The impact of frailty and its associations among a sample of community-dwelling older adults

Introduction: Frailty, sarcopenia and fragility fractures are powerful correlated and all of them are predictors of clinical adverse outcomes. Elderly individuals with have a fragility fracture should be assessed for frailty and sarcopenia to better develop a care plan. For these reason interventions are necessary to determinate and treat frailty .

Objectives: The present study investigates the prevalence of frailty and associated factors among the older adults who were assessed within the scope of a geriatric study in the Fatih District of the Istanbul Province.

Methods: The study included community-dwelling older adults aged 61–101 years who were living in the Fatih District of the Istanbul Province between November 2014 and May 2015. The number of drugs regularly used by the participants and the number of diseases were recorded. It was evaluated whether the participants experienced falling / risk of falling / fear of falling in the last 1 year. Visual analog scale (VAS) was used in the assessment of chronic pain. The other instruments used for assessment included the FRAIL scale for frailty screening; the 6-item KATZ Activities of Daily Living (ADL) scale; the 8-item LAWTON-BRODY Instrumental Activities of Daily Living Scale (IADL) for the measurement of functional capacity; the European Quality 5 Dimensions (EQ-5D) questionnaire for the assessment of quality of life; the Mini-Cog test for cognitive screening; the Geriatric Depression Scale-Short Form (GDS-SF) for depression screening; the Mini Malnutrition Assessment-Short Form (MNA-SF) for malnutrition screening; and the Romberg test and postural instability test for walking. Hand grip strength (HGS) was measured using a Jamar hydraulic hand dynamometer and the thresholds for hand grip strength were evaluated < 27 kg < 16 kg in men and women, respectively, based on the European Working Group on Sarcopenia in Older People (EWGSOP2) definition. Muscle mass was measured through a bioimpedence analysis (TANITA-BC532). Low muscle mass (young adult mean-2SD) and the thresholds for muscle mass were evaluated as < 9.2 kg/m2 vs 7.4 kg/m2 in men and women, respectively, based on national data. Sarcopenia was defined as a reduction in muscle mass and muscle function [usual gait speed (UGS) or muscle strength] based on the European Working Group on Sarcopenia in Older People (EWGSOP2) definition.

Results: The study included 204 older adults (94 men and 110 women), with a mean age of 75.4±7.3 years. Of the cases, 30.4% were robust, 42.6% were pre-frail and 27% were frail. Significant differences were recorded in number of diseases (p=0.006), frail score (p=0.002), malnutrition (p=0.004) and the results of a clock-drawing test (CDT)(p=0.040), number of drugs ,chronic pain(p=0.001), as well as in the fear of falling, IADL, GDS-SF, -EQ-5D scores ,BIA fat, BIA muscle and hand grip strength (p < 0.001) between the groups. The frailty groups differed significantly in terms of the presence of malnutrition, fear of falling, urinary incontinence (UI), chronic pain, Romberg sign, postural instability, level of ambulation, presence of depression, dementia , falls within the last one year (p < 0.001) and gender (p=0.004). A regression analysis evaluating independent frailty-associated factors [dependent variable: frailty (robust vs. prefrail +frail)], revealed an association with the number of drugs (OR=1.24, p=0.036), cognitive disorder (OR=0.30, p=0.016) and EQ-5D (OR=1.53, p=0.017).

Conclusions: The present study established the prevalence of frailty in the Fatih district community, in which the most prominent associated factors were cognitive dysfunction, low quality of life, and multiple drug usage. Nationwide population studies involving multiple centers are required.