Predictability of Frailty Index and Its Components on Mortality in Older Adults in China

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2016 Jul 27

PMID 27455962

Citations 25

Authors

Fang Yang

Danan Gu

Affiliations

Soon will be listed here.

Abstract

Background: Frailty represents an increased vulnerability to external stressors due to decreased physiological reserve and dysfunction in multiple bodily systems. The relationship between frailty and mortality has been well-documented in the literature. However, less is known about the predictive powers of frailty index and its components on mortality when they are simultaneously present. This study aimed to examine the predictive powers of frailty index and its multiple components on mortality in a nationally representative sample of older adults in China.

Methods: We used a sample of 13,731 older adults from the 2008/2009 and 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Frailty was measured using the cumulative deficit approach, and was constructed from 38 health variables (39 deficits). We selected 8 major sets of components: activities of daily living (ADL) (6 deficits), instrumental ADL (IADL) (8 deficits), functional limitations (5 deficits), overall cognitive functioning (1 deficit), chronic disease conditions (11 deficits), self-reported health (2 deficits), hearing and vision impairment (2 deficits), and psychological distress (1 deficit). Survival analysis was used to examine the roles of the frailty and its components in mortality.

Results: Results showed that almost all the components of the frailty index (except chronic diseases) were significant predictors of mortality when examined individually. Among the components, ADL and IADL disabilities remained significant when considering all the components simultaneously. When the frailty and its components were simultaneously analyzed, the frailty remained a robust predictor of mortality across the age and sex groups, while most components lost their significance except ADL, IADL, and cognitive function components in some cases.

Conclusions: Frailty measured by cumulative deficits has a stronger predictive power on mortality than its all individual components. ADL and IADL disability play a greater role in mortality than other components when considering all the components of frailty.

Citing Articles

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Qin F, Guo Y, Ruan Y, Huang Z, Sun S, Gao S Front Public Health. 2023; 11:1154809.

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Gao Y, Du L, Cai J, Hu T Front Public Health. 2023; 10:1098794.

PMID: 36743188 PMC: 9895937. DOI: 10.3389/fpubh.2022.1098794.

References

Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M146-56. DOI: 10.1093/gerona/56.3.m146. View

Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M . Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J. 2002; 143(3):398-405. DOI: 10.1067/mhj.2002.121264. View

Mitnitski A, Graham J, Mogilner A, Rockwood K . Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr. 2002; 2:1. PMC: 88955. DOI: 10.1186/1471-2318-2-1. View

Mitnitski A, Mogilner A, MacKnight C, Rockwood K . The mortality rate as a function of accumulated deficits in a frailty index. Mech Ageing Dev. 2002; 123(11):1457-60. DOI: 10.1016/s0047-6374(02)00082-9. View

Gallant M . The influence of social support on chronic illness self-management: a review and directions for research. Health Educ Behav. 2003; 30(2):170-95. DOI: 10.1177/1090198102251030. View

Mitnitski A, Mogilner A, Rockwood K . Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal. 2003; 1:323-36. PMC: 6084020. DOI: 10.1100/tsw.2001.58. View

Ishizaki T, Kai I, Imanaka Y . Self-rated health and social role as predictors for 6-year total mortality among a non-disabled older Japanese population. Arch Gerontol Geriatr. 2005; 42(1):91-9. DOI: 10.1016/j.archger.2005.05.002. View

Goggins W, Woo J, Sham A, Ho S . Frailty index as a measure of biological age in a Chinese population. J Gerontol A Biol Sci Med Sci. 2005; 60(8):1046-51. DOI: 10.1093/gerona/60.8.1046. View

Rockwood K, Song X, MacKnight C, Bergman H, Hogan D, McDowell I . A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173(5):489-95. PMC: 1188185. DOI: 10.1503/cmaj.050051. View

10.

Schupf N, Tang M, Albert S, Costa R, Andrews H, Lee J . Decline in cognitive and functional skills increases mortality risk in nondemented elderly. Neurology. 2005; 65(8):1218-26. DOI: 10.1212/01.wnl.0000180970.07386.cb. View

11.

Jacobs J, Hammerman-Rozenberg R, Maaravi Y, Cohen A, Stessman J . The impact of visual impairment on health, function and mortality. Aging Clin Exp Res. 2005; 17(4):281-6. DOI: 10.1007/BF03324611. View

12.

Lam B, Lee D, Gomez-Marin O, Zheng D, Caban A . Concurrent visual and hearing impairment and risk of mortality: the National Health Interview Survey. Arch Ophthalmol. 2006; 124(1):95-101. DOI: 10.1001/archopht.124.1.95. View

13.

Kulminski A, Yashin A, Arbeev K, Akushevich I, Ukraintseva S, Land K . Cumulative index of health disorders as an indicator of aging-associated processes in the elderly: results from analyses of the National Long Term Care Survey. Mech Ageing Dev. 2007; 128(3):250-8. PMC: 1866299. DOI: 10.1016/j.mad.2006.12.004. View

14.

Yashin A, Arbeev K, Kulminski A, Akushevich I, Akushevich L, Ukraintseva S . Cumulative index of elderly disorders and its dynamic contribution to mortality and longevity. Rejuvenation Res. 2007; 10(1):75-86. DOI: 10.1089/rej.2006.0500. View

15.

Rockwood K, Mitnitski A . Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007; 62(7):722-7. DOI: 10.1093/gerona/62.7.722. View

16.

Rockwood K, Andrew M, Mitnitski A . A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007; 62(7):738-43. DOI: 10.1093/gerona/62.7.738. View

17.

Kulminski A, Ukraintseva S, Kulminskaya I, Arbeev K, Land K, Yashin A . Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc. 2008; 56(5):898-903. PMC: 2703425. DOI: 10.1111/j.1532-5415.2008.01656.x. View

18.

Searle S, Mitnitski A, Gahbauer E, Gill T, Rockwood K . A standard procedure for creating a frailty index. BMC Geriatr. 2008; 8:24. PMC: 2573877. DOI: 10.1186/1471-2318-8-24. View

19.

Gu D, Dupre M, Sautter J, Zhu H, Liu Y, Yi Z . Frailty and mortality among Chinese at advanced ages. J Gerontol B Psychol Sci Soc Sci. 2009; 64(2):279-89. PMC: 2655172. DOI: 10.1093/geronb/gbn009. View

20.

Millan-Calenti J, Tubio J, Pita-Fernandez S, Gonzalez-Abraldes I, Lorenzo T, Fernandez-Arruty T . Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality. Arch Gerontol Geriatr. 2009; 50(3):306-10. DOI: 10.1016/j.archger.2009.04.017. View