An Empirical Study Of Frailty Based On Comprehensive Health Assessment

BackgroundHealthy aging is a major public health burden globally.China is in the stage of rapid progression of aging.The physical function,psychological spirit,social support and other aspects of comprehensive health status in elderly population are found to be associated with the occurrence and development of negative outcomes such as death,disability or hospitalization.The construction of comprehensive health evaluation system facilitates the screening and grading of individual health status by quantitative assessment in the elderly.Frailty is an important criterion for comprehensive evaluation of health status,which increases the risk of mortality and other adverse events.Frailty can be reversed through risk factors identification,risk evaluation and precise intervention.Alterations of metabolites in the body are closely associated with diseases,thereby dynamically reflecting the final output of the interaction between cellular activity and external environment.Metabolomics has the potential to effectively integrate the information of endogenous and exogenous exposure.The analysis of metabolic characteristics of frailty helps to enrich the risk factor spectrum of frailty.MethodsIn the Part ?,an umbrella meta-analysis of the association between comprehensive health factors and all-cause mortality in the elderly was made,which also established the item pool of the geriatric comprehensive health evaluation system.In the Part ?,the geriatric comprehensive health evaluation system was constructed by Delphi survey.Both the reliability and validity were tested,and the norm of geriatric comprehensive health score was formulated through an empirical study of population.In the part ?,the influential factors of frailty were selected by Lasso-logistic regression based on comprehensive health assessment in a cross-sectional study.We developed a discrete Bayesian network topology in order to display the association of frailty with its influential factors,as well as potential relations between these factors.The effect of one or more factors on frailty can be inferred by conditional probability.Non-targeted metabolomics was used in Part ? to explore the differential metabolites in frail,pre-frail and robust elderly population.The metabolic characteristics related to frailty were analyzed.Results1.This umbrella meta-analysis demonstrates that several health-related factors are associated with all-cause mortality among non-hospitalized older adults.After the assessment of epidemiological credibility,robust or highly suggestive evidence supported that risk factors including frailty,low short physical performance battery(SPPB)score,low steps per day,metabolic syndrome,low body mas index(BMI),malnutrition,current smoking,cognitive frailty,grip strength loss,slow pace,visual impairment,urinary incontinence,widowhood and daily long sleep duration(more than six hours)were associated with all-cause mortality.Corresponding protective factors were Mediterranean diet,high or moderate-intensity of physical activity.Factors that were linked with a higher risk for all-cause mortality and presented suggestive evidence were high BMI,former smoking,sarcopenia,comorbidity and erectile dysfunction,which with a lower risk were low intensity of physical activity.Weak evidence supported that daily short sleep duration(less than six hours)and depression was associated with an increased risk of all-cause mortality,while increased green space exposure and long low-intensity physical activity were associated with a reduced risk of all-cause mortality.2.A 29-item comprehensive health evaluation system was developed after a tworound Delphi survey,which encompassed three dimensions as follows: physiology,psychology,as well as social support and environment.This evaluation system was tested with good reliability and validity.The geriatric comprehensive health score was calculated by the weight distribution of the above evaluation system.The mean,percentile and demarcation norm of comprehensive health score according to different age and gender groups were established through an empirical study,which recruited 2,040 nonhospitalized elderly people.The geriatric comprehensive health score was significantly related to the frailty.3.In a multi-center cross-sectional study of non-hospitalized elderly populations,the prevalence of frailty was 8.33%,8.03% and 13.28% according to the criteria of Fried phenotype,FRAIL and frailty index,respectively.Discrete Bayesian network suggested that age,nutritional status,instrumental activities of daily living(IADL),balance and social support were directly related to frailty.Falling,chronic pain,anxiety,blood creatinine levels,vision and hearing were indirectly networked with frailty.Knowing the status of any one or more of the above influential factors,the risk of frailty can be inferred using conditional probability.4.Non-targeted metabolomic analysis based on a matched case-control study revealed that multiple alterations of metabolic substances in pre-frail/frail subjects,including amino acids derivatives,organic acid and its derivatives,oxidized lipids,bile acids,choline,acyl carnitine,and glycerol phospholipid.The four common differential metabolites were 3-indolepropionic acid,4-Methoxyphenylacetic acid,guanidinoacetic acid and D-urobilinogen,which were mainly involved in the disturbance of amino acid metabolism pathway.Among the differential metabolites,guanidinoacetic acid,snGlycero-3-Phosphocholine,and 5-aminovaleric acid enabled to discriminate frailty and pre-frailty from the robust status.ConclusionThe comprehensive health status is closely associated with the risk of all-cause mortality in the elderly.The geriatric comprehensive health evaluation system has good reliability and validity,and the geriatric comprehensive health score has significant correlation with the frailty.Frailty and its influencing factors constitute a complex network,in which age,nutritional status,IADL,balance and social support are directly related to frailty.Significant alterations of metabolic substances were found in frail and pre-frail subjects,mostly by regulating amino acid metabolic pathway.This study provides methodological evidence and practical guidance for the management and intervention of the comprehensive health status of the elderly population,and establishes a theoretical basis for the early diagnosis,risk prediction and precise treatment of frailty.