Alberto Zucchelli1, Davide L Vetrano2, Alessandra Marengoni3, Giulia Grande4, Giuseppe Romanelli5, Amaia Calderón-Larrañaga4, Laura Fratiglioni6, Debora Rizzuto4. 1. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden; Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy. Electronic address: a.zucchelli001@unibs.it. 2. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden; Department of Geriatrics, Catholic University of Rome, 00168 Rome, Italy. Electronic address: davide.vetrano@ki.se. 3. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden; Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy. 4. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden. 5. Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy. 6. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden; Stockholm Gerontology Research Center, 11330 Stockholm, Sweden.
Abstract
BACKGROUND: Frailty and multimorbidity are both strongly associated with poor health-related outcomes, including mortality. Being multimorbidity one of the major determinants of frailty, we aimed to explore whether, and to what extent, frailty without multimorbidity plays an independent role in shortening life. METHODS: We used data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Among the 3363 adults aged 60+ enrolled at baseline, those without multimorbidity (i.e.: less than two chronic diseases) (N = 1115) have been characterized according to Fried's frailty phenotype (i.e. robust, prefrail, and frail). The association between frailty and mortality was estimated using piecewise proportional hazard regression models in three five-year time periods. RESULTS: Among participants without multimorbidity, 424 (38%) were prefrail and 19 (2%) were frail. During the 15-year follow-up, 263 (24%) participants died: 19%, 29%, and 63% of those who were robust, prefrail, and frail at baseline, respectively. Within the first 5 years of follow-up, prefrail and frail participants had more than doubled mortality risk in comparison to robust ones (HR for pre-frailty 2.08, 95% CI 1.15-3.76; HR for frailty 2.69, 95% CI 1.22-5.97). Beyond 5 years, a trend of increased mortality rate was still detectable for prefrail and frail subjects in comparison to robust ones. CONCLUSIONS: Physical frailty and pre-frailty are associated with short-term mortality in a cohort of older adults free from multimorbidity. Frailty could be a clinical indicator of increased risk of negative health outcomes even among subjects without multiple chronic conditions.
BACKGROUND: Frailty and multimorbidity are both strongly associated with poor health-related outcomes, including mortality. Being multimorbidity one of the major determinants of frailty, we aimed to explore whether, and to what extent, frailty without multimorbidity plays an independent role in shortening life. METHODS: We used data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Among the 3363 adults aged 60+ enrolled at baseline, those without multimorbidity (i.e.: less than two chronic diseases) (N = 1115) have been characterized according to Fried's frailty phenotype (i.e. robust, prefrail, and frail). The association between frailty and mortality was estimated using piecewise proportional hazard regression models in three five-year time periods. RESULTS: Among participants without multimorbidity, 424 (38%) were prefrail and 19 (2%) were frail. During the 15-year follow-up, 263 (24%) participants died: 19%, 29%, and 63% of those who were robust, prefrail, and frail at baseline, respectively. Within the first 5 years of follow-up, prefrail and frail participants had more than doubled mortality risk in comparison to robust ones (HR for pre-frailty 2.08, 95% CI 1.15-3.76; HR for frailty 2.69, 95% CI 1.22-5.97). Beyond 5 years, a trend of increased mortality rate was still detectable for prefrail and frail subjects in comparison to robust ones. CONCLUSIONS: Physical frailty and pre-frailty are associated with short-term mortality in a cohort of older adults free from multimorbidity. Frailty could be a clinical indicator of increased risk of negative health outcomes even among subjects without multiple chronic conditions.
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