Lauren R Pollack1, Stephanie Litwack-Harrison2,3, Peggy M Cawthon2,3, Kristine Ensrud4, Nancy E Lane5, Elizabeth Barrett-Connor6, Thuy-Tien Dam1,7. 1. Columbia University Medical Center, New York. 2. California Pacific Medical Center Research Institute, San Francisco, California. 3. Department of Epidemiology and Biostatistics, University of California, San Francisco, California. 4. University of Minnesota and Minneapolis VAHCS, Minneapolis, Minnesota. 5. University of California, Davis, California. 6. University of California, San Diego, California. 7. Merck & Co., Inc., North Wales, Pennsylvania.
Abstract
OBJECTIVES: To describe the natural history of frailty transitions in a large cohort of community-dwelling older men and identify predictors associated with progression to or improvement from states of greater frailty. DESIGN: Prospective cohort study. SETTING: Six U.S. sites. PARTICIPANTS: Community-dwelling men aged 65 and older (N = 5,086). MEASUREMENTS: Frailty was measured at baseline and an average of 4.6 years later. Frailty was defined as having three or more of the following components (low lean mass, weakness, self-reported exhaustion, low activity level, and slow walking speed); prefrailty was defined as having one or two components. Separate multivariable logistic regression models were analyzed for progression and improvement in frailty status. RESULTS: Of the 5,086 men, 8% were frail, 46% were prefrail, and 46% were robust at baseline. Between baseline and follow-up, 35% progressed in frailty status or died, 56% had no change in frailty status, and 15% of prefrail or frail participants improved, although only 0.5% improved across two levels, from frail to robust. In multivariable models, factors associated with improvement in frailty status included greater leg power, being married, and good or excellent self-reported health, whereas presence of any instrumental activity of daily living (IADL) limitations, low albumin levels, high interleukin-6 levels, and presence of chronic obstructive pulmonary disease or diabetes mellitus were associated with lower likelihood of improvement in frailty status. CONCLUSION: Improvement in frailty status was possible in this cohort of community-dwelling older men, but improvement from frail to robust was rare. Several predictors were identified as possible targets for intervention, including prevention and management of comorbid medical conditions, prevention of IADL disability, physical exercise, and nutritional and social support.
OBJECTIVES: To describe the natural history of frailty transitions in a large cohort of community-dwelling older men and identify predictors associated with progression to or improvement from states of greater frailty. DESIGN: Prospective cohort study. SETTING: Six U.S. sites. PARTICIPANTS: Community-dwelling men aged 65 and older (N = 5,086). MEASUREMENTS: Frailty was measured at baseline and an average of 4.6 years later. Frailty was defined as having three or more of the following components (low lean mass, weakness, self-reported exhaustion, low activity level, and slow walking speed); prefrailty was defined as having one or two components. Separate multivariable logistic regression models were analyzed for progression and improvement in frailty status. RESULTS: Of the 5,086 men, 8% were frail, 46% were prefrail, and 46% were robust at baseline. Between baseline and follow-up, 35% progressed in frailty status or died, 56% had no change in frailty status, and 15% of prefrail or frail participants improved, although only 0.5% improved across two levels, from frail to robust. In multivariable models, factors associated with improvement in frailty status included greater leg power, being married, and good or excellent self-reported health, whereas presence of any instrumental activity of daily living (IADL) limitations, low albumin levels, high interleukin-6 levels, and presence of chronic obstructive pulmonary disease or diabetes mellitus were associated with lower likelihood of improvement in frailty status. CONCLUSION: Improvement in frailty status was possible in this cohort of community-dwelling older men, but improvement from frail to robust was rare. Several predictors were identified as possible targets for intervention, including prevention and management of comorbid medical conditions, prevention of IADL disability, physical exercise, and nutritional and social support.
Authors: Jeremy Walston; Evan C Hadley; Luigi Ferrucci; Jack M Guralnik; Anne B Newman; Stephanie A Studenski; William B Ershler; Tamara Harris; Linda P Fried Journal: J Am Geriatr Soc Date: 2006-06 Impact factor: 5.562
Authors: René Rizzoli; Jean-Yves Reginster; Jean-François Arnal; Ivan Bautmans; Charlotte Beaudart; Heike Bischoff-Ferrari; Emmanuel Biver; Steven Boonen; Maria-Luisa Brandi; Arkadi Chines; Cyrus Cooper; Sol Epstein; Roger A Fielding; Bret Goodpaster; John A Kanis; Jean-Marc Kaufman; Andrea Laslop; Vincenzo Malafarina; Leocadio Rodriguez Mañas; Bruce H Mitlak; Richard O Oreffo; Jean Petermans; Kieran Reid; Yves Rolland; Avan Aihie Sayer; Yannis Tsouderos; Marjolein Visser; Olivier Bruyère Journal: Calcif Tissue Int Date: 2013-07-05 Impact factor: 4.333
Authors: Eric Orwoll; Janet Babich Blank; Elizabeth Barrett-Connor; Jane Cauley; Steven Cummings; Kristine Ensrud; Cora Lewis; Peggy M Cawthon; Robert Marcus; Lynn M Marshall; Joan McGowan; Kathy Phipps; Sherry Sherman; Marcia L Stefanick; Katie Stone Journal: Contemp Clin Trials Date: 2005-10 Impact factor: 2.226
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: Jonathan F Bean; Dan K Kiely; Sharon LaRose; Richard Goldstein; Walter R Frontera; Suzanne G Leveille Journal: J Am Geriatr Soc Date: 2010-12 Impact factor: 5.562
Authors: James M Shikany; Elizabeth Barrett-Connor; Kristine E Ensrud; Peggy M Cawthon; Cora E Lewis; Thuy-Tien L Dam; Jackilen Shannon; David T Redden Journal: J Gerontol A Biol Sci Med Sci Date: 2013-12-04 Impact factor: 6.053
Authors: Monica C Tembo; Mohammadreza Mohebbi; Kara L Holloway-Kew; James Gaston; Sharon L Brennan-Olsen; Lana J Williams; Mark A Kotowicz; Julie A Pasco Journal: Calcif Tissue Int Date: 2021-05-20 Impact factor: 4.333
Authors: Ana Ayesta; María Teresa Vidán Astiz; María Jesús Valero Masa; Javier Segovia; María Dolores García Cosío; Manuel Martínez-Sellés Journal: Clin Cardiol Date: 2018-03-25 Impact factor: 2.882