Research On The Identification And Transition Of Frailty Among Older Adults In An Age-friendly Community

PART ONE Comparison of three frailty instruments for prediction of adverse outcomes among community-dwelling older adultsObjectives:To compare the ability of Frailty Phenotype(FP),FRAIL and Frailty Index(FI)to predict adverse outcomes among old adults in an age-friendly community.Methods:A prospective cohort study in an age-friendly community in Beijing,China was designed.All residents age 75 years or above who underwent annual routine physical examinations in the summer of 2018(July to September)were continuously included.Frailty was evaluated by FP,FRAIL and FI.The agreement between instruments was assessed by Cohen kappa coefficient.The predictive value of the frailty instruments for adverse outcomes[unplanned hospital visits,activity of daily living(ADL)decline and falls]during 1-year follow-up period were analyzed using decision curve analysis(DCA)and receiver operating characteristic curve(ROC)analysis.Results:A total of 188 older adults(mean age 84.0±4.4 years,58.5%female)were included in the research.The prevalence of frailty was 32.4%(FP),25%(FRAIL)and 42.6%(FI)separately.The agreement between instruments was moderate to good(kappa:0.44?0.61).DCA showed clinical intervention had a higher net benefit than "treat all"and "treat none" when risk of unplanned hospital visits ?30%,risk of functional decline or falls ?15%,though the curves of the instruments overlapped across all relevant risk thresholds.The three instruments had similar predictive value for unplanned hospital visits(area under ROC,AUC:FP 0.63;FRAIL 0.64;FI 0.69).FRAIL and FI had similar predictive value for ADL decline(AUC:FRAIL 0.63;FI 0.65).Only FI had predictive value for falls(AUC:0.65).Subgroup analysis was performed by sex,for the old men,FRAIL and FI had similar predictive value for unplanned hospital visits(AUC:FRAIL 0.65;FI 0.66),FI had a predictive value for ADL decline(AUC:0.75)and three instruments had similar predictive value for falls(AUC:FP 0.75;FRAIL 0.74;FI 0.73);The three instruments had similar predictive value for unplanned hospital visits and FI performed better than FRAIL(AUC:FP 0.64;FAIIL 0.62;FI 0.71),but all instruments had no predictive value for ADL declines and falls.After adjusted for age and gender,frailty(odds ratio,OR:1.35,95%confidence interval,CI:1.02-1.78)and physical function(walking speed OR:0.15,95%CI:0.04-0.59;timed up and go test OR:1.04,95%CI:1.00-1.07;short physical performance battery OR:0.85,95%CI:0.75-0.95)were independently associated with ADL decline,but CCI and ADL decline were not.Frailty(AUC:0.62)and physical function(AUC:walking speed 0.64,timed up and go test 0.63,short-physical performance battery:0.62)performed better than CCI(AUC:0.58,P>0.05)for prediction of ADL decline among old adults aged 80 or above.Conclusions:Interventions based on the risk of adverse outcomes predicted by any frailty instruments had clinical value for the old adults in community.Multidimensional measures of frailty were better than unidimensional measures for prediction of adverse outcomes.FRAIL may be best in practice because it is simple.The ability of the three frailty instruments for prediction of adverse outcomes among the old adults varies between different genders.PART TWO Frailty transitions and associated factors among community-dwelling older adultsObjectives:To analyze the frailty transitions and the factors associated with frailty transitions among old adults in age-firendly community.Methods:A cohort from an age-friendly community in Beijing China was included.Frailty status were assessed by FRAIL both in baseline and one-year follow-up.The baseline data of all the older adults in the cohort,including geriatric comprehensive assessment items(frailty,physical function and geriatric syndrome)and laboratory indicators including white blood cell,hemoglobin,albumin,and hypersensitive C-reactive protein(hsCRP)were recorded.Binary logistic regression and Lasso regression were used to analyze the association between factors and frailty transitions(worsening:from non-frailty to frailty;improvementfrom frailty to non-frailty).Receiver operating characteristic curve(ROC)was used to evaluated the predictive ability of factors for frailty transitions.Results:Among all participants,183(aged 83.9±4.4 years,female accounting for 59%)completed the baseline and 1-year follow-up frailty assessment.The changes of the frailty status between baseline and 1-year follow-up only occurred between adjacent status and it was more common for status decline or remain unchanged than status improvement.Binary logistic regression indicated after adjusting for age and gender,walking speed(odds ratio,OR:0.01,95%confidence interval,CI:0.002-0.12),timed up and go test(OR:1.08,95%CI:1.02-1.15),Short-Physical Performance Battery(OR:0.79,95%CI:0.68-0.92),albumin(OR:0.78,95%CI:0.64-0.94)and hsCRP(OR:1.21,95%CI:1.00-1.47)were associated with frailty worsening;Cognitive function(OR:6.73,95%CI:1.15 to 39.19)was associated with frailty improvement.Lasso regression showed age(?:0.01),walking speed((3:-2.34),timed up and go test(?:0.01),malnutrition(?:0.94),depression(?:0.30),albumin(?:-0.08)and hsCRP(?:0.26)were associated with frailty worsening;Timed up and go test(?:0.01)and cognitive function(?:0.78)was associated with frailty improvement.Age(area under ROC,AUC:0.68),walking speed(AUC:0.81),timed up and go test(AUC:0.77),albumin(AUC:0.68)and hsCRP(AUC:0.80)could predict frailty worsening;Cognitive(AUC:0.69)could predict frailty improvement.Conclusion:Frailty changed dynamically.Age,walking speed,timed up and go test,albumin and hsCRP were associated with frailty worsening among old adults in community.Cognitive function was associated with frailty improvement.Age,walking speed,timed up and go test,albumin,hsCRP and cognitive function may predict frailty transitions.PART THREE The predictive value of frailty,physical function and comorbidity on the activity of daily living decline among community-dwelling older adults ?80 yesrsObjectives:To analyze the predictive value of frailty,physical function and comorbidity on the activity of daily living(ADL)decline of the old adults aged 80 or above in an age-friendly community.Methods:The subjects were aged 80 years or above from a corhort in an age-friendly community in Beijing.Frailty was evaluated by frailty phenotype,physical function was assessed by walking speed,timed up and go test(TUG)and Short-Physical Performance Battery(SPPB)and comorbidity was evaluated by Charlson Comorbidity Index(CCI).ADL decline was defined as ADL score decrsesed?1 point after the end of the one-year follow-up period.The association between frailty,comorbidity and physical function and ADL decline was analyzed by binary logistic regression separately.The predictive value of the above factors for ADL decline were analyzed using receiver operating characteristic curve(ROC)analysis.Results:159 pariticipants(mean age 85.2±3.4 years,female 42.8%)were included in the analysis.After adjusted for age and gender,frailty(odds ratio,OR:1.35,95%confidence interval,CI:1.02-1.78)and physical function(walking speed OR:0.15,95%CI:0.04-0.59;TUG OR:1.04,95%CI:1.00-1.07;SPPB OR:0.85,95%CI:0.75-0.95)were independently associated with ADL decline,but CCI and ADL decline were not.Frailty(AUC:0.62)and physical function(AUC:walking speed 0.64,TUG 0.63,SPPB:0.62)performed better than CCI(AUC:0.58,P>0.05)for prediction of ADL decline among old adults aged 80 or above.Conclusions:Frailty and physical function were better than CCI in predicting ADL decline among old adults aged 80 or above in community.For the older adults with stable chronic disease,frailty and physical function assessment should be included in community management.