Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study
Tóm tắt
Background and aims: The term frailty is used to describe older persons at high risk for adverse health outcomes. In 2001, Fried et al. proposed a now widely cited definition which suggests that frailty is a clinical entity related to, but distinct from, ADL disability and comorbidity. Frailty status was assessed based on the presence of any three of the following five characteristics: shrinking, weakness, poor endurance, slowness, and low activity. The objectives of the current study are to estimate the prevalence of frailty in a sample of community-dwelling older persons, to identify sociodemographic and health variables associated with frailty, and to examine the complex relationships between frailty and comorbidity, ADL disability and IADL disability. Methods: This study is based on cross-sectional analysis of 740 community-dwelling seniors from the Montreal Unmet Needs Study (MUNS). The five characteristics of frailty were operationalised using measures available in MUNS. The Cochran-Mantel-Haenszel test was used to identify variables associated with frailty. Overlaps between frailty, comorbidity and disability were assessed using proportions. Results: Overall, 7.4% were classified as frail, 49.7% prefrail and 42.8% non-frail. Frailty was associated with age, sex, income, education, number of chronic diseases, ADL disability, and IADL disability. Among those classified as frail, 29.1 % had disabilities in ADLs, 92.7% in IADLs and 81.8% had comorbidity. Conclusion: Findings on the relationship between frailty and sociodemographic variables, morbidity and disability, support previous studies, providing further evidence that although frailty seems to be a distinct geriatric concept, it also overlaps with other concepts.
Tài liệu tham khảo
Bergman H. The Canadian Initiative on Frailty and Aging. Aging Clin Exp Res 2003; 15: 1–2.
Hogan DB, MacKnight C, Bergman H. Models, definitions, and criteria of frailty. Aging Clin Exp Res 2003; 15: 1–29.
Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–56.
Puts MT, Lips P, Deeg DJ. Sex differences in the risk of frailty for mortality independent of disability and chronic diseases. J Am Geriatr Soc 2005; 53: 40–7.
Woods NF, LaCroix AZ, Gray SL et al. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc 2005; 53: 1321–30.
Chin APM, Dekker JM, Feskens EJ, Schouten EG, Kromhout D. How to select a frail elderly population? A comparison of three working definitions. J Clin Epidemiol 1999; 52: 1015–21.
Rockwood K, Song X, MacKnight C et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489–95.
Ferrucci L, Cavazzini C, Corsi A et al. Biomarkers of frailty in older persons. J Endocrinol Invest 2002; 25: 10–5.
Ottenbacher KJ, Ostir GV, Peek MK, Snih SA, Raji MA, Markides KS. Frailty in older Mexican Americans. J Am Geriatr Soc 2005; 53: 1524–31.
Quail JM, Addona V, Wolfson C, Podoba JE, Levesque LY, Dupuis J. Association of unmet need with self-rated health in a community dwelling cohort of disabled seniors 75 years of age and over. Eur J Ageing 2007; 4: 45–55.
Podoba JE. Unmet needs for community services among the elderly: impact on health services utilization [PhD Thesis]. Montreal, Canada: McGill University; 2004.
Roccaforte W, Burke WJ, Bayer BL, Wenger SP. Validation of a telephone version of the mini-mental state examination. J Am Geriatr Soc 1992; 40: 697–702.
Beland F, Bergman H, Lebel P et al. A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2006; 61: 367–73.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9: 179–86.
Payette H, Gray-Donald K, Cyr R, Boutier V. Predictors of dietary intake in a functionally dependent elderly population in the community. Am J Public Health 1995; 85: 677–83.
Azegami M, Ohira M, Miyoshi K et al. Effect of single and multi-joint lower extremity muscle strength on the functional capacity and ADL/IADL status in Japanese community-dwelling older adults. Nurs Health Sci 2007; 9: 168–76.
Alexander NB, Guire KE, Thelen DG et al. Self-reported walking ability predicts functional mobility performance in frail older adults. J Am Geriatr Soc 2000; 48: 1408–13.
Cochran WG. Some methods for strengthening the common chi-square tests. Biometrics 1954; 10: 417–51.
Bandeen-Roche K, Xue QL, Ferrucci L et al. Phenotype of frailty: characterization in the women’s health and aging studies. J Gerontol A Biol Sci Med Sci 2006; 61: 262–6.
Cesari M, Leeuwenburgh C, Lauretani F et al. Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study. Am J Clin Nutr 2006; 83: 1142–8.
Gill TM, Gahbauer EA, Allore HG, Han L. Transitions between frailty states among community-living older persons. Arch Intern Med 2006; 166: 418–23.
Purser JL, Kuchibhatla MN, Fillenbaum GG, Harding T, Peterson ED, Alexander KP. Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc 2006; 54: 1674–81.
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002; 287: 356–9.
Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB Jr, Walston JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 2004; 52: 625–34.
Bergman H, Wolfson C, Sourial N et al. Frailty Data (FrData): Examining Candidate Domains of Frailty in the Elderly. [abstract] Can J Geriatr 2006; 9: 70.
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59: M255–63.