The Synergic Effects of Frailty on Disability Associated with Urbanization, Multimorbidity, and Mental Health: Implications for Public Health and Medical Care

Overview

Journal Sci Rep

Specialty Science

Date 2018 Sep 22

PMID 30237508

Citations 11

Authors

Wei-Ju Lee

Li-Ning Peng

Chi-Hung Lin

Hui-Ping Lin

Ching-Hui Loh

Liang-Kung Chen

Affiliations

Soon will be listed here.

Abstract

Frailty is garnering increasing interest as a potential target in disability prevention. Since it is uncertain how frailty interacts with multimorbidity, urbanization, and mental health to affect disability, we investigated the epidemiology of frailty and its synergies with these factors. The study enrolled 20,898 participants aged 65 and older living in New Taipei city. All participants received face to face interview to assess frailty, multimorbidity, urban or rural residence, and mental health. Individual versus combined effects of risk factors were evaluated using the Rothman synergy index. Prevalence of frailty was 5.2% overall, 7.2% in multimorbid participants, 9.6% in rural residents, and 20.8% in those with mental disorders. Logistic regression, adjusted for age and sex, showed significant associations between disability and frailty (OR 8.5, 95% CI 6.4-11.2), multimorbidity (OR 1.3, 95% CI 1.0-1.6), urbanization (OR 1.3, 95% CI 1.0-1.7), and mental disorders (OR 7.3, 95% CI 5.6-9.5); these factors had a significant synergic effect on disability. Frailty is common in older adults and associated with disability, and was synergetic with multimorbidity, mental disorders, and residing rurally. Targeting frailty prevention and intervention needs a special attention on those vulnerable groups.

Citing Articles

Exploring the bidirectional causality between neuroticism and frailty: a Mendelian randomization analysis.

Xing Y, Pu R, Fu M, Wang Z, Wang Z, Shang X Hereditas. 2025; 162(1):8.

PMID: 39856793 PMC: 11763127. DOI: 10.1186/s41065-025-00370-2.

The prevalence of disability in older adults with multimorbidity: a meta-analysis.

Zhang J, Sun Y, Li A Aging Clin Exp Res. 2024; 36(1):186.

PMID: 39254880 PMC: 11387458. DOI: 10.1007/s40520-024-02835-2.

Synergistic effects of cognitive frailty and comorbidities on disability: a community-based longitudinal study.

Rivan N, Murukesu R, Shahar S, Rajab N, Subramaniam P, Ooi T BMC Geriatr. 2024; 24(1):448.

PMID: 38778287 PMC: 11112824. DOI: 10.1186/s12877-024-05057-3.

Is the combination of depression symptoms and multimorbidity associated with the increase of the prevalence of functional disabilities in Brazilian older adults? A cross-sectional study.

da Rosa P, Marques L, Correa V, de Oliveira C, Schneider I Front Aging. 2023; 4:1188552.

PMID: 37288071 PMC: 10242069. DOI: 10.3389/fragi.2023.1188552.

The Effect of Urbanization on Health Care Expenditure: Evidence From China.

Shao Q, Tao R, Luca M Front Public Health. 2022; 10:850872.

PMID: 35242736 PMC: 8885621. DOI: 10.3389/fpubh.2022.850872.

References

Collard R, Boter H, Schoevers R, Oude Voshaar R . Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012; 60(8):1487-92. DOI: 10.1111/j.1532-5415.2012.04054.x. View

Barnett K, Mercer S, Norbury M, Watt G, Wyke S, Guthrie B . Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380(9836):37-43. DOI: 10.1016/S0140-6736(12)60240-2. View

Ezeh A, Oyebode O, Satterthwaite D, Chen Y, Ndugwa R, Sartori J . The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet. 2016; 389(10068):547-558. DOI: 10.1016/S0140-6736(16)31650-6. View

Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith S . Managing patients with multimorbidity in primary care. BMJ. 2015; 350:h176. DOI: 10.1136/bmj.h176. View

