Frailty – relationship to selected comorbidities in hospitalized seniors over 28 years
Authors:
Weber Pavel 1,2; Weberová Dana 3; Meluzínová Hana 2; Polcarová Vlasta 1; Bielaková Katarína 1
Authors‘ workplace:
Všeobecná interní klinika Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice Brno
1; DIASTOP, diabetologická a interní ambulance, U Pošty 14, Brno
2; Interní gastroenterologická klinika Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice Brno
3
Published in:
Geriatrie a Gerontologie 2024, 13, č. 2: 70-76
Category:
Original Article
Overview
Objective: In the foreground of frailty (F) syndrome, the dysregulation of physiological systems in a broad sense during aging is still reported without identification of the immediate specific cause. With this work, we want to point out some aspects and relationships of F to selected comorbidities typical of older age over the past 28 years.
Methodology: This is a retrospective cohort study of patients from 1995–2022 who were acutely admitted to our clinic. There were a total of 29,646 people aged 65 to 105. Of this number, there were 18,867 women with an average age of 81.7 ± 7.7 years, while there were only 10,787 men with an average age of 79.0 ± 7.6 years. Women were almost 3 years older than men (p < 0, 01).
Results: Ischemic heart disease and hypertension occurred in the years 1995-2022 in both sexes, regardless of F, in approximately ²⁄³ of acutely hospitalized patients. Similarly, atrial fibrillation oscillates permanently in around ¹⁄ of patients. Obesity with a BMI over 30 fluctuates between ¼ and ¹⁄³ without difference on F for both sexes. Malnutrition with a BMI below 19 is two- to three-fold present at all times in both sexes with F and pre-F. Diabetes affects around a third of hospitalized patients; chronic renal insufficiency occurred in 15 to 27 %, and malignancy was present in one-fifth to one-tenths of admissions without any apparent predominant preference. Mortality was tenfold higher in individuals acutely hospitalized with F and pre-F in both sexes. It ranged between 23–27.6 % for men and 16.5–18.8 % for women; while in the group of acutely admitted patients without F, it was from 2.0 to 4.1 % in men and 1.3-3.2 % in women. The mortality trajectory of individuals with F and pre-F over 28 years in acutely hospitalized patients remains unchanged.
Conclusion: The presence of syndrome F as an unfavorable prognostic factor should fundamentally modify the strategy of current diagnosis and further treatment (including prevention). Effective management of F is based on correct prediction, prevention and rapid therapy of possible complications both during acute and elective procedures.
Keywords:
geriatrization of medicine, population aging, acute hospitalization of the elderly, frailty syn-drome, comorbidities, mortality
Sources
1. Fried LP, Tangen CM, Walston J, et al. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3): 146–
156.
2. Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14(6): 392–397.
3. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 5(173): 489–495.
4. Nooijen CFJ, Blom V, Ekblom O, al. The effectiveness of multi-component interventions targeting physical activity or sedentary behaviour amongst office workers: a three-arm cluster randomised controlled trial. BMC Public Health 2020; 20(1): 1329.
5. Hudáková A, Majerníková L, Obročníková A, et al. Evaluácia syndromu frailty v rámci fyzickej schopnosti u seniorov. Rehabil Fyz Lék 2020; 27(3): 156–163.
6. Krajčík Š, a kol. Geriatria. 2., doplněné a přepracované vydání. Bratislava: Herba 2022.
7. Sobhani A, Fadayevatan R, Sharifi F, et al. The conceptual and practical definitions of frailty in older adults: a systematic review. J Diabetes Metab Disord 2021; 20(2): 1975–2013.
8. Kastner M, Cardoso R, Lai Y, et al. Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis. CMAJ 2018; 190(34): E1004–E1012.
9. Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59(3): 255–263.
10. Comer A, Fettig L, Torke AM. Identifying goals of care. Med Clin North Am 2020; 104(5): 767–
775.
11. Velazquez-Diaz D, Arco JE, Ortiz A, et al. Use of artificial intelligence in the identification and diagnosis of frailty syndrome in older adults: scoping review. J Med Internet Res 2023; 20(25): e47346.
12. Weber P, Ambrošová P, Weberová D, et al. Geriatrické syndromy a syndrom frailty – zlatý grál
geriatrické medicíny. Vnitř Lék 2011; 57(6): E2010_18 online.
13. Nakazato Y, Sugiyama T, Ohno R, et al. Estimation of homeostatic dysregulation and frailty using biomarker variability: a principal component analysis of hemodialysis patients. Sci Rep 2020; 10(1): 10314.
14. Fried LP, Cohen AA, Xue QL, al. The physical frailty syndrome as a transition from homeostatic symphony to cacophony. Nat Aging 2021; 1(1): 36–46.
15. Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Amer Geriat Soc 2006; 54(6): 991–1001.
16. Rodríguez-Romero R, Herranz-Rodríguez C, Kostov B, et al. Intervention to reduce perceived loneliness in community-dwelling older people. Scand J Caring Sci 2021; 35(2): 366–374.
17. Laurindo LF, Barbalho SM, Guiguer EL, et al. GLP-1a: Going beyond traditional use. Int J Mol Sci 2022; 23(2): 739.
18. Pilotto A, Rengo F, Marchionni N, et al. Comparing the prognostic accuracy for all-cause mortality of frailty instruments: a multicentre 1-year follow-up in hospitalized older patients. PLoS One 011; 7(1): e29090.
19. Rodríguez-Mañas L, Féart C, Mann G, et al.; on behalf of the FOD-CC group. Searching for an operational definition of frailty: A Delphi method based consensus statement. The Frailty Operative Definition-Consensus Conference Project. J Gerontol A Biol Sci Med Sci 2013; 68: 62–67.
20. Inouye SK. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Amer Geriat Soc 2007; 55 (5): 780–791.
21. Gao Q, Hu K, Yan Ch, et al. Associated factors of sarcopenia in community-dwelling older adults: A systematic review and meta-analysis. Nutrients 2021; 13(12): 4291.
22. Nascimento CM, Ingles M, Salvador-Pascual A, et al. Sarcopenia, frailty and their prevention by exercise. Free Radic Biol Med 2019; 132: 42–49.
23. Ni Lochlainn M, Cox NJ, Wilson T. Nutrition and frailty: Opportunities for prevention and treatment. Nutrients 2021; 13(7): 2349.
24. Lorenzo-López L, Maseda A, de Labra C, et al. Nutritional determinants of frailty in older adults: A systematic review. BMC Geriatr 2017; 17(1): 108.
25. Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health. Lancet 2019; 394(10206): 1365–1375.
26. Wang Z, Wang Q, Pei J, et al. Association between the frailty and cognitive impairment among patients with hypertension – a post hoc analysis of the SPRINT trial. J Am Heart Assoc 2023; 12(7): e028736.
27. Evans JK, Usoh ChO, Simpson FR, et al. Long-term impact of a 10-year intensive lifestyle intervention on a deficit accumulation frailty index: Action for Health in Diabetes trial. J Gerontol A Biol Sci Med Sci 2023; 78(11): 2119–2126.
28. Shakya S, Bajracharya R, Ledbetter L, et al. The association between cardiometabolic risk factors and frailty in older adults: A systematic review. Innov Aging 2022; 6(5): igac032. igac032. eCollection 2022.
29. Marengoni A, Zucchelli A, Vetrano DL, et al. Heart failure, frailty, and pre-frailty: A systematic review and meta-analysis of observational studies. Int J Cardiol 2020; 316: 161–171.
30. Wang Z, Du X, Hua Ch, et al. The effect of frailty on the efficacy and safety of intensive blood pressure control: A post hoc analysis of the SPRINT trial. Circulation 2023; 148(7): 565–574.
31. Li B, Li Y, Zhang Y, et al. Visceral fat obesity correlates with frailty in middle-aged and older adults. Diabetes Metab Syndr Obes 2022 19; 15: 2877–2884.
32. Serra-Prat M, Terradellas M, Lorenzo I, et al. Effectiveness of a weight-loss intervention in preventing frailty and functional decline in community-dwelling obese older people. A randomized controlled trial. J Frailty Aging 2022; 11(1): 91–99.
33. Collard RM, Boter H, Schoevers RA, et al. Prevalence of frailty in community-dwelling older persons: A systematic review. J Am Geriatr Soc 2012; 60: 1487–1492.
34. Weber P, Weberová D, Polcarová V, et al. Frailty – prevalence výskytu u akutně hospitalizovaných seniorů v letech 1995–2022. Geri a Gero 2023; 12(2): 65–71.
35. Qian-Li Xue, Bandeen-Roche K, Jing Tian, et al. Progression of physical frailty and the risk of all-cause mortality: Is there a point of no return? J Am Geriatr Soc 2021; 69(4): 908–915.
36. Romero-Ortuno R, Wallis SJ, Biram RW, et al. Clinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: an observational study. Eur J Intern Med 2016; 35: 24–34.
37. Vaňková H, Topinková E, Hrnčiariková D, et al. Vyhodnocení syndromu křehkosti (frailty) u geriatrického pacienta. Geri a Gero 2023; 12(1): 5–8.
38. Ida S, Kaneko R, Imataka K, et al. Relationship between frailty and mortality, hospitalization, and cardiovascular diseases in diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol 2019; 18(1): 81.
39. Aldafas R, Crabtree T, Alkharaiji M, et al. Sodium-glucose cotransporter-2 inhibitors (SGLT2) in frail or older people with type 2 diabetes and heart failure: a systematic review and meta-analysis. Age Ageing 2024; 2; 53(1): afad
254.
40. Ritt M, Ritt JI, Sieber CCh, Gaßmann KG. Comparing the predictive accuracy of frailty, comorbidity, and disability for mortality: a 1-year follow-up in patients hospitalized in geriatric wards. Clin Interv Aging 2017; 12: 293–304.
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