A prospective analysis examining frailty remission and the association with future falls risk in older adults in England

Association of changes in frailty status with the risk of all-cause mortality and cardiovascular death in older people: results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

BACKGROUND

Few studies have investigated the association between changes in frailty status and all-cause mortality, inconsistent results were reported. What's more, studies that evaluated the effect of changes of frailty on cardiovascular death in older population are scanty. Therefore, the present study aims to investigate the association of such changes with the risk of all-cause mortality and cardiovascular death in older people, using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

METHODS

A total of 2805 older participants from two consecutive waves (i.e. 2011 and 2014) of the CLHLS were included for analysis. Based on the changes in frailty status from wave 2011 to wave 2014, participants were categorized into 4 subgroups, including sustained pre/frailty, robustness to pre/frailty, pre/frailty to robustness and sustained robustness. Study outcomes were all-cause mortality and cardiovascular death, and Cox regression analysis examined the association of changes in frailty status with outcomes.

RESULTS

From wave 2011 to wave 2014, 33.2% of the participants had frailty transitions. From wave 2014 to wave 2018, there were 952 all-cause mortalities and 170 cardiovascular deaths during a follow-up of 9530.1 person-years, and Kaplan-Meier analysis demonstrated that cumulative incidences of the two outcomes were significantly lower in more robust participants (all log-rank p < 0.001). Compared with the subgroup of sustained pre/frailty, the fully adjusted HRs of all-cause mortality were 0.61 (95% CI: 0.51-0.73, p < 0.001), 0.51 (95% CI: 0.42-0.63, p < 0.001) and 0.41 (0.34-0.49, p < 0.001) in the subgroup of robustness to pre/frailty, the subgroup of pre/frailty to robustness, and the subgroup of sustained robustness, respectively. The fully adjusted HRs of cardiovascular death were 0.79 (95% CI: 0.52-1.19, p = 0.256) in the subgroup of robustness to pre/frailty, 0.45 (95% CI: 0.26-0.76, p = 0.003) in the subgroup of pre/frailty to robustness and 0.51 (0.33-0.78, p = 0.002) in the subgroup of sustained robustness when comparing to the subgroup of sustained pre/frailty, respectively. Stratified analysis and extensive sensitivity analyses revealed similar results.

CONCLUSIONS

Frailty is a dynamic process, and improved frailty and remaining robust are significantly associated with lower risk of all-cause mortality and cardiovascular death in older people.

Frailty and Environmental Attributes in Older Adults: Insight from an Ecological Model

Many studies on frailty have primarily focused on individual-level risk factors such as demographics and lifestyle. While guidelines for frailty management recommend modifications to an individual's lifestyle, their lifestyle behaviors are significantly influenced by their surroundings. Recently, the association between frailty and environmental attributes has drawn attention as a result of the increase in evidence that multiple factors affect health conditions and behaviors associated with frailty. These findings can be organized based on an ecological model involving five nested levels that influence an individual's behaviors, namely, an intrapersonal/individual core (age, education, and attitude), an interpersonal level (persons and groups), an organizational/institutional level (organization and workplace), a community level (natural, built, and social environments), and a system/public policy level (public policies from local to national). This study reviewed possible factors associated with frailty from the onset and its progression at each level of the ecological model and their implications regarding frailty prevention. Additionally, we introduce a policy-level approach for frailty prevention in Japan-which encourages residents to engage in the local society by participating in community places or groups that are referred to as "Kayoi-no-ba"-and aggregate its status from a government report. This perspective on community building is consistent with the concept of an ecological model. However, few studies have verified the effects of policy- or system-level approaches on disability and frailty prevention. Further studies from an ecological perspective are needed to fulfill multilevel interventions for frailty prevention.

Frailty in Kingdom of Saudi Arabia-Prevalence and Management, Where Are We?

A recent report from the United Nations state that the percentage of elderly individuals in the Kingdom of Saudi Arabia (KSA) will witness a sharp increase in the next three decades (5.6% in 2017 to 23% by 2050). This situation will lead to an increased prevalence of comorbidities and hence, will require close monitoring and constant care of such individuals who are prone to suffer from complications such as arthritis, cardiovascular disorders, diabetes, neurological disorders, etc. Frailty is one such age-related phenomenon which enhances the risk of falling, functional restrictions and greater vulnerability to adverse consequences, which tend to lead to institutionalization. Such factors highlight the importance of the urgent awareness for circumventing the progression of frailty toward a compromised health status. This concise report is an attempt to sum up the relevant research articles published with regard to frailty and concomitant diseases in the last 5 years. It also sums up the research on frailty in the KSA elderly population, till date. This article reflects the opinions of an author on tackling such issues through a well-directed mechanism involving interdisciplinary transitional care and geriatric co-management.