Lee W, Chen L, Peng L, Chiou S, Chou P . Personal mastery attenuates the adverse effect of frailty on declines in physical function of older people: A 6-year population-based cohort study. Medicine (Baltimore). 2016; 95(34):e4661. PMC: 5400336. DOI: 10.1097/MD.0000000000004661. View

Chen L, Liu L, Woo J, Assantachai P, Auyeung T, Bahyah K . Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014; 15(2):95-101. DOI: 10.1016/j.jamda.2013.11.025. View

Chen L, Wu Y, Liu L, Lee W, Hwang A, Peng L . Association Among Serum Insulin-Like Growth Factor-1, Frailty, Muscle Mass, Bone Mineral Density, and Physical Performance Among Community-Dwelling Middle-Aged and Older Adults in Taiwan. Rejuvenation Res. 2017; 21(3):270-277. DOI: 10.1089/rej.2016.1882. View

Liu L, Lee W, Chen L, Hwang A, Lin M, Peng L . Association between Frailty, Osteoporosis, Falls and Hip Fractures among Community-Dwelling People Aged 50 Years and Older in Taiwan: Results from I-Lan Longitudinal Aging Study. PLoS One. 2015; 10(9):e0136968. PMC: 4562637. DOI: 10.1371/journal.pone.0136968. View

Cortina-Borja M, Smith A, Combarros O, Lehmann D . The synergy factor: a statistic to measure interactions in complex diseases. BMC Res Notes. 2009; 2:105. PMC: 2706251. DOI: 10.1186/1756-0500-2-105. View

10.

Rothman K . The estimation of synergy or antagonism. Am J Epidemiol. 1976; 103(5):506-11. DOI: 10.1093/oxfordjournals.aje.a112252. View

11.

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med. 2007; 45(4):247-51. DOI: 10.1016/j.ypmed.2007.08.012. View

12.

Lin S, Lee W, Chou M, Peng L, Chiou S, Chen L . Frailty Index Predicts All-Cause Mortality for Middle-Aged and Older Taiwanese: Implications for Active-Aging Programs. PLoS One. 2016; 11(8):e0161456. PMC: 4990295. DOI: 10.1371/journal.pone.0161456. View

13.

Yu P, Song X, Shi J, Mitnitski A, Tang Z, Fang X . Frailty and survival of older Chinese adults in urban and rural areas: results from the Beijing Longitudinal Study of Aging. Arch Gerontol Geriatr. 2011; 54(1):3-8. DOI: 10.1016/j.archger.2011.04.020. View

14.

Cheng T . Reflections on the 20th anniversary of Taiwan's single-payer National Health Insurance System. Health Aff (Millwood). 2015; 34(3):502-10. DOI: 10.1377/hlthaff.2014.1332. View

15.

Craig C, Marshall A, Sjostrom M, Bauman A, Booth M, Ainsworth B . International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35(8):1381-95. DOI: 10.1249/01.MSS.0000078924.61453.FB. View

16.

Chiang C, Chen P, Huang L, Kuo P, Tung Y, Liu C . Impact of universal health coverage on urban-rural inequity in psychiatric service utilisation for patients with first admission for psychosis: a 10-year nationwide population-based study in Taiwan. BMJ Open. 2016; 6(3):e010802. PMC: 4785302. DOI: 10.1136/bmjopen-2015-010802. View

17.

Santos-Eggimann B, Cuenoud P, Spagnoli J, Junod J . Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci. 2009; 64(6):675-81. PMC: 2800805. DOI: 10.1093/gerona/glp012. View

18.

Cesari M, Perez-Zepeda M, Marzetti E . Frailty and Multimorbidity: Different Ways of Thinking About Geriatrics. J Am Med Dir Assoc. 2017; 18(4):361-364. DOI: 10.1016/j.jamda.2016.12.086. View

19.

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

20.

Stringhini S, Carmeli C, Jokela M, Avendano M, Muennig P, Guida F . Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet. 2017; 389(10075):1229-1237. PMC: 5368415. DOI: 10.1016/S0140-6736(16)32380-7. View