Frailty and the prediction of dependence and mortality in low- and middle-income countries: a 10/66 population-based cohort study

Jotheeswaran At; Renata Bryce; Matthew Prina; Daisy Acosta; Cleusa P Ferri; Mariella Guerra; Yueqin Huang; Juan J Llibre Rodriguez; Aquiles Salas; Ana Luisa Sosa; Joseph D Williams; Michael E Dewey; Isaac Acosta; Zhaorui Liu; John Beard; Martin Prince

doi:10.1186/s12916-015-0378-4

Frailty and the prediction of dependence and mortality in low- and middle-income countries: a 10/66 population-based cohort study

Jotheeswaran At, Renata Bryce, Matthew Prina, Daisy Acosta, Cleusa P Ferri, Mariella Guerra, Yueqin Huang, Juan J Llibre Rodriguez, Aquiles Salas, Ana Luisa Sosa, Joseph D Williams, Michael E Dewey, Isaac Acosta, Zhaorui Liu, John Beard, Martin Prince

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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.

Original language	English
Article number	138
Number of pages	12
Journal	BMC Medicine
Volume	13
Issue number	1
Early online date	10 Jun 2015
DOIs	https://doi.org/10.1186/s12916-015-0378-4
Publication status	Published - 10 Jun 2015

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At, J., Bryce, R., Prina, M., Acosta, D., Ferri, C. P., Guerra, M., 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. (2015). Frailty and the prediction of dependence and mortality in low- and middle-income countries: a 10/66 population-based cohort study. BMC Medicine, 13(1), Article 138. https://doi.org/10.1186/s12916-015-0378-4

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title = "Frailty and the prediction of dependence and mortality in low- and middle-income countries: a 10/66 population-based cohort study",

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.",

author = "Jotheeswaran At and Renata Bryce and Matthew Prina and Daisy Acosta and Ferri, {Cleusa P} and Mariella Guerra and Yueqin Huang and Rodriguez, {Juan J Llibre} and Aquiles Salas and Sosa, {Ana Luisa} and Williams, {Joseph D} and Dewey, {Michael E} and Isaac Acosta and Zhaorui Liu and John Beard and Martin Prince",

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doi = "10.1186/s12916-015-0378-4",

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At, J, Bryce, R , Prina, M, Acosta, D, Ferri, CP, Guerra, M, Huang, Y, Rodriguez, JJL, Salas, A, Sosa, AL, Williams, JD, Dewey, ME, Acosta, I, Liu, Z, Beard, J & Prince, M 2015, 'Frailty and the prediction of dependence and mortality in low- and middle-income countries: a 10/66 population-based cohort study', BMC Medicine, vol. 13, no. 1, 138. https://doi.org/10.1186/s12916-015-0378-4

TY - JOUR

T1 - Frailty and the prediction of dependence and mortality in low- and middle-income countries

T2 - a 10/66 population-based cohort study

AU - At, Jotheeswaran

AU - Bryce, Renata

AU - Prina, Matthew

AU - Acosta, Daisy

AU - Ferri, Cleusa P

AU - Guerra, Mariella

AU - Huang, Yueqin

AU - Rodriguez, Juan J Llibre

AU - Salas, Aquiles

AU - Sosa, Ana Luisa

AU - Williams, Joseph D

AU - Dewey, Michael E

AU - Acosta, Isaac

AU - Liu, Zhaorui

AU - Beard, John

AU - Prince, Martin

PY - 2015/6/10

Y1 - 2015/6/10

N2 - 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.

AB - 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.

U2 - 10.1186/s12916-015-0378-4

DO - 10.1186/s12916-015-0378-4

M3 - Article

C2 - 26063168

SN - 1741-7015

VL - 13

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 138

ER -

Frailty and the prediction of dependence and mortality in low- and middle-income countries: a 10/66 population-based cohort study

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