Frailty and mortality, disability and mobility loss in a Spanish cohort of older adults: the FRADEA study.

Original Fried's frailty criteria have not demonstrated their prognostic validity of mortality, disability and mobility loss in European cohorts. To analyze whether frailty implies increased risk of death, incident disability in basic (BADL) or instrumental (IADL) activities of daily living, or mobility impairment. Concurrent cohort study. Albacete City, Spain. 993 participants over age 70 from the FRADEA Study. Mortality, BADL and mobility using the Barthel Index, and IADL using the Lawton IADL Index, were recorded. BADL disability was defined as loss of the ability to perform bathing, grooming, dressing, toilet use, or feeding, while deterioration of mobility was defined as loss of ability to perform transfers, walk, or use stairs, and IADL disability as losing any of the activities included in the Lawton Index. The risk of presenting adverse events was determined by Cox and Kaplan-Meier proportional hazard analysis and logistic regression adjusted for age, sex, function, and comorbidity. Mean follow-up was 534 days (SD 153), during which 105 participants (10.6%) died. Mean time to death was 363 days (SD 218), while 192 (25.4%) lost at least one BADL, 492 (60%) at least one IADL, and 222 (28.9%) lost mobility. Frail subjects had a greater adjusted risk of death (HR 5.5, CI 95% 1.5-20.2), of losing BADL (HR 2.5, CI 95% 1.3-4.8), of losing mobility (HR 2.7, CI 95% 1.5-5.0), and of losing IADL (HR 1.9, CI 95% 1.1-3.3) than non-frail patients. Fried's frailty criteria are associated with death, incident disability, and mobility impairment in a Spanish cohort of older adults.

Abizanda P ，Romero L ，Sánchez-Jurado PM ，Martínez-Reig M ，Gómez-Arnedo L ，Alfonso SA ... -  《-》

Frailty and mortality or incident disability in institutionalized older adults: the FINAL study.

Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic. To determine the association between frailty and mortality or incident disability in basic activities of daily living (BADL) in institutionalized Spanish older adults. Concurrent cohort study. Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain. Of the 324 institutionalized adults older than 65 years enrolled at baseline, 21 (5.5%) were lost during the one-year follow-up. Of the 303 remaining, 63 (20.8%) died, 91 (30.0%) developed incident disability, and 140 (49.2%) were free of both events. 16 participants were not suitable for analysis due to incomplete data. Frailty was defined by the presence of three or more Fried criteria: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Incident disability in BADL was considered when new onset disability in bathing, grooming, toileting, dressing, eating or transferring was detected with the Barthel index. Logistic regression models were constructed adjusted for age, sex, body mass index (BMI), previous Barthel index and Minimental State Examination (MMSE), and high comorbidity (Charlson index ≥3). 287 participants with valid data. Mean age 84.2 (SD 6.8), with 187 (65.2%) women. 199 (69.3%) were frail, and 72 (25.1%) had high comorbidity. Mean BMI 27.6 (SD 5.2), Barthel index 53.4 (SD 37.1), and MMSE 14.2 (SD 9.7). At follow-up, 43 (21.6%) frail participants and 15 (17.0%) non-frail ones died. 73 (46.8%) frail participants and 16 (21.9%) non-frail ones developed incident disability in BADL (p<0.001). Frailty was associated with incident disability or mortality (OR 3.3; 95% CI 1.7-6.6) adjusted for all study covariables. In a cohort of institutionalized older adults, frailty was associated with mortality or incident disability in BADL.

de la Rica-Escuín M ，González-Vaca J ，Varela-Pérez R ，Arjonilla-García MD ，Silva-Iglesias M ，Oliver-Carbonell JL ，Abizanda P ... -  《-》

[Frailty and long term mortality, disability and hospitalisation in Spanish older adults. The FRADEA Study].

The objective of this study was to analyse whether frailty is related to long-term mortality, incident disability in basic activities of daily living (BADL), and hospitalisation. A concurrent cohort study conducted on 993 participants over age 70 from the FRADEA Study. Frailty was determined with Fried frailty phenotype. Data was collected on mortality, hospitalisation and incident disability in BADL (bathing, grooming, dressing, toileting, eating or transferring) during the follow-up period. The risk of adverse events was determined by logistic regression, Kaplan-Meier analysis, and Cox proportional hazard analysis adjusted for age, sex, Barthel index, comorbidity and institutionalization. Mean follow-up was 952 days (SD 408), during which 182 participants (18.4%) died. Frail participants had an increased adjusted risk of death (HR 4.5, 95%CI: 1.8-11.1), incident disability in BADL (OR 2.7, 95%CI: 1.3-5.9) and the combined event mortality or incident disability (OR 3.0, 95%CI: 1.5-6.1). Pre-frail subjects had an increased adjusted risk of death (HR 2.9, 95%CI: 1.2-6.5), incident disability in BADL (OR 2.1, 95%CI: 1.2-3.6), and the combined event mortality or incident disability (OR 2.2, 95%CI: 1.3-3.6). There was a positive association between frailty and hospitalisation, which almost reached statistical significance (OR 1.7, 95%CI: 1.0-3.0). Frailty is long-term associated with mortality and incident disability in BADL in a Spanish cohort of older adults.

Martínez-Reig M ，Flores Ruano T ，Fernández Sánchez M ，Noguerón García A ，Romero Rizos L ，Abizanda Soler P ... -  《-》

A New Functional Classification Based on Frailty and Disability Stratifies the Risk for Mortality Among Older Adults: The FRADEA Study.

The aim of the current study was to investigate whether a new functional classification, based on basic (BADL) and instrumental (IADL) activities of daily living and frailty, is associated with mortality in older adults during 10 years of follow-up. Cohort study, with a follow-up of 10 years. A total of 924 participants aged 70 and older from the Frailty and Dependence in Albacete (FRADEA) study, a population-based sample of Spanish older adults. At baseline, a new functional classification of 8 categories was constructed with limitations in BADL using the Barthel Index, limitations in IADL using the Lawton IADL Index, and the criteria of the frailty phenotype. Associations with 10-year mortality were assessed using Kaplan-Meier curves and Cox proportional hazard models. The risk of mortality gradually increased toward the less functionally independent end of the classification. The presence of mild, moderate, or severe BADL impairment was associated with mortality, in models adjusted for age, sex, comorbidity and institutionalization. The analyses also revealed that those who were BADL independent, IADL dependent and prefrail [hazard ratio (HR) = 2.27, 95% confidence interval (CI) = 1.22-4.20], and those who were BADL independent and frail (HR = 3.74, 95% CI = 1.88-7.42) had an increased risk of mortality. A new functional classification composed of BADL, IADL, and frailty representing the functional continuum is effective in stratifying the risk for mortality in older adults. Frailty is a high-mortality-risk state close to subjects with mild disability in BADL, needing an intensive specialized approach. Prefrailty with any impairment in IADL has an intermediate mortality risk and should be offered primary care interventions.

Hoogendijk EO ，Romero L ，Sánchez-Jurado PM ，Flores Ruano T ，Viña J ，Rodríguez-Mañas L ，Abizanda P ... -  《-》

Nutritional risk, nutritional status and incident disability in older adults. The FRADEA study.

Martínez-Reig M ，Gómez-Arnedo L ，Alfonso-Silguero SA ，Juncos-Martínez G ，Romero L ，Abizanda P ... -  《-》