Title
Frailty and the prediction of dependence and mortality in low- and middle-income countries: A 10/66 population-based cohort study
Date Issued
10 June 2015
Access level
open access
Resource Type
journal article
Author(s)
Jotheeswaran A.T.
Bryce R.
Prina M.
Acosta D.
Ferri C.P.
Huang Y.
Rodriguez J.J.L.
Salas A.
Sosa A.L.
Williams J.D.
Dewey M.E.
Acosta I.
Liu Z.
Beard J.
Prince M.
Publisher(s)
BioMed Central Ltd.
Abstract
Background: In countries with high incomes, frailty indicators predict adverse outcomes in older people, despite a lack of consensus on definition or measurement. We tested the predictive validity of physical and multidimensional frailty phenotypes in settings in Latin America, India, and China. Methods: Population-based cohort studies were conducted in catchment area sites in Cuba, Dominican Republic, Venezuela, Mexico, Peru, India, and China. Seven frailty indicators, namely gait speed, self-reported exhaustion, weight loss, low energy expenditure, undernutrition, cognitive, and sensory impairment were assessed to estimate frailty phenotypes. Mortality and onset of dependence were ascertained after a median of 3.9 years. Results: Overall, 13,924 older people were assessed at baseline, with 47,438 person-years follow-up for mortality and 30,689 for dependence. Both frailty phenotypes predicted the onset of dependence and mortality, even adjusting for chronic diseases and disability, with little heterogeneity of effect among sites. However, population attributable fractions (PAF) summarising etiologic force were highest for the aggregate effect of the individual indicators, as opposed to either the number of indicators or the dichotomised frailty phenotypes. The aggregate of all seven indicators provided the best overall prediction (weighted mean PAF 41.8 % for dependence and 38.3 % for mortality). While weight loss, underactivity, slow walking speed, and cognitive impairment predicted both outcomes, whereas undernutrition predicted only mortality and sensory impairment only dependence. Exhaustion predicted neither outcome. Conclusions: Simply assessed frailty indicators identify older people at risk of dependence and mortality, beyond information provided by chronic disease diagnoses and disability. Frailty is likely to be multidimensional. A better understanding of the construct and pathways to adverse outcomes could inform multidimensional assessment and intervention to prevent or manage dependence in frail older people, with potential to add life to years, and years to life.
Volume
13
Issue
1
Language
English
OCDE Knowledge area
Psiquiatría
Medicina general, Medicina interna
Subjects
Scopus EID
2-s2.0-85016035785
PubMed ID
Source
BMC Medicine
ISSN of the container
17417015
Source funding
Alzheimer's Association
Sponsor(s)
The 10/66 Dementia Research Group population based surveys were funded by: The Wellcome Trust (UK) (GR066133); the World Health Organisation; the US Alzheimer’s Association (IIRG-04-1286); and the Fondo Nacional de Ciencia Y Tecnologia, Consejo de Desarrollo Cientifico Y Humanistico, Universidad Central de Venezuela (Venezuela). Authors acknowledge the support received from Wellcome Trust Capacity Strengthening Strategic Award to the Public Health Foundation of India and a consortium of UK universities. The funding bodies had no role in the design of the study, in the collection, analysis and interpretation of data, in the writing of the manuscript, or in the decision to submit the manuscript for publication.
Sources of information:
Directorio de Producción Científica
Scopus