death) and associated
factors were assessed.
Results: Most participants remained unchanged from their baseline status (57.1% non-frail,
83.4% pre-frail, 66.7% frail). Regarding frailty transitions, 42.9% of non-frail older
adults at baseline had progressed to a pre-frail status by the 1-year follow-up, and
7.9% of pre-frail older adults had become frail. Importantly, 33.3% of frail older
adults regressed to a pre-frail status and 8.7% of pre-frail adults had regressed
to a non-frail status. Non-frail females tended to progress to pre-frailty significantly
more than males (p = 0.006), and mortality was higher among participants classified as frail at baseline
(10.7%). Logistic regression showed that the main determinants of worsening frailty
were hearing impairment (OR 3.180; 95% CI 1.078–9.384), congestive heart failure (OR
10.864; 95% CI 1.379–85.614), and polypharmacy (OR 2.572, 95% CI 1.096–6.037).
Conclusion: Our results confirm the dynamic of frailty and the bidirectional nature
of frailty transitions, and indicate the need for preventing and treating these conditions
in later life in order to minimize the burden of frailty.
Keywords
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Article Info
Publication History
Published online: November 15, 2018
Accepted:
November 8,
2018
Received in revised form:
October 10,
2018
Received:
July 19,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